imagining the future: enabling technology - iriss · imagining the future- enabling technology: how...
TRANSCRIPT
13
IMAGINING THE FUTURE ENABLING TECHNOLOGY Report produced by Kevin Doughty Centre for Usable Home Technology
Report commissioned by IRISS
December 2013
COPYRIGHT AND ATTRIBUTION
copy 2013 Institute for Research and Innovation in Social Services
This work is licensed under the Creative Commons Attribution-Noncommercial 25 UK Scotland Licence To view a copy of this licence visit httpcreativecommonsorglicensesby-nc25scotland
This means you may copy or use the work only for non-commercial purposes and you must attribute the work to the author Kevin Doughty and to IRISS
For more information about this research please contact enquiriesirissorguk
IMAGINING THE FUTURE -shy‐ ENABLING TECHNOLOGYHOW TECHNOLOGY MIGHT AFFECT SOCIAL CARE BY 2025
1 BACKGROUND
Predicting what13 might13 change by tomorrow next13 week next13 month or even next13 year isrelatively safe But13 in 10 to 15 years there is time for the rule book to be completelyrewritten and for all accepted learning to be cast13 aside to be replaced by somethingcompletely different Some activities that13 are common today might13 have seemedimprobable fifteen years ago (in the late 1990s) for example using the video game consolesto help recover function following a stroke or a fall or ordering groceries online via13 TVscreens
Predictions must13 have both a basis in technology but13 must13 also be considered with respect13 to the likely speed of adoption and the natural resistance to change (ie culturalacceptance) By concentrating on technologies that13 are designed to improve quality of lifehelp people to perform tasks more easily or which manage the risks associated withindependence we will move some way towards understanding how social care maydevelop and how the tools available to social workers will need to change
But13 this will be only half of the story and perhaps not13 the half that13 will have the greaterimpact Technological developments in other areas -shy‐ politics culture energy nationalfinances diet ethics privacy and transport13 policy -shy‐ might13 have an even greater impact13 onpeople who are deemed to be vulnerable or needy as they might13 live on the margins andtherefore be more susceptible to relatively small changes Relatively small doses of suchinnovations might13 then become an important13 aspect13 of strategies or interventions that13 social workers are most13 likely to propose13
This project13 therefore requires a dual track13 approach that13 involves
1 a consideration of existing technological developments and2 how other changes could make a difference to people
The first part reviews technologies and trends that13 are already happening This ismoderated by how society will change both in the way that13 it13 reacts to the technology andin the way that13 its values change as a result13 of external factors such as the economic statusof the country the ability of the NHS and other organisations to deal with the needs of anageing population and various other events that13 can change attitudes either overnight13 orover the course of time
The second13 part draws on six vignettes (or case studies) as a way of helping us imagine howoutcomes might13 be different13 depending on the kinds of technology and communicationthat13 are available These case studies offer opportunities to consider
2
bull Firstly the type of person and the range of issues that13 are likely to affect13 people andfamilies
bull Secondly the likely impact13 of technology on such cases Not13 surprisingly somecases will need the same dedication of social work staff and traditional means ofsupport13 that13 they might13 require today and did require ten years ago Others might13 require a very different13 approach and outcomes that13 could depend on theavailability of and access to new technologies These represent13 perhaps the most13 exciting cases because they can show improved outcomes lower cost and greatersatisfaction for all stakeholders if the initial consultation assessment13 and prescribedservice take advantage of the relevant13 technological interventions
3
ne13
le13
ne13
2 TECHNOLOGICAL CHANGES THAT13 COULD HAVE13 A DIRECT13 IMPACT ON SOCIAL CARE
Taken as whole lsquotechnologicalrsquo developments can be overwhelming so this section breaksup technology into discrete elements and considers the likely impact13 of each In this waywe intend to make it13 easier to understand and to imagine in a real and constructive wayhow and when they might13 become significant
21 Personal computing13
In reality we absorb and integrate new technology all the time some of us a different13 ratesthan others Consider how over 40 years computers and the internet13 moved from beingobscure and specialised tools to driving commonplace consumer devices Most13 computingdevices already have more processing power than the spacecraft13 that13 landed men on themoon in 1969
1970 bull A computer was a large device (a lsquomainframersquo the size of large wardrobe) that required13 acarefully13 regulated air-shy‐conditioned roomo Information was input through punch-shy‐cardso There was no keyboard and no video display
1980s bull The first personal computers arrived but were mainly for enthusiastsbull Word processors arrived in offices allowing text editing and formattingbull By the end13 of the decade desktop PCs13 were popular but still relied on the user learning arca
commands13 (eg the Amstrad)1990s bull Email virtually unheard of at work and at home
bull The Apple Mac with its pointing device (mouse) and Graphical User Interface made it possib to use a computer without learning13 arcane13 commands
bull Microsoft followed with Windows and by the end of the decade desktop computers werecommonplace
bull In the mid 1990s the word wide web arrived and the word lsquointernetrsquo13 entered everydayvocabulary
bull lsquoDial-shy‐uprsquo access to13 the internet available at work and13 at home via a modem and13 telephone li bull First generation of mobile13 phones take13 off ndash texting unexpectedly popular
2000s bull Broadband13 replaces lsquodial-shy‐uprsquo allowing lsquoalways onrsquo internet connectionbull Smartphones allow us to connect to the13 internet on the movebull Smartphones can record videobull Youtube allows free sharing of videobull Online shopping commonplacebull Laptops increase13 in popularitybull Email widespread in personal and working lifebull Social networks part of everyday life13 (eg Facebook -shy‐ one billion13 members)bull Email widely considered a plague that needs controlling
2010s bull Tablets increasing in popularity at expense of laptopsbull Touch screensbull Video phone (skype) making face to face communication an affordable realitybull Email widely considered a plague that needs controllingbull Future13 Identities report finds lsquoPeople13 are13 accustomed to switching seamlessly between the13
internet and the physical13 world and use social13 media to conduct their lives in a way thatdissolves the divide between13 online and13 offline identitiesrsquo13 httpwwwbisgovukforesightour-shy‐workpolicy-shy‐futuresidentity
4
Accessibility acceptability and fashion
People adopt13 new technologies at different13 rates and some reject13 them completely Themobile phone might13 seem ubiquitous but13 some people refuse to have anything to do withthem
Some new devices are emerging such as an lsquoi-shy‐watchrsquo -shy‐ a kind of i-shy‐phone worn on the wristwhile a number of companies have suggested that they will use flexible electronic circuit13 boards to produce conformable devices that13 might13 be integrated into clothing or producedas a band that13 could be worn on the forearm
Google has been experimenting with heads-shy‐up displays which would allow someone to viewa display without13 having to carry a screen This approach would enable an individual toreceive real-shy‐time information as they walked around It might13 promote virtual visits todistant13 locations and virtual reality scenarios for games will increasingly interact13 with thereal world
It is likely that13 there will be an increasing choice allowing users to select13 devices most13 appropriate to their own lifestyle Ease of use may become a more important13 factor infuture designs thus enabling all citizens to enjoy ownership and applications of thetechnology
It is possible that13 not13 owning such a device or not13 being able to fully utilise it will become acharacteristic of the disadvantaged few -shy‐ and perhaps the people who will most13 need helpfrom13 social workers
22 Information generation and storage
As recently as ten years ago the amount13 of digital data13 or information we could store wasstrictly limited by the capacity and cost13 of storage media tapes floppy discs and harddrives The cost13 has fallen so much that13 today there is effectively ample space to store allthe data13 that13 we can create
The challenge is to store it securely and in such a way that it can then be retrieved quicklywhen needed and from13 any location13
We can now easily access bus and train timetables online the Kindle has created a hugemarket13 in e-shy‐books and even the Argos catalogue is expected to be available only as a digitaldownload
Cloud storage is the term used to describe a world in which we no longer keep our data13 (documents books photos video) on our own devices Instead we store them on cloudservices such as Flickr Youtube Google Drive We can even keep personal data13 such asreceipts using services such as httpwwwimmobilisecom which offers an online
5
portfolio for your personal belongings And Final Fling is an example that13 enables us to planfor our death
If entire identities are effectively digitised and stored in this way people who have not13 allowed their data13 to be created and warehoused in this way will be seriouslydisadvantaged They could be forced to join an underworld of digital refuseniks who areunable to apply for jobs for a passport for a driving licence and for welfare payments
23 Stratification13 and analytical techniques
The amount13 of data13 collected about13 each individual in society is increasing rapidly The data13 gathered by government13 and health systems tends to be highly structured which allowseasy comparisons to be made between any individualrsquos result13 and an average value forsimilar people This leads to important13 knowledge of distributions and how they might13 change over time
But13 commercial organisations such as supermarkets and online retailers also routinelygather data13 about13 our purchases our movements and our preferences This is known as BigData and analytical techniques known as Data Mining are evolving which look for trendsthat13 might13 offer some level of prediction
From an individual perspective Big Data13 can tell people how much they are like everybodyelse Indeed a personal analysis might13 tell them that13 there are another several hundredpeople just13 like them in Glasgow in Scotland in the UK in Europe or in the world How thisinformation is used is the important13 issue If it13 is used to make people feel lsquonormalrsquo then it13 can be positive but13 equally if it13 is used to stop people feeling that13 they are lsquospecialrsquo thenthis could lead to a loss of self-shy‐esteem
24 Communication13 technologies
The origins13 of social alarms lie in sheltered housing The assumption during the 1950s and1960s was that13 the people who needed to live in this type of accommodation were bothvulnerable and relatively poor As telephone lines were at that13 time a luxury whichcouldnrsquot13 be afforded by many hard-shy‐wired warden-shy‐call systems similar to the hospitalbedside call were devised Subsequently they evolved into two-shy‐way intercom systemsbetween the resident13 and a call monitoring centre rather than a local warden
These hard-shy‐wired arrangements were bespoke to each manufacturer and were thereforelimited in performance and in linking in with other peripheral devices and telecare Duringthe 1970s the telephone became less of a luxury and the number of households of allincome levels who had their own telephone lines rose rapidly
6
The 1990s saw the emergence of home computing the BBC Micro and gaming machinessuch as the Commodore 64 and the Attari Electronic mail (e-shy‐mail) until then the preserveof academic and research institutions moved into the mainstream at first13 connecting via13 (relatively slow) modems and ordinary telephone lines One drawback was that13 thetelephone could not13 be used at the same time as the computer was connected to theinternet a frequent13 cause of family friction In the late 1990s and early 2000s this problemwas solved when broadband became more widely available and cheaper allowing fasterspeeds an always-shy‐on facility and the ability to use the telephone at the same time
As broadband speed and capacity continued to increase so did the ability to use theinternet13 to access video music and all kinds of electronic commerce (for example shoppingtravel)
Perhaps even more dramatic have been the improvements made in mobilecommunications Third Generation (3G) phones allow us to use the Internet13 lsquoon the moversquovia13 smart13 phones and tablet13 devices Fourth Generation (4G) began rolling out13 in 2012offering faster access
By 2025 one can13 confidently13 predict13 that wireless13 communications13 will13 be available across13 the UK and with a bandwidth which13 can13 support13 both audio and video13 services
Effectively anyone who wants to speak to people will be able to do so and the only peoplewho will not13 be able to do this will be those who wish to hide or to avoid contact
25 The internet of things and the Quantified13 Self
The internet13 works by connecting computers around the world Each computer connectedto the internet13 has a unique address (known as an IP -shy‐ Internet13 Protocol -shy‐ number) Manydevices13 now contain some kind of microchip which makes such a device in effect acomputer
This means that13 electrical appliances from washing machines to refrigerators cancommunicate with other machines also connected to the Internet Indeed manufacturershave provided this facility for a number of years in order to monitor performance and tocheck remotely on their operational status The same principle can be applied inagriculture a cow on a farm could be identified by an IP address allowing the farmer and adairy to its monitor its milk output13 or its health
As more and more devices acquire an internet13 address we talk about13 the lsquointernet13 ofthingsrsquo lsquoequipping all objects in the world with minuscule identifying devicesrsquo(httpenwikipediaorgwikiInternet_of_Things) These things might13 include buildingsthe home healthcare and transport healthcare providers cars and emergency serviceslocations such as industrial parks hospitals car parks and police stations and devices suchas tablet13 computers and cash machines
7
The development13 of small and relatively low-shy‐cost13 medical devices for measuring relevant13 vital signs or medical parameters such as pulse rate and blood sugar level means that13 individuals can take their own measurements and then take responsibility forunderstanding their meaning (with appropriate support13 where necessary) and modifyingtheir behaviour accordingly
The availability of smart13 phones capable of running apps (specialised lsquoapplications) has ledto the development13 of new measures of well-shy‐being that13 are based on the individualinputting information on location the way that13 they feel and their interactions with othersThe smartphone can provide additional context13 automatically including location thenumber of conversations the distance travelled and external parameters such as theweather and the temperature This supports the idea13 of a life that13 can be measured in asensitive manner many times a day and without13 being seen as intrusive This leads to theconcept13 of the Quantified Self
Knowing how one feels and how one lives in a way that13 can be measured and easilycompared with other people can have both benefits and disadvantages The benefits tosociety mainly stem from an ability to identify people who are unhealthy both with respect13 to acute needs and from a predictive point13 of view those who are likely to be unwell atsome time in the future In the mental health space people who have bipolar disorder canbe monitored and supported more efficiently perhaps leading to a reduction in self-shy‐harmand suicide
There are likely to be some people who rebel against13 the need for measuring their owncondition daily and for ever They could view the measurement13 regime as being arestriction on their own lives preventing them from doing what13 they want13 to do because ofthe need to compete with their own measurements This could lead them to walk awayfrom treatment13 regimes resulting in a sudden decline in their well-shy‐being
26 Social networks
Social capital1 refers to the collective or economic benefits derived from cooperationbetween individuals and groups and highlights the importance of social networks that13 linkfamily friends neighbours and communities Wellbeing can be affected by connectivitypeople who have low social capital are likely to be lonely but13 also are more likely to reject13 public health initiatives such as flu jabs which could be beneficial to their health and well-shy‐being
The number of older people who live alone has been increasing for many decades By 2025two out13 of every five older people are likely to live alone Their quality of life may dependon them being able to build strong social networks Traditionally these networks were built13
1 lsquoJust as a screwdriver (physical capital) or a university education (cultural capital or human capital) can increase productivity (both individual and collective) so do social contacts affect theproductivity of individuals and groupsrsquo httpenwikipediaorgwikiSocial_capital
8
on neighbourhoods clubs and pubs and religious groups Meetings became social eventsand absence either signified a rejection of the group or a trigger for other members tobegin to visit But13 what13 happens when a network starts to disintegrate because of death orgeographic dispersal or because the individual loses physical capacity Can web-shy‐basedsocial networks compensate by nullifying geographic separation or by building newnetworks
Skype arguably demonstrates that13 lsquogeography is historyrsquo by making possible free real timevideo communication with family and friends thousands miles and continents apart Thebarrier of course is being able to afford a computer and a broadband connection whichmay limit13 use by lower socio-shy‐economic groups However its potential as a support13 mechanism should not13 be underestimated the technology is simple and it13 works we needonly the social economic and political will to make it13 happen In Scotland older peopleenjoy free bus travel why not13 free broadband
Social networks such as Friends Reunited and more significantly Facebook have emergedas vehicles that13 can not13 only link friends together but13 can also become a means of appealingfor associations and linkages that13 can be supported by the sharing of personal information
The inclusion of a camera13 on smartphones makes it13 easy to share photographs which canenrich communication For example proud parents may announce the arrival of a newbaby with a picture that13 everyone might13 wish to see On the other hand employers might13 also see evidence of why someone who has phoned in sick is unavailable for work on aparticular day Being aware of and able to set13 privacy levels is therefore important13 in orderto control who can see your personal information and news young people and vulnerableadults in particular may admit13 more people as lsquofriendsrsquo (or connections) than might13 beadvisable
The lifetime of major social networks is likely to be limited to a few years as new businessmodels13 emerge and new promotional strategies offer benefits to subscribers This mayoffer an opportunity for new networks to be created to deal specifically with those peoplewho are excluded in any way including those who will be referred to social services forassessment13 and support
27 Entertainment
Many people still remember the coronation of Queen Elizabeth in 1953 being shown live ontelevision This was an important13 milestone in establishing this new medium as acompetitor to radio and the cinema13 as a source of entertainment The arrival of colour TVin the late 1960s contributed to the declining popularity of cinemas and theatres many ofwhich closed
Today many homes have a TV in every room and technology has advanced to deliver highdefinition and 3D pictures on very large screens or lsquohome cinemasrsquo with surround sound
9
Paradoxically perhaps radio is more popular than ever and cinema13 has bounced back fromdecline to once again become an important13 element13 in the social lives of many people
Video images still or moving can be displayed also on laptops tablet13 devices andsmartphones which means that13 people can be entertained or informed on the move Sometrain operators have followed airlines in providing an lsquoat13 seatrsquo entertainment13 experience13 which can be offered with certain choices though many passengers prefer to use their owndevices and content In the future it13 seems likely that13 access to both audio and videoentertainment13 will be possible at any location and in a way that13 doesnrsquot13 interfere with theenvironment13 of other passengers
For those who want13 neither video nor audio (eg music) entertainment reading mayremain the entertainment13 of choice Many older people have struggled to find suitablereading materials as a result13 of the closure of local public and mobile libraries Some peoplecannot13 support13 the weight13 of a book while others lack the dexterity to turn the pagesOthers have sight13 problems which prevent13 them from reading small print All theseproblems can be overcome using either text13 to speech technologies (which are replacingtalking books) or by using e-shy‐reader devices which allow font13 sizes to be increased easily andwhich offer simple interfacing for moving pages backwards or forwards
In the future it13 must13 be assumed that13 all entertainment13 media13 will be held in the lsquocloud2rsquoand will be downloadable to an appropriate device on payment13 of a fee provided that13 acommunications contract13 is in place
The pre-shy‐requisites will bebull A device (eg PC laptop tablet Kindle)bull A contract13 with a telecoms provider (eg BT Virgin Sky) for broadbandbull A contract13 or contracts with media13 provider(s) (eg Netflix iTunes)
Those who lack any of these components may be entertainment13 excluded
28 Cash13 and13 money
Cash has been king since the abolition of the gold standard It is an expensive method oftransferring money between people and organisations and is a considerable overhead forindustry and for individuals travelling between different13 countries The highest13 denominations are lightweight13 and easily lost stolen or destroyed while the smallest13 denominations are heavy dirty and difficult13 to handle It is surprising that13 physical cashcontinues to be used It can only be a matter of time before it13 is digitised and replaced byvirtual cash
2 This means the material (book film or whatever) is stored in a remote computer (thecloud) and downloaded (or lsquostreamedrsquo) to your device on demand and possibly onlytemporarily
10
Large payments were previously made by cheque They are expensive to process by thebanks because people can write them by hand which makes them difficult13 to readelectronically and automatically Consequently they require human intervention and this isnot13 what13 modern banks wish to do so they want13 to promote greater use of debit13 and credit13 cards The latter were used initially as a cheque guarantee but13 are now being used almost13 exclusively as a means of withdrawing cash from ATMs and for making paymentselectronically UK banks wanted to do away with cheques by mid-shy‐2012 but13 they had toperform a u-shy‐turn under pressure from charities representing older people It is apparent13 that13 digital cheques and other cheque-shy‐replacement13 strategies will be introduced soon that13 satisfy the most13 pressing concerns of older people
It was difficult13 to see how cash could be replaced for payments for lower cost13 items such asnewspapers and sweets until the era13 of contactless payments Near field communicationsystems are likely to replace bar-shy‐codes to carry product13 identification information Theycan be read by electronic receivers The same technology can be two-shy‐directional allowinginformation to be passed from a smart13 phone to a reader and back again The smart13 phoneeffectively becomes a wallet13 which can be digitally filled by the owner and then emptiedwhen making purchases For small sums of money this approach is ideal and is likely to berolled out If cash disappears then begging will become difficult13 and welfare paymentsmade on a card Such cards are already used by social services as a means of providingclaimants with a means of receiving self directed care and support By restricting use of thecard to outlets that13 can provide care and support13 services opportunities for spending thecash inappropriately are restricted
It follows that13 many users of social services will need to have a smart13 phone as well as acard that13 can be used to buy services In the future smart13 phones may be provided as aloan item to claimants for social care This could include a digital wallet13 facility as well asthe communications and information ecosystem that13 would allow these people to receive awhole range of other services that13 would prevent13 their social exclusion and which could beused directly to provide them with information and access to entertainment
29 Biometrics and fraud13 prevention
Identity theft13 is used by criminals to pretend to be someone else in order to accessresources or obtain credit13 and other benefits in that13 persons name Although the concept13 has been around for centuries it13 is a growing concern in the digital world as we acquiremultiple online identities for bank accounts social networks and using public services such13 as paying tax electoral registration etc
Passwords are fraught13 with difficulty typically they are hard for humans to remember andeasy for machines to crack Efforts are therefore focused on other forms of provingidentity for example
11
bull Fingerprints have been accepted for over two thousand years to confirm identitymostly in criminal justice The technique has been applied to door-shy‐lock opening insome supported housing schemes There are practical problems associated withregistering lsquoallowedrsquo fingerprints and the useful lifetime of such products is also onlyabout13 three or four years
bull Retinal imaging and DNA analysis have been relatively slow to follow but13 only dueto the sophistication required for measurements and the time taken for testing Acombination of retinal imaging with facial gestures and blinking is possible in the labbut13 currently takes half a minute to achieve a match -shy‐ and this is achieved only withthe use of considerable computer processing power This sort13 of time makesapplications in mass people transfer impossible
Current13 research in this area13 is focusing on the uniqueness of other body parts such as earsand knees as biometric indicators The ears have great13 potential because they are usuallyexposed though hidden sometimes behind hair and other times by hats and other clothingOn the other hand the knees are rarely visible and however unique they may be there willbe cultural and religious obstacles to overcome before scanning could become a regularpart13 of identity confirmation The cameras which are central to such systems used to beexpensive but as the cost13 of high quality cameras continues to fall (there is one in nearlyevery mobile phone) it13 becomes feasible to devise identification devices that13 use multiplecameras to simultaneously recognise the eye and the ear
Movement analysis can be used to identify people by their walk gait13 and other biorhythmsprovide unique signatures It is possible to learn someone elsersquos gait13 though and injury orillness13 can have a temporary effect13 on gait
Over the next13 ten years with more sophisticated databases and image processing facilitiesthe cost13 of implementing advanced biometrics will fall enabling their application acrossmore diverse areas and in more social opportunities Potentially cameras will use cloud-shy‐technologies to provide individuals with instant13 recognition of anyone approaching them inthe street This could prompt13 a name or the occasion when they were last13 seen or spokento as a secondary method of control in much the same way as Internet13 banking seeks toavoid fraud This13 has13 the13 potential to remove13 the13 need for13 passwords13 and might13 then be13 the basis of machine-shy‐based13 communication13 either in front13 of a laptop or tablet13 device orwhen using13 a smart13 phone
There will need to be special measures introduced to support13 people with any form ofdisability as they might13 well have one or more sensory deficits Similarly people maystruggle to communicate following a stroke or a serious accident Nevertheless it13 may bereasonable to conclude that13 such systems will be both available and acceptable within thenext13 10 to 12 years
12
210 Health13 information
Health records in the form of written documents x-shy‐ray images and clinical observations arean important13 means of making all interventions efficient13 and safe Increasingly people havemany different13 conditions (comorbidities) and may be treated by several specialists Asthese physical records are moved inevitably some get13 lost estimates suggest13 that13 one inthree records is lsquolostrsquo at any one time
The best13 resource for information about13 a patient13 is his or her primary care record which isheld by the GP The UK was an early adopter of electronic primary care records and can beproud of the way that13 these have enabled population-shy‐based information to be collectedand analysed Scotland (and to a lesser extent13 Wales) has led the way in ensuring that13 allthese records are accessible through anonymised approaches that13 allow researchers toexamine trends and improve analysis of performance Fundamental to this has been theallocation of a unique identifier At13 the same time individuals can access these recordsboth to check for accuracy and to see what13 their doctor has said about13 them
This13 has13 the potential to make people more responsible for their own conditions andmight lead to better13 self-shy‐care13 and changes in behaviour13 that might reduce13 the13 incidence13 or severity13 of chronic conditions13 that are related13 to lifestyle
In the future we can expect13 the primary electronic health record to be linked with hospitaladministration systems picture archiving systems and other records held by hospitals sothat13 appropriate medical staff can have access to all relevant13 data
When the social care record is added to the mix then this will mean fewer but13 shorter andbetter assessments for social workers and for healthcare staff They will knowcircumstances and factors that13 could influence the choice of approaches This supports theidea13 of there being only one record consisting of several components all of which areaccessible by an appropriate professional at any time and in any place
The13 ambitions13 described above13 are not13 limited by technology most13 of the interoperabilityissues between rival commercial record systems have been resolved and databaseproviders are being compelled to support13 joint13 working The English NHS Mandate requiresTrusts to effectively replicate arrangements already in place in Scotland and in Wales andthis will go a long way towards achieving a genuinely paperless NHS well before 2020 Withnew biometric identification technologies individual records will be available to out-shy‐of-shy‐hours physicians and to those working in an AampE department13 irrespective of theconsciousness state of a patient
New telecare and telehealth technologies will produce significant13 more volumes of data13 which are currently held in different13 places and owned by different13 organisations rarely thepatient These data13 will also need to be shared but13 only in a manner that13 is acceptable toeveryone Patients may not13 want13 all their mental health information published in a formthat13 can be viewed by social workers GPs may not13 want13 to have access to all the data13 that13 might13 suggest13 that13 there is a domestic crisis to which they had neither the wish nor capacity
13
to respond Monitoring systems that13 support13 the lsquoquantified13 selfrsquo may also offer data13 that13 may or may not be added to the full recordThe future of health information might13 therefore be about13 providing individuals with themeans of producing relevant13 information storing it13 somewhere secure and then viewing it13 at a later time but13 in a format13 (or with advice) that13 is acceptable
See also httpmydexorg lsquoMydex gives individuals back control over their personal datarsquo
(see also Digital Scotland 2020 Achieving World-shy‐Class digital infrastructure a final report13 tothe Scottish Government13 httpwwwscotlandgovukPublications2013029054lsquoconnectivity by any device anywhere and anytimersquo)
211 The Future of Healthcare
The strains on our healthcare delivery system are becoming greater as they are in otherdeveloped countries as a result13 of an aging population rising expectations and unhealthylifestyles The necessary changes will require a significant13 shift13 in resources13 fromsecondary13 care13 where unit costs13 are high to community13 carewhere people can generallybe treated at home
The future must13 therefore necessarily involve efficiencies in hospitals and in the way that13 people can be treated in less expensive locations ultimately in their own homes Hospitalswill use more sophisticated diagnostic tools including scanners of all types to non-shy‐invasivelyprobe inside peoplersquos bodies This will result13 in more day cases and hospital stays (alreadyaveraging under a week) to even shorter periods with on-shy‐going support13 provided inintermediate care settings that13 might13 include hotels care homes or the personrsquos own homeif it13 is clean safe secure and has all the necessary amenities (include access to theInternet)
Advances in medical technology will allow more treatments to be delivered in the homeThis will mean fewer visits by clinical staff and fewer opportunities to attend primary carecentres Pharmacists will become suppliers of information as well as drugs so the balanceof care will shift13 significantly away from doctors who will work in different13 ways relying13 increasingly on telemedicine to bring the specialist13 to the patient13 for an online consultation13 For example if a patient13 complains of nausea13 and severe headaches a virtual consultationcan be offered almost13 immediately and without13 having to send a patient13 with a potentiallyserious and acute condition on a potentially long journey to a hospital
In the above example a neurologist13 may ask further questions as well as conduct13 acomplete neurological examination using videoconferencing technology Airedale GeneralHospital consultants have new contracts that13 require them all to be available for virtualconsultations The first13 benefit13 has been in reducing the need for prisoners at local jails tobe brought13 into AampE (which may need to be locked down depending on the circumstancesand the potential for violence of the individuals involved) potentially saving hundreds of
14
pounds in security costs It also avoids the need for healthcare staff to have to go into aprison environment
The principles described above are already saving lives through telestroke services whichlead to more people being thrombolysed appropriately and avoiding long term support13 that13 often follows a stroke incident Teledermatology has been practised for a number of yearsand results in rapid diagnosis and resolution of problems that13 previously required significant13 time for remedy
212 Gadgets and13 DIY13 healthcare
There are at least13 three elements to healthcare
bull Gathering information on symptoms and physiological parametersbull Interpreting the information andbull Responding to the diagnosis with treatment
Many people choose to exercise self-shy‐care because this gives them control whilst13 avoidingthe need to share their concerns and personal details with others A lsquodo It yourselfrsquoapproach might13 even be encouraged by the NHS as a viable way of using scare resources
Medical devices that monitor vital signs are mature and have been miniaturised so that13 they can be used in the home by individuals with little or no medical training Indeed bloodsugar monitors are being produced specifically for use outside the hospital and in such away that13 they can be used reliably by people with advice and training being provided onlinevia13 YouTube
Many medical monitoring devices do no more than produce a single measure which theuser may record or respond to Others link wirelessly to smart13 phones allowing data13 to bestored and entered into a personal health record where trending opportunities existingIndeed individuals can easily enter their data13 into an app running on their laptop tablet13 orsmart13 phone This trending information may be useful13 for self-shy‐care and could be passed onto a physician though the volume of data13 produced in this way and doubts about13 thequality of the data are likely to persuade GPs to discount13 data13 produced in this way
This gap in knowledge can be filled with advice information and diagnosis that13 can beobtained online using a lsquoDoctor Googlersquo approach The quality of such diagnosis may varysignificantly although there are many sources of information that13 are both supported andapproved by the NHS (and by similar sources in other countries) However with a data-shy‐richapproach and a choice of diagnosis people may be empowered to take a greater role inhealthcare
15
The final component13 for the DIY enthusiast13 is the treatment13 option Many people fear longterm use of medication produced by the big pharmaceutical industry and prefer morenatural remedies which are available over the counter More medical treatment13 devicesare available that13 stimulate blood flow and counter pain through the use of electrical andphysical stimulation
The evidence may be weak at present13 but13 might13 grow as more people use them and as theircost13 drops The13 impact13 of13 such technologies13 on vulnerable13 people13 is13 difficult13 to gauge
213 Telecare
Support13 provided at a distance to people in their own homes is known as telecare Thename implies remote monitoring and interaction and includes the monitoring of the homeenvironment13 and of the individual as well as the interaction of the individual with thisenvironment Definitions have become difficult13 due to some US medical devicemanufacturers introducing the term telehealth to describe medical telecare such as remotemeasurement13 and collection of vital signs data
In the UK telecare alarm services have matured quickly using the robust13 platform andinfrastructure of social alarm systems which were originally used by tenants in shelteredhousing schemes to seek help when they didnrsquot13 own a telephone The majority of telecareservice users today live in their own homes and use dispersed alarm units to link with amonitoring centre through the telephone network Improved assessments of needs andrisks to independence have resulted in combinations of sensors being used to support13 theoption of staying put13 rather than moving into residential care or having increasing levels ofdomiciliary support They support13 the policy of bringing care closer to home and ofencouraging people to become partners in their long term support13 arrangements
Telecare services developments over the past13 decade include standalone items such asautomatic lights which have achieved significant13 efficiencies especially for people who arefrail and prone to falling and to those suffering from mild cognitive impairment epilepsyand anxiety People who have long term conditions including chronic conditions such asdiabetes and hypertension can also be managed more effectively through telecare supportThe benefits of telecare services include a relief of stress for family caregivers enablingthem to continue to provide unpaid support13 while holding down a job and maintaining theirquality of life
New developments enable continuous monitoring of behaviour and smart13 devices that13 canfor example remotely control the cooker the water supply and door entry Such13 monitoring may detect13 incidents early and prevent13 emergencies arising Devices arebecoming smaller and easier to embed quickly within the home environment making themmore acceptable and less noticeable Longer battery life means less frequent13 maintenancevisits
16
The13 monitoring13 centre13 becomes13 an information hub13 offering13 both advice13 and a vehicle13 for checking that someone is coping especially following a trigger event such as a stay inhospital or the illness13 of an informal13 carer
New systems utilise web technology that13 allows family members to be more proactive inthe monitoring of their relatives This can lead to greater interaction with them especiallywhen the relatives live a considerable distance away (perhaps in another country) Thesenext13 generation systems might13 include video conferencing and the use of tablets smart13 phones or smart13 TVs but13 when an emergency response is required (perhaps to lift13 someoneup after a non-shy‐injurious fall) there remains a need for human intervention
The13 future13 of13 telecare13 might therefore13 include13 an increasing13 dependence13 on volunteersfrom13 the13 community to provide13 the13 required support Social networking may need to beused13 to support13 telecare technologies
214 Mobile healthcare
While telecare can support13 people effectively in their own homes it13 is now recognised that13 being able to go out13 to enjoy open spaces and to overcome the fear that13 the home is aprison is an important13 part13 of improving well being and supporting a higher quality of lifeExtending telecare technologies to operate outside the home is known as mobile healthcare(or mCare) and is based on mobile telephone networks rather than landlines
The simplest13 form of mCare requires only a basic mobile phone to deliver telephone callsvoice13 messages and SMS (text13 messages) The technology is mature and there are countlessapplications in use both in the UK and in developing countries such as Africa13 and India13 where mobile telephones have already achieved a saturation level and where fixedtelephone infrastructures are not13 likely to be established at any time Such telephones areuniversally available in the UK and are used by the vast13 majority of people including manyolder people especially if they have been introduced to the low cost13 (pound30) devices that13 have large buttons large displays and a separate large button for calling an emergencynumber
Smart13 phones are rapidly replacing basic phones and allow the use of a large range of lsquoappsrsquothat13 are being developed to provide information and for enhanced experiences In thehealthcare space Skype FaceTime Vidyo and GoToMeeting with HD Faces are all current13 examples of video conferencing software available on tablets and smartphones
The specific software will depend on the nature of the communication desired
bull Skype will13 manage a simple video phone callbull Where an AampE physician needs to share a CT scan of head with a Neurologist13 on call
from home GoToMeeting would be more appropriate
17
bull If the physician would rather have a dedicated online meeting room that13 patientsand colleagues can simply drop in for a virtual meeting a Vidyo virtual room may bemore appropriate
This technology can suit13 any form of lifestyle including many people with complex needswhose lifestyle is not13 consistent13 with a fixed address
Social care apps are available already to deal with problems of sensory deficit
bull Guiding a blind person through GPS navigation and reading signs through appslinked to the devicersquos camera13
bull The microphone can be used as a hearing aidbull Speech recognition software can be used either to replay speech at a slower speed
or for translation into a language of choicebull Speech can also be selected for people who have a stammer or who have a problem
with their larynxbull Apps are becoming contextually aware recognising situations and locations and are
thus becoming a personal assistant13 for people with disabilities
By 2020 it is therefore possible that a smartphone may13 be prescribed13 for people who13 need13 social13 care13 together with13 a range of apps that have been13 selected13 to meet13 theirassessed13 needs
Whilst13 smart13 phones tablet13 devices and apps may become an important13 part13 of anindividualrsquos personal support13 armoury the potential of mCare will be limited only by anindividualrsquos ability to make use of all its functions Each device could become a part13 of anindividualrsquos personality supporting them to improve behaviour take exercise avoidtemptation and manage their own health and well-shy‐being Potentially mCare could becomethe most13 important13 element13 of social care and support13 within 10 years
215 Artificial Sensing and Enhancement Devices
bull It is estimated that13 one in seven people has imperfect13 hearingbull The numbers who are born deaf are quite small and many of these people may
have some form of hearing restored through surgery or through technologybull Similarly while there may be nearly a million people registered as blind or having a
severe visual impairment the vast13 majority lose their sight13 during their lives as aresult13 of disease
bull New treatments will deliver sight13 recovery or restoration over the course of the next13 10 to 20 years
Fortunately technology can provide excellent13 sensing capabilities that13 are already providingpeople with external portable devices for enhancing their lives The simple hearing aid is anexcellent13 example of a device which has been improved through both miniaturisation
18
personalisation and enhanced performance Today digital hearing aids use sub-shy‐miniaturemicrophones that13 can be unidirectional or omnidirectional and which can be adjusted insensitivity over an extended range Tomorrowrsquos devices can be switched between modesby the user so that13 they can benefit13 from hearing perfectly in any environment Indeedthey can be used with adaptive filtering technologies (as used by helicopter pilot13 headsets)to eliminate some sounds so that13 the rich speech (or music) components alone remainFuture developments will be on optimising control so that13 the user can switch seamlesslybetween different13 amplification applications without13 appearing to be distracted A smart13 phone or mp3 music player may be used as either a processing unit13 or as a ubiquitousoutput13 device that13 looks cool and natural
These same technologies will also be developed for use within the home environment13 fortimes when a deaf user isnrsquot13 present13 or is asleep Acoustic signatures associated withadverse events and incidents such as the hiss of a gas leak the crackle of a fire the sound ofa smoke detector the drip or a water leak or the sound of breaking glass can be directlyassociated with programmed actions Speech will be recognised interpreted translatedsimplified or displayed so that13 an individual knows what13 is said and can be provided withclear instructions on how to respond
Video cameras have become smaller and cheaper and capable of producing high definitionimages The problem of storing and editing these large image files is being solved by thearrival of cloud computing
Electronic noses are already capable of detecting the quality of wine and fresh fruit Similartechnology will be based in smart13 phones and will be able to analyse the air to warn of13 foodthat is no longer fresh and of other indicators of danger including gases that13 have13 little13 natural13 smell These13 devices13 could support13 people with13 cognitive impairment13 -shy‐ whose13 sense of smell13 tends13 to deteriorate -shy‐ to live independently
Many older and vulnerable people are at risk of hypothermia during the winter Sensordevices can provide warnings of low temperature In the same way heat13 stress can be adanger during the summer months so sensors can alert13 people of the need to openwindows or to operate a fanFinally people who have damaged13 their fingers13 or hands will be able to wear sensorsembedded in artificial skin or in gloves that13 will enable them to identify textures and shapesand be able to dress and undress without13 the assistance of carers
216 Robotics
We may recoil at the idea13 of personal care being delivered by robotic devices but13 it13 is likelythat13 within a decade personal assistants will exist13 to assist13 with household tasks These areunlikely to be humanoid and are more likely to be machines dedicated to helping frailpeople to support13 their own weight13 and to carry trays of food around the home
19
There are four broad classes of robot13 under development13 that13 are likely to mature within 10to 12 years
1 Miniature industrial robots that13 have been programmed to perform specific taskswith precision They are likely to be relatively heavy enabling them to bear weight13 but13 still have the necessary flexibility to carry an individual over short13 distancesplacing them in a chair or on a bed They will have sensors and cameras to provideimmediate feedback and to adjust13 rapidly in response to verbal commands or cues13 from the user Some designs may build on existing assistive devices such as abathroom hoist13 or a bathing aid to become intelligent13 extensions of productsalready on the market A stair lift13 with intelligence is already being designed by a UKcompany and is aimed at providing the user with more control of the journeybetween floors of a house
2 The second group of devices might13 be described as intelligent13 furniture Beds andchairs are already available that13 adjust13 to make the user more comfortable and also13 to help them get13 into or out13 of bed The control units are fairly cumbersome andare suited to operation by a carer Voice activated controls and built-shy‐in intelligencewill give the user more control and independence Other items of furniture to whichintelligence might13 be added would be tables whose height13 can adjust13 and whichhold items of food and medicine securely The table would recognise these objectsand could provide prompts or reminders
3 Mobile robots form the third group These could be goffers that13 can either fetchand carry items such as newspapers drinks or trays or which can accompany theuser when they move between rooms providing them with support13 or prompts Thistype of robot13 could be an intelligent13 walking frame with wheels which13 could13 doubleup as a smart13 wheelchair when necessary
4 Finally there are companion robots These might13 be in the form of an electronicpet typically a cat13 or a dog though the Japanese Paro robot13 is a seal Pets canrespond to stroking and being patted they can also remind their owners that13 theyneed to take exercise and to eat drink and take their medication Various designsare already available which provide feedback but13 future models would includecameras and a screen to provide a mobile means of information and interactionwith other people over the Internet Intelligence within the device could allow themto have a personality of their own and gain knowledge by scraping data13 fromwebsites so that13 they can generate speech and have conversations about13 the newsthe weather or sports results
217 Transport and transfer technologies
Walking is good exercise and is a no-shy‐cost13 form of transport13 that13 is encouraged because of itsimpact13 on well-shy‐being For an individual with a chronic disability or suffering from theeffects of an accident13 or an injury this becomes impractical without13 an assistive technology(AT) A walking stick is the simplest13 example of AT
20
Within the home the stair lift13 has enabled people who live in conventional properties that13 are on two or more floors to continue to use facilities on different13 floors when climbing thestairs has become too difficult This is often the case for people who have arthritis a lowerlimb amputation a long term condition such as Chronic Obstructive Pulmonary Disease orpeople approaching the end of life and who have chosen to die in their own homes
Designs have improved so that13 a curved staircase is no longer an issue and the reliabilityhas reached a level where breakdown is a rare occurrence13 Through-shy‐floor lifts have been analternative proposition but13 they remain too large for most13 properties Alternativeapproaches may emerge using air pressure or water pressure as the driving force ABrazilian design already utilises a plastic tube in which a pod is moved effortlessly up anddown
Electronic wheelchairs are now available that13 allow the individual to become moreindependent13 as they allow the user to control both propulsion and steering Some modelshave the capability of mounting a pavement13 or a step or even a flight13 of stairs Personalmuscle amplification devices have been developed originally with the intention of helpingpeople who are confined to a wheelchair due to a neurological disorder to perform sometasks from a standing position Indeed the Rex walkerrsquos manufacturers claim that13 anyonewho can propel themselves in a wheelchair could walk by using Rex
Other approaches have focused on the rehabilitation of people after major accidents that13 have caused partial paralysis They quickly extend into exoskeleton designs that13 enableanyone to gain a mechanical advantage and thus to tackle physical tasks that13 would not13 otherwise be possible These suits are the focus of major research projects across theworld Some13 products such as the system developed by Honda are being tested inAssisted Living facilities and are likely to become more and more enabling over the next13 decade
Similar benefits are also occurring outside the home with a number of novel carryingsystems appearing over the past13 few years They are generally termed lsquoscootersrsquo but13 thiscovers a wide range of systems and devices ranging from the Segway a device that13 is amobile platform on which the user stands and navigates through to conventional electricvehicles that13 have been developed from golf buggies There remain a number of issuesconcerning their use on roads or on pavements but13 similar problems will need to beresolved for bicycles to play their full part13 in enabling people to get13 more exercise13 Thepotential for hybrid scooters remains
218 Smart domestic appliances and personal hygiene
The bathroom is a dangerous place and one where many older and disabled people slip andsuffer a fall Many older people recall taking a bath in a tin tub in front13 of an open fireToday the options tend to be a level access shower (ie a type of wet13 room) for anyoneunable to get13 into a bath There are various aids to help people get13 into and out13 of thebath most13 involving a seat13 that13 can be raised or lower with some bath-shy‐tubs having a door
21
There has been some research into alternative methods of keeping the body clean Sanyointroduced a machine in 1970 modelled on a clothes or dish washing machines the personsits on a seat13 inside the machine where13 they are cleaned by a set13 of water jets These havenot13 proved popular and furthermore require the individual to be transported to themachine Thus the technology may find application in nursing homes but13 are unlikely to beattractive to people living independently in the community
The washing needs of people change over time Over the past13 20 years body piercingshave appeared which have demanded additional attention to avoid the problemsassociated with poor hygiene and metals Similarly hair may be permed and dyed usingchemicals which are much stronger and which might13 damage the hair Add to this thepainting of finger and toe nails and the washing needs are rather different13 to what13 theymight13 have been even ten years ago Finally tattoos were once popular only with sailorsToday they are likely to be found on the arms backs and legs of both men and womenNew ways of cleaning these tattoos will be needed especially if they become infected orare sites at which pressure sores develop
Even if a personrsquos body is clean if their clothes are dirty they may become socially isolatedBut13 the washing of clothes can be strenuous even if a launderette is used The need toconserve water has driven research into ultrasound techniques to beat13 the dirt13 out13 ofclothing while some companies are experimenting with polymer chips These13 ldquogreenrdquo13 technologies are quickly maturing and are likely to be standard in the next 10 years
Other smart13 household appliances are already appearing on the market13 and may soonbecome common13 in UK homes13
bull Robovac devices have sensors to enable them to detect13 dirt13 on carpets and to adjust13 their operation accordingly
bull Refrigerators can read bar codes or RFID tags to identify their contents and theirldquouse byrdquo13 dates enabling them to inform the owner that13 they should use theproducts before they are out13 of date They can be linked to the Internet13 to reorderitems as they are consumed or to suggest13 menu options for the individual based ontheir preferences or according to the diet13 required to manage a condition
bull Ovens will automatically switch off if they are left13 without13 attention for too longand drying machines will set13 times automatically
Devices may be linked so that13 they are more efficient and report13 maintenance issues sothat13 they can be repaired (perhaps remotely) before they suffer a catastrophic breakdown
219 Personal and home13 security
It might13 appear perverse but13 people with very little personal wealth and property are morelikely to be the victims of crime than those who have expensive items This may be due towhere poorer people tend to live or because people who have valuable assets take greater
22
steps to protect13 them There can be no doubt13 that13 crime has a very negative effect13 onindividuals and on their families creating a fear factor that13 may be difficult13 to remove Theimpact13 on quality of life is therefore very considerable especially if it13 forces people to stayat home behind locked doors effectively isolating themselves from society
Modern policing places increasing reliance on the use of closed circuit13 television (CCTV)Town centres are covered by cameras used increasingly in the fight13 against13 crime by bothdetecting anti-shy‐social incidents and identifying the people involved They are also used tomonitor the movement13 of cars that13 may be involved in incidents of burglary and violenceand are fast13 becoming the primary mechanism of law enforcement13 agencies to solve crime
CCTV has moved into the home to record movement but13 monitoring the footage is timeconsuming and often not13 practical Cameras are now available which provide an instant13 video feed to a smart13 phone when movement13 is detected These may have intercomcapability allowing someone to remotely speak to an intruder sometimes before they havegained access to a building This may serve as a deterrent13 and when fitted alongside simpledevices that13 switch lights on randomly around the home may force burglars to goelsewhere
As the price of cameras continues to fall the option of carrying a camera13 on the body that13 continuously monitors personal space is becoming more useful Using wireless networksthe data13 collected can be sent13 continuously to the cloud for safe storage It cansubsequently be retrieved to provide evidence (video and audio) of confrontations enablingsuccessful prosecutions to be made The smart13 phone itself is becoming a valuable itemthat13 is attractive to criminals These can be tethered to personal attack buttons usingwireless technology allowing the device to be activated by the pressing of a button if theowner is being attacked The phones can then be tracked and located by the police whilebeing rendered useless to the assailant
Bogus callers are a perennial problem for vulnerable people Video door bells can beconfigured to display images and record the words of visitors before they are admittedallowing remote monitoring centres to oversee the situations and use image recognitionsoftware to confirm the bona13 fide of visitors Such13 arrangements may become13 commonplace13 over13 the13 next five13 or13 six years13 significantly13 improving the safety of peopleliving independently
220 Personal safety
The biggest13 risks to personal safety stem from fires and falls Most13 fires are the result13 ofpoor cooking practices resulting in burns or scalds Floods and gas emissions are caused bya failure to remember to close taps
The current13 approach involves detection of an emergency situation as soon as possible but13 always after a problem has already occurred This responsive approach can minimise therisks provided that13 there is a protocol in place for intervening This could increasingly be an
23
automated response such as the switching off of the gas of water or the switching on of asprinkler system or a water mist13 system
In the future monitoring systems will be more sophisticated and will have sensors and localintelligence to identify activities In this way reminders can be issued before an emergencyoccurs13 This lsquosmart kitchenrsquo approach may become13 an integral part of13 homes of13 vulnerable13 people
A prototype system has been developed at the Culture Lab in Newcastle Sensors havebeen embedded into cooking utensils enabling the kitchen to identify what13 the person istrying to cook or prepare It can provide interventions as messages on an instructionscreen
Accidents also occur out13 of doors People with dementia13 might13 become lost13 and may havepoor road safety awareness Location devices based on GPS have advanced from large andheavy receivers that13 were used on ships and boats to small battery-shy‐operated devices that13 can be carried in the hand or in a handbag The current13 generation of locators has limitedbattery life and are rather too large to be secreted about13 a personrsquos clothing while devicesthat13 are integrated into a wrist-shy‐watch are rather clunky and unattractive
Within 10 years the13 technologies13 will have13 matured and will be13 much smaller13 so that theycan be embedded in shoes in walking sticks hats or any other item of clothing Powerrequirements will have reduced so that13 energy harvesting from the movements of theindividual will be sufficient13 to keep these products working for several weeks without13 theneed for recharging The devices will not13 simply indicate to others where the individualhappens to be but13 will provide subtle guidance cues to direct13 them home
Cameras might13 also form part13 of the personal security systems that13 will protect13 people fromaccidents Data13 may be sent13 to the cloud and analysed in real time if the person is in adangerous location and can provide prompts either to the individual or broadcast13 advice toothers to clear the danger These systems may be embedded in items of clothing (such as ahat) or they may be attached to spectacles
221 Energy and13 portable power supplies
The demands of developing economies for more power will inevitably lead to higherdomestic fuel charges in the UK especially as oil and gas reserves dwindle
By 2018 UK homes should be fitted with new smart13 meters The specifications for these13 devices have yet13 to be finalised but13 will include a means of identifying wasteful use ofenergy including TV sets that13 are left13 on and unattended fridges and freezers that13 are set13 attoo low temperatures and dryers that13 are used for too long or when the weather is suitablefor using a washing line They could be an enabling factor that13 supports changes inbehaviour driven by a need to use less power but13 it13 is unlikely that13 they will offer a bigreduction in costs that13 are already a problem for many vulnerable families
24
More generally the need for power conservation will include devices that13 are moreefficient and a significant13 emphasis on heat13 retention in buildings through betterinsulation
The energy crisis may force many people to spend more time in community settingsincluding shops and public buildings where they can benefit13 from the warmth Increasingreliance on mobile communication devices will lead to increasing demand for batterycharging facilities
Greater use may be made of portable devices for generating power based on solar cellswind or hand motion
222 Smart cities and homes
The Digital City initiatives have been based on information and how it13 can be used most13 effectively to make people aware of what13 is going on around them This means bettercoordination of resources more rapid access to advice and a battery of sensors measuringevery conceivable parameter from sound and light13 levels through to air quality andtemperature fluctuations There are several Digital or Smart13 City initiatives currently beingimplemented both in the UK and across the world They may significantly impact13 the livesof the millions of people living in them but13 the timeframe for outcome benefits to influenceplanning and design elsewhere is likely to be at least13 20 years and therefore outside thetimeframe of the current13 project
Housing plays a big role in the lives of most13 people both through their aspirations to moveup in the world (usually to a bigger property with a garden) and as the heart13 of the familylife which is associated with good quality of life UK properties have a life span approaching100 years which is about13 double that13 of their European counterparts (and certainly longerthan the wooden-shy‐frame buildings built13 in North America13 for example) A shortage ofhouses has plagued improvements in social welfare for the past13 30 years There is anargument13 that13 there are enough houses but13 the wrong size and in the wrong places andthis has some basis in fact13 as demography changes lead to more people (and more olderpeople) living alone However if there are two million homes in Scotland each with alifespan of 100 years then the renewal rate needs only to be 20000 per annum to maintainthe status quo However it13 must13 be clear that13 the impact13 of smart13 house development13 willbe small The focus should therefore be on adapting existing properties to render themmore appropriate for vulnerable people
Housing adaptations are a branch of assistive technologies The technologies for providingdifferent13 forms of accessible bath and level access shower are well-shy‐established with littleresearch considering anything other than alternative building materials and methods formaintaining the temperature of the bathwater Different13 technologies for bathing will beconsidered separately
25
Thus housing technologies are not likely to impact on social work13 within the next 20years13 though13 the use of information13 technology13 to ensure that people are aware of what13 is available is likely to be commonplace well before then
26
3 BEHAVIOUR AND ATTITUDE CHANGES DUE TO TECHNOLOGICALADVANCES
Technology is only one factor that13 will affect13 the way society changes in the next13 10 or 15years This chapter will consider the context13 in which the technological developmentsoutlined in the previous chapter will be supported (or held back) by societal factors
When the impact13 of such factors has been considered we can then apply theseassumptions to a number of case studies listed in Appendix13 A13
The headings selected for this chapter are not13 arbitrary as they reflect13 the context13 in whichtechnological changes must13 be considered They must13 include consideration of factors suchas demography and long-shy‐term conditions already addressed in the introduction to thesepapers together with the aspects of workforce and citizenship considered in the parallelpapers The additional elements here focus on trends that13 are already occurring and whichmay leave people struggling with the changes that13 occur
Finally there is a need to consider the attitudes of people to technology generally andespecially to the issues of privacy and social responsibility that13 could be radically changedby technology In some cases public opinion will prevent13 some forms of technology beingdeveloped if not13 commercialised In other cases some technologies will be fast-shy‐trackedeither at the request13 of government13 or because of a clear public demand for theopportunities that13 it13 can bring
Predictions13 about the13 future13 must inevitably be13 subject to considerable13 uncertainty butthat is no reason to stop thinking what might happen
31 The Welfare State
The UK can be rightly proud of the way that13 its welfare state has developed during the past13 100 years to provide a safety net13 of financial support13 to people and to their families whenthey are unemployed destitute homeless or challenged by crises and emergencies Therange of benefits received is considerable some are complex and many people struggle tounderstand their entitlements Some are universal some are discretionary some apply onlyto parents others to anyone
The total cost13 of providing these benefits continues to rise and when the economy isstagnating there is inevitably both political pressure often supported by popular publicopinion to introduce welfare reform so that13 people who do not13 work cannot13 be better offthan they would be if they were in full-shy‐time employment This strategy requires a universalbenefit13 to be introduced so that13 it13 is easier for claimants to access support13 but13 also easierfor agencies to identify the total benefits received The idea13 of a benefits cap then becomes
27
more practical to introduce especially if all the processes involved in making a claim arehandled electronically Indeed this encourages government13 to insist13 on applications forbenefits to be made on-shy‐line Unfortunately this will marginalise those people who haveneither a computer nor access to the internet thus emphasising the digital divide in amanner which works against13 some of the most13 disadvantaged people in society
There are currently few tangible links between digital technology and welfare provisionThe most13 obvious are universal benefits such as a free television licence (worth pound14550)13 for13 everyone aged 75 or older with blind and visually impaired people entitled to a 50discount13 irrespective of their age The significance of this position is that13 6 of revenuesgenerated through licence fees are to fund BBC on-shy‐line services13 such13 as websites and i-shy‐player In Scotland the BBCrsquos Alba Gaelic language television service is predominantlyfunded13 by MG Alba an organisation funded by the Scottish Government It is thereforeconceivable that13 in the future licence fees may be used to directly subsidise access toinformation and advice through the Internet13 for vulnerable people whether it13 is throughbroadband access or through a set-shy‐top box which removes the need for a computer in thehome to access particular websites or to use e-shy‐mail services
A second age-shy‐related benefit13 available in the UK is the winter fuel subsidy People whoreceive certain benefits receive the payments automatically while others must13 make aclaim Those who are not13 eligible for benefit13 due to a lack of an address for example missout13 on these payments and also on Cold Weather payments of pound25 for each seven dayperiod of very cold weather between 1 November and 31 March
The development13 of new warm home initiatives plus the complex of subsidies that13 theelectricity supply industry and government13 offer to people with solar cells further changesthe economic arguments Global warming may lead to greater variations in weatherextremes but13 might13 also increase the amount13 of electricity that13 can be generated byalternative (green) sources such as wind and solar cells It is estimated that13 energyconsumption in the UK increased by 17 between Christmas and Easter 2013 compared toprevious years as a result13 of cold weather but13 the above subsidy scheme did not13 benefit13 older people because two of the seven day cold periods were after 31st March It must13 beassumed that13 there will be more people living in fuel poverty in the future and this will leadto more cases of cold related illness including influenza13 and stroke
32 Management of long term conditions
The management13 of long term conditions will be improved for patients who are compliant13 with their medication regime so it13 is possible that13 there may be compulsion to adhere tothe prescription Such compulsion may be monitored using technology Indeed the remotemonitoring of vital signs using telehealthcare will become commonplace as the old boxesand sensors are replaced by devices that13 can be worn continuously or which can beembedded into the fabric of homes (including furniture and bedding) or can be worn asvests or patches They will wirelessly transmit13 data13 to smartphones or tablets and mobile
28
transmission and cloud technology will enable real-shy‐time data13 collection analysis andfeedback
One of the diseases which is projected to increase most13 significantly over the comingdecade is Type 2 diabetes Whilst13 there is a hereditary susceptibility to this condition formany people including those from the Middle East13 and the Asian sub-shy‐continent it13 is also adisease which tends to affect13 those people who are overweight13 andor have a sedentarylifestyle If untreated diabetes can lead to dizziness and collapse at any time but13 can alsohave more devastating long term consequences which include kidney failure strokeblindness and in extreme cases lower limb amputations Management13 therefore includesdaily monitoring of blood glucose levels and major dietary changes such as a significant13 reduction in the consumption of carbohydrates as well as a rigid exercise regime
Many newly diagnosed diabetics follow this advice closely and can lead normal lives for 40years or more but13 some struggle to accept13 the change in lifestyle required as well asremembering which foods are allowed and how much exercise they need to takeIndividual support13 plans are now forthcoming and over the next13 ten years best13 practicewill emerge in the form of smartphone apps that13 are personalised and which can becomean individualrsquos health coach This level of support13 will be fine for some people but13 otherswill need incentives so it13 is likely that13 gaming technologies will be introduced perhapsoffering rewards for good compliance There will be a temptation for some people tocheat perhaps allowing others to perform exercise for them or changing theirconsumption details
Many of these opportunities for cheating will be removed through the use of a uniquebiometric identifier a technology that13 will be mature enough to use in place of passwordson smartphones However the biggest13 challenge may be in encouraging older people to usethe technology Many older people have multiple morbidities Indeed a survey of Scottishpatients implied that13 42 of people aged over 80 will suffer from three long termconditions It will be essential for those people to comply with treatment13 regimes if they arenot13 to have the functional deficits that13 follow
33 Finding people who13 donrsquot fit
People who have low social capital are likely to have few relatives and friends with whomthey regularly communicate and are also unlikely to be part13 of community or faithorganisations such as clubs societies and church groups They also die several yearsyounger than most13 of the population often because they donrsquot13 engage with public healthinitiatives such as vaccinations against13 flu regular checks on their blood pressure bloodsugar levels or in the case of women smear tests or mammography The most13 likelyreason for disappearing beneath the radar of such initiatives is their mobility which leadsalmost13 inevitably to them having no fixed abode and no fixed telephone line It thenbecomes very difficult13 for them to be contacted because their mobile telephones are likelyto have Pay-shy‐As-shy‐You-shy‐Go contracts that13 donrsquot13 require validated names addresses and bankaccounts
29
It follows that13 some of the most13 vulnerable people in society including those who live onthe streets are effectively unknown to both the NHS and to social work departments untilthey are referred in a crisis This could be an emergency presentation to a hospital Accident13 and Emergency Department13 where they will come into contact13 with a social worker becausedischarge may be unsafe This often highlights the importance of the prevention agenda13 and the potential for avoiding admissions to hospital by intervening at an earlier stage
The advantages of being able to locate people who are vulnerable to specific diseases willincrease as genetic testing becomes more routine It is already possible to determine whomight13 be most13 at risk of breast13 cancer and prostate cancer as a result13 of family history Addto this the evidence that13 particular diet13 and exposure to environmental factors can furtherincrease risk then it13 is evident13 that13 individuals can be identified and offered treatmentsthat13 could save their lives many years before they become ill In the case of cancersperhaps only the individual is involved but13 for infectious diseases it13 is the whole of societythat13 is at risk if someone contracts one of the new strains of influenza or if someonechooses not13 to be vaccinated against13 rubella In Chinese airports all visitors are screenedfor fever and refused entry if they tested positive in cities the public are monitored in thesame way Similar approaches may be necessary in the UK if potential carriers cannot13 otherwise be identified
34 Volunteering
It is estimated that13 72 per cent13 of people volunteered to perform a charitable act13 at least13 once during 2012 a rise from 65 per cent13 the previous year About13 four out13 of every 10volunteers offer their services formally to one or more organisations The remaindervolunteer informally by helping out13 a friend or a neighbour Around 50 per cent13 volunteered at least13 once a month in the past13 year up from 41 per cent13 on the previous13 year Most13 have retired many of them before the statutory retirement13 age Those whodonrsquot13 feel able to offer time have offered their financial support13 at a time when the fundingavailable from sources such as the National Lottery has been decreasing Despite economicausterity donations to charities have been increasing 74 per cent13 said they had given tocharity at least13 once in the previous month up from 72 per cent13 the previous year
Strikingly 78 per cent13 of people strongly believe that13 they are part13 of their localneighbourhood an increase from 70 per cent13 10 years previously Community cohesion isstronger than ever 87 per cent13 of people believe their local area13 is a place where peoplefrom different13 backgrounds get13 on well together compared to 80 per cent13 in 2003
The role of volunteers in supporting vulnerable people is therefore likely to increase overthe next13 decade perhaps exploiting the success of the army of volunteers that13 was highlysuccessful in London during the Olympic and Paralympic games The greatest13 role for suchvolunteers may be in providing informal care for older people Already the UK has someseven million informal carers whose value in monetary terms has been calculated to be
30
more than the combined budgets of the NHS and social care Maintaining or extending thisprovision will help to support13 services in the future and may be supported by technology
Whilst13 there is ample evidence to suggest13 that13 telecare services support13 informal carers asmuch as (if not13 more than) the people that13 they are caring for it13 is the potential for utilisingthe internet13 and apps to make their role easier to coordinate and hence more effectivethat13 is likely to be most13 successful moving forward
Many of these focus on particular tasks that13 informal carers can help offer to older peoplesuch as organising their medication A pillbox program is just13 one feature of an app calledBalance It also includes sections for caregiving tips notes for the doctor and the patientsappointments plus a lsquolearning sectionrsquo with articles on aspects of Alzheimers and an RSSfeed for news about13 the disease Tyze is another multi-shy‐functional app it13 allows carers to
bull Organise appointmentsbull Plan outingsbull Share storiesbull Send updates to other family members
Another application is Rally Round which helps carers to organise someone to perform littlejobs often on a temporary basis when someone has dementia physical frailty or isrecovering from accident13 or illness Similar applications are MeMaxi and Finerday
35 The High13 Street
The shape and appearance of UK shopping centres have been changing for half a centuryPeople complain that13 centres are losing their identity with one town looking like everyother both in terms of the stores and in terms of the layout But13 there are three trendswhich are having a profound impact13 on many of the most13 vulnerable people in society
bull Centres lock their doors at 6pm or in some cases 10pm -shy‐ thus denying people whosuffer from claustrophobia13 from window shopping at times when other shoppershave left
bull Out13 of town shopping malls -shy‐ these US style centres are ideal for people in carsbecause they offer free parking which is essential for people who want13 to buy largeritems but13 difficult13 for people who have no transport13 and who must13 rely on publictransport13 that13 is often deficient
bull The rise of online shopping -shy‐ which means that13 many potential shoppers only visit13 High Street13 stores to check the prices before returning home to make a purchaseonline
It is the third of these effects that13 has the greatest13 potential for changing the High Street13 forever and it13 is making life for traditional retailers increasingly difficult13 at a time when highrents are crippling stores large and small It is difficult13 to see how this trend is likely tochange because consolidation in banking and estate agencies is already forcing the closure
31
of other High Street13 players while additional pressures on pubs has led to the closure ofthousands of pubs every year
Those figures however demonstrate that13 consumers still value what13 the high street13 canoffer -shy‐ the chance to inspect13 what13 theyrsquore thinking of buying -shy‐ as well as the new opennessof the internet Customer service makes a difference to people especially if there is aproblem and goods need to be returned One of the most13 common reasons for furniture tobe returned for example is that13 when a sofa13 or a wardrobe was delivered it13 couldnrsquot13 fit13 through the front13 door or up the stairs In the future people will be able to benefit from13 visualisation technology they will upload the floor plans of their homes enabling theretailer to inform them of the problem before they try to delivery Augmented reality viewwill similarly allow customers to see what13 a new item of furniture will look like in itsintended place so that13 they can be more informed about13 the effect13 of size and colour
In terms of improving the viability of the High Street stores will have to focus on theimportance of brand which could mean that13 individual independent13 retailers will have topartner with national suppliers to support13 a local tailored offering based on products that13 are designed for a more global market This is a lsquoconnected High Streetrsquo approach whichcould be enabled by the developments in internet13 availability and smart13 phone accessdescribed in the previous section
The overall effect13 of all these changes could mean that13 town centres become smaller but13 more vibrant13 areas They could thrive if people are attracted there in large numbers whichmeans that13 retail must13 be developed alongside restaurants pubs galleries and other leisureopportunities This is possible in new shopping centres which are already being integratedwith transport13 hubs including railway and bus stations but13 may be more of a design13 challenge for older towns and cities with large Victorian buildings To ensure that13 morepeople are welcomed into the new centres they should include attention to green spacesand areas where people can relax without13 feeling that13 they are second class citizensbecause they donrsquot13 have the same buying power
3513 Privacy
To some people privacy is their right13 to live their lives without13 interference they may seethe State as a potential lsquoBig Brotherrsquo spying on their every move and judging their actions13 and activities Other people have fewer concerns about13 the role of the State but13 great13 fearof individuals interfering with and invading their privacy Some embrace the concept13 of lsquomyspacersquo an area13 of a square metre or so into which nobody can enter without13 permissionThis allows them to avoid physical contact13 and to feel safe from any form of threateningbehaviour
Yet13 this idea13 of private space and its potential violation is merely the tip of the iceberg asfar as privacy is concerned more significant13 is the idea13 of personal (and private)information being shared with anyone and everyone This could be related to identityopinion or image for an individual who wants to remain anonymous or even secretive thisis going to become an increasing problem as technology provides the means of taking
32
photographs recording conversations and capturing environment13 with something as smalland ubiquitous as a mobile phone The fact13 that13 this information can then be shared withthe rest13 of the world using e-shy‐mail Twitter and Facebook makes the problem all the moredifficult So the threat13 is no longer solely from the long lenses of the Paparazzi but13 fromanyone (and that13 means everyone) who has even the most13 basic of mobile phones
This relates to the changing views of society on what13 information should remain privateand what13 should be shared with others The success of social media13 has been based on anattitude of lsquosharing everythingrsquo with either your friends or the world This has introduced anaiumlve idea13 in the minds of some younger people (especially those known as Millennials ieaged 18-shy‐30) that13 everyone can be their friends whilst13 perhaps failing to reinforce the bondsof genuine friendship with any form of test13 or restriction Technology could play a role indefining these friendships and allowing individuals to understand what13 makes a goodfriend but13 this approach has yet13 to be developed and may be slow to overcome the needfor some people to measure their own popularity simply as the number of people that13 theycan list13 as friends on their Facebook page
It follows that13 there may be a need for a new definition of privacy that13 is in keeping withthe web and its ability to display images and opinion in an unregulated manner This needsto embrace past13 concerns about13 the ability of an individual to live without13 the threat13 ofothers being able to watch them whilst13 offering some protection from random postingsabout13 them online Perhaps this could include a right13 to be able to edit13 or remove anythingrelating to themselves on the Web including images that13 are not13 news-shy‐worthy Theownership of image rights may be an associated issue that13 needs to be addressedespecially as modern technology can remove an individual from a group (or a background)13 view provide digital touch-shy‐up or air-shy‐brushing and then republish it13 in a different13 contextHowever there is general agreement13 that13 personal information (such as contact13 details andbank codes) should not13 have a place on the web Surprisingly few people take proactivemeasures to prevent13 tracking functions being activated
It follows that13 too much privacy could lead to younger people fearing that13 they maybecome lost13 in a digital world It is not13 surprising then that13 they are prepared to make lots13 of personal information available often with no fear of how it13 might13 be used by othersWhen Google glasses and similar technologies become available during the next13 few yearsthey will have the potential to identify a stranger walking down the street and to find manyof their secrets to present13 to the wearer in a fraction of a second They could know moreabout13 them than their genuine friends know -shy‐ so who will be their friends in the future
36 Data sharing and13 protection
By lsquodata13 sharingrsquo we mean the disclosure of data13 held by one organisation on an individualto a third party organisation(s) or the sharing of data13 between different13 parts of anorganisation Some data13 sharing doesnrsquot13 involve personal data13 because it13 has beenanonymised in such a way that13 the statistics can be used for the collective good without13 theidentification of the individual The Data13 Protection Act13 (DPA) is in place to provide a legal
33
framework that13 ensures that13 organisations that13 hold personal data13 must13 act13 responsibly atall times These principles adequately describe the position of public and government13 bodies especially social services departments who are responsible for the informationconcerning the health and well-shy‐being of individuals -shy‐ and hence by implication thesensitive data13 relating to their vulnerability
The legal framework that13 applies to private and third sector organisations differs from that13 which applies to public sector organisations which may only act13 within the defined limits oftheir statutory powers However all bodies must13 comply fully with the data13 protectionprinciples and this situation is unlikely to change within the next13 10 to 15 years In someprivate sector contexts there are legal constraints on the disclosure of personal dataHowever most13 private and third sector organisations have a general ability to shareinformation provided this does not13 breach the DPA or any other law It is advisable for acompany to check its constitutional documents such as its memorandum and articles13 ofassociation to make sure there are no restrictions that13 would prevent13 it13 from sharingpersonal data13 in a particular context The type of data13 held is therefore a subject13 ofconcern as it13 may be difficult13 for legislation to keep up with the additional layers of data13 created on-shy‐line and through the Internet13 of Things
Private and third sector organisations should have regard to any industry-shy‐specific regulationor guidance about13 handling individualsrsquo information as this may affect13 the organisationrsquosability to share information They should also be aware of the legal issues that13 can arisewhen sharing personal data13 with public sector bodies This becomes more of an issue asprivate and third sector bodies are carrying out13 a wider range of traditionally public sectorfunctions Opportunities for inappropriate sharing of sensitive data13 will therefore inevitablyincrease
Public authorities must13 comply with the Human Rights Act13 (HRA) legislation in theperformance of their functions The HRA also applies to organisations in the private sectorinsofar as they carry out13 functions of a public nature which could include delivering a socialcare activity Where the HRA applies organisations must13 not13 act13 in a way that13 would beincompatible with rights under the European Convention on Human Rights Article 8 of theConvention giving everyone the right13 to respect13 for their private and family life their homeand their correspondence is especially relevant13 to sharing personal data If personal data13 isdisclosed or shared in ways that13 comply with the DPA the sharing or disclosure of that13 information is also likely to comply with the HRA The problem may still be in policing theActs and the rights of an individual if they believe that13 their personal data13 has been sharedor accessed by an inappropriate organisation or individual
A legal industry may be born to deal with such matters but13 this is unlikely to benefit13 peoplewho cannot13 afford the fees involved They would require either legal aid or to employ13 more13 lsquono win no feersquo companies Public attitudes to such costs might13 become negative unlessthey prove successful in preventing breaches of data13 security There may need to belegislation to provide a stronger basis for forcing compliance with privacy laws
34
37 Connecting with13 people
We are social creatures most13 of us rely on our friendships and interactions with friendsand families to share our happiest13 moments and experiences Research suggests that13 thishappiness is infectious at all levels and leads to a 15 increase in the happiness of a closecontact 10 for a second degree contact13 such as the friendrsquos spouse and a 6 increase fora friend of a friend It is hardly surprising that13 the success of social media13 such as Facebookis intimately related to the ability of people to quickly share their happiest13 moments with asmany of their friends and connections as possible
All this has happened during the rise of the Internet13 and the corresponding increase inopportunities for connecting online ie this is a 21st Century phenomenon which has beenfacilitated by Information and Communications Technology But13 the Internet13 remains in itsinfancy and we are only beginning to understand and exploit13 its potential In terms ofaccessing the Internet there are now perhaps two billion people who have access with99 of them having gained this during the past13 decade This number will have doubled bythe period 2020 to 2025 It is likely that13 everyone who wants to be connected in the UK willby then be connected Turning this on its head only those who donrsquot13 want13 to be online willnot13 be on the Internet13 within a decade Connecting with the unconnected will therefore bea case of identifying those people who donrsquot13 want13 to be found unfortunately these mayinclude many people who need the support13 of social care organisations It means that13 theywill be looking for support13 only when they are in crisis unless other ways of finding andormonitoring them are found
While the number of people connected via the Internet13 has exploded this might13 bedwarfed by the number of connected lsquothingsrsquo During 2009 the number of thingsconnected to the Internet13 surpassed the number of connected people at which point13 webegan to experience what13 this report13 has described as the lsquoInternet13 of Thingsrsquo Yet 99 ofall physical objects that13 could join this network are not13 yet13 connected but13 the number couldgrow by 25 every year for the next13 decade so that13 there could be 100 billion connectedobjects by 2025 some of which will be owned or used by everyone in the UK includingthose people who donrsquot13 want13 to be connected themselves We will then have an Internet13 of Everything which will be the smart13 connection of people data events and actions
With each new person object or data13 that13 comes online the connection possibilitiesbetween all these elements grows exponentially The rise of big data mobile networkingcloud storage and data13 mining technologies will all play a critical role in the Internet13 ofEverything The result13 will be new capabilities richer experiences and unprecedentedvalue for individuals businesses communities and countries everywhere The lsquonetworkeffectrsquo of the Internet13 of Everything will be a very powerful thing the true impact13 of whichwe wonrsquot13 fully understand for several years As it13 develops however those who are not13 connected will feel even more digitally and socially excluded There will be a need to reachout13 to vulnerable people unless the process of claiming requires proof of online identityand the payments to be received can only be redeemed using a chipped card or adownloaded app onto a smartphone This is of course the way that13 welfare arrangementsare already developing thus it13 might13 prove impossible to make a successful claim without13
35
already being connected to lsquothe systemrsquo either through an online presence or through theInternet13 of Things
38 Downloading everything
Sixty years ago information was discovered by reading books often in a library wherenotes had to be made because the books or journals couldnrsquot13 be removed Then in theearly 1960s the first13 office photocopying machines were introduced into the UK theyimmediately meant13 that13 pages or articles from books could be copied and taken away to beread and summarised later Within a few years photocopying became a replacement13 forreading as researchers became less adept13 at selecting a few sentences and every deskbecame a depository for reams of printed paper Paper became the means of recordingeverything from bank statements through to music
We now appreciate that13 printing everything is a waste of both the ink (or toner) used tocreate the black print13 and of paper which requires trees to be chopped down and pulpedbefore it13 can be pressed into thin sheets Saving paper is therefore seen as green and goodfor the planet Fortunately we no longer need to print13 everything because computermemory is unlimited thanks to the cloud and we can then view pages and articles onportable or fixed screens
The internet13 has everything and it13 is all available instantly for downloading providing thereis a device available to accept13 it and there is sufficient13 communication bandwidth toperform the transfer of data13 sufficiently quickly Thus we can record all text13 articles that13 are relevant13 to us including digital records of birth certificates qualifications and passportsand the need for original printed versions will decline But13 we can also do this forphotographs Most13 handheld computing devices include at least13 one camera so they cangenerate enormous number of pictures which can be kept13 for posterity without13 having toconsume inks and special papers to print13 them
But13 the materials that13 can be downloaded donrsquot13 stop at pictures software is available that13 can grab TV shows after they air and movies as soon as theyre released In the same wayit13 is possible to schedule music comic books video games and practically anything else asa download with minimal effort People will need enormous hard drives if they want13 theirown digital copies of these files so will more than likely make use of cloud storage that13 willbe available from many organisations The location of the servers may become sensitivedue to border restrictions as will the security of the data13 and the way that13 it13 is backed up sothat13 it13 is resilient13 to failures
It may be evident13 that13 application forms for all types of welfare payment13 will be availableonly for downloading so that once digitised they can be processed by computer andrecords sent13 to various servers for subsequent13 storage and processing Some people maywant13 to keep their data13 on them once it13 has been downloaded Pen drives can already holdseveral GB of data so it13 is likely that13 people will be able to carry their downloaded data13 withthem at all times irrespective of the size and complexities of the information
36
39 Health13 and13 well-shy‐being
The general health of the population is unlikely to deteriorate noticeably within 10 to 20years Indeed expectations of the population are that13 things must13 improve as surgicaltechniques mature and as pharmaceutical interventions become more personalised andpowerful However the rising demand for health services due to an ageing population andthe increasing cost13 of providing sophisticated therapies will make delivering a free anduniversal health service difficult13 without13 substantial increases in taxation This is unlikely tohappen in the UK even though spending on health services will be protected against13 thecuts facing other services
There will have to be changes in how the NHS works For twenty years hospitals have beenclosed and replaced by fewer new facilities so that13 the bed count13 is reduced This has led toa significant13 shift13 in resources to primary care and community care supporting shorter staysin hospital and speedier transfer back home for people after surgery or illness This hasbeen13 successful but13 there remain problems with demand for GP services especially out-shy‐of-shy‐hours and at weekends Indeed despite the introduction of NHS24 and similar help-shy‐linesthe demand for GP appointments continues to increase Delays are inevitable and this willincrease system failures with more unnecessary deaths and a failure for people to access adiagnosis that13 might13 lead to early interventions and ultimately lower delivery costs Over250 more patients are added to waiting lists every day
This will lead to a new model of primary care consistent13 with existing changes which haveseen surgeries move from High Street13 locations to medical centres close to bus routes andwith more parking for patients The process of making an appointment13 is changing from atelephone-shy‐based interview process dominated by a medically-shy‐unqualified receptionist13 to achoose and book approach using an online process linked to electronic patient13 records Thiswill give patients more convenience but13 will allow priority for those who have Internet13 access at the expensive of those who are digitally excluded Making the process of bookingan appointment13 quick and easy may also increase demand from people who do not13 need tobe seen as it13 will fail to identify those in greatest13 need
A greater use of telehealth and telecare technologies will be inevitable beginning with thefirst13 contact13 as an encounter using the telephone e-shy‐mail or video conferencing -shy‐ a visit13 tothe GP surgery should be a last13 resort and should involve a nurse consultation in the first13 instance This would be consistent13 with three quarters of appointments currently involvinga chronic disease or long term condition which relates to improved self-shy‐care The support13 ofthese patients at home should be prioritised through tele-shy‐ and web-shy‐based technologies andshould involve training and coaching through a network of nurse practitioners Home visitsshould generally be unnecessary through the use of these technologies but13 could besupplemented by satellite surgeries manned by nursing in community premises or inpharmacies nurseries and Internet13 cafes
The homes13 of people who13 need13 closer monitoring can then become part13 of virtual wardswith real or electronic visits by health professionals University Hospital Southampton NHSFoundation Trust13 already looks after patients who have undergone surgery such as a hip orknee13 replacements in virtual wards with high levels of satisfaction The Royal Free London
37
NHS Foundation Trust13 offers a similar service but13 plans to add the possibility of videoconsultations between patient13 and consultant
310 Attitudes to public health issues ndash obesity smoking alcohol abuse drugs
As self-shy‐care becomes the focus of the NHS the public will increasingly understand that13 thecosts and availability of services are being harmed by the poor health behaviour ofrelatively small numbers of people The link between public health initiatives today andhealthcare needs and costs in the future will become increasingly evident13 as a result13 of theway that13 information is presented Thus the overweight13 smoker who currently attractsconcern and pity when they are diagnosed with diabetes and COPD is increasingly beingseen as the victim of their own stupidity or lack of self-shy‐discipline If they continue to neglect13 medical advice and continue with an unhealthy lifestyle then the way that13 they receivetreatment13 and consume resources will become a matter for the entire population
Obesity is seen as due to a combination of poor diet13 and a sedentary lifestyle No longer isthe idea13 that13 people are lsquobig bonedrsquo acceptable Governments will respond initially byrequiring manufacturers and food processors to provide nutritional information onpackaging and on menus in restaurants But13 people can choose not13 to read the data13 and toneglect13 both the importance of food quality content13 and quantity This will increasepressure to introduce fat13 or sugar taxes and these are likely to be in force within a decade
Although the high taxes on tobacco products has forced some smokers to reduce theirconsumption or to give up altogether the impact13 has been reduced by the smuggling ofproducts from overseas and by the availability of duty-shy‐free cigarettes for people returningfrom foreign holidays and business meetings Further measures are planned to changepackaging and to include even more graphic images and warnings on cigarette packages tomake smokers aware of the effects of smoking on their health and well-shy‐being There is asyet little evidence of how successful this might13 be More effective has been the banning ofsmoking in public places including trains and aircraft Expensive medical interventions suchas heart13 transplants will be denied to individuals until they change their lifestyle behaviourSmokers might13 therefore be increasingly ostracised leading to a loss of esteem This mayhave a particular impact13 on people who already suffer from mental health problems whoare more likely to smoke
The overuse of alcohol is being recognised as a major factor in hospital admissions withNHS figures showing an increase of over 40 in such admissions over the past13 decadeLinked to this has been a 75 increase in prescriptions to treat13 alcohol dependency Fewpeople have sympathy for those who waste their limited income on booze If they havechildren or other dependents they will be the ones who suffer and who may need thesupport13 of social care
Drug users are already significant13 users of social services as their habit13 is likely to makethem unemployable They receive little sympathy from the general public because they areseen as criminals and people who waste public resources Levels of drug abuse have been
38
slowly increasing over the years but13 this trend is slowly being reversed Indeed the numberof people using drugs during the past13 year has fallen to its lowest13 level for nearly 20 years(below 9) with cannabis being most13 likely often following excessive drinking Aselectronic noses and other technologies can detect13 traces of drugs it13 seems likely that13 success in overcoming addiction can be measured objectively This may become a two-shy‐edged sword rewarding those who can turn around their lives but13 further marginalisingthose who canrsquot13 or wont13 accept13 the lsquocold turkeyrsquo
311 Attitudes to surveillance
Issues associated with privacy confidentiality and data13 security have been discussedpreviously in the context13 of information technology the World Wide Web and the ease ofcollecting recording recalling analysing and displaying data The monitoring of individualsand their methods of using this information can be regarded as surveillance As thequantities of data13 increase along with the number of devices that13 can be used to access itthe surveillance tools will also increase in their sophistication Indeed the Big Data13 approaches described in the previous section will enable the combination of structureddata13 (such as the information held in databases) to be married with unstructured data13 fromimages in such a way that13 it13 can be mined
Whilst13 the lsquodigital surveillancersquo methods described above may cause most13 concern topeople because of its impact13 on anonymity it13 is the collection and analysis of images that13 are the major concern to people as they contemplate the ways that13 lsquoBig Brotherrsquo maydevelop to restrict13 freedom Every major UK city and town centre has an array of CCTVcameras that13 continually record activities from every angle If it13 used to be true that13 nobody in London was more than 10 yards from a rat it13 is certainly the case today that13 nobody can be more than this distance from being in view of a surveillance camera Yetthey receive so much positive publicity from TV programmes where their footage is used todetect13 vehicles close to a crime scene or to monitor the movements of suspects that13 theyare now accepted by the public as a deterrent13 in the same way as lsquobobbies on the beatrsquowere seen 25 years ago There is therefore little public reaction to the expansion in the useof video surveillance except13 for the practical observation of how so many views can beinspected and recorded
Looking to the future the tumbling cost13 of video technology will surely lead to anotherincrease in the number of devices The aerial views taken from towers will besupplemented by more local views taken by devices that13 are embedded in the fabric ofbuildings or carried by individuals either on their person (for example on clothing orspectacles) or in the bags that13 they carry The time and date-shy‐stamped images as Big Datawill be recorded to lsquothe Cloudrsquo where it13 can be added to other data It can then be usedwhen an incident13 has occurred or to provide further detail of night-shy‐time activities
It follows that13 there will be no hiding place for people who simply want13 to disappear Theymay respond by wearing clothing (such as hoodies) that13 hide their faces or which make it13 difficult13 to distinguish gait13 or mannerisms from which they might13 be identified New forms
39
of clothing may be designed to make shapes more difficult13 to analyse and these might13 become the uniforms of a class of person who wants to live in a way that13 they donrsquot13 interact13 with officials from any ministry or local government13 department If they also obstruct13 services then they will be considered to be anarchists of some form sparking protests fromother sectors of society
31213 Attitudes to driving
Motor cars have been a feature of UK roads for over a century but13 it13 is only during the past13 50 years that13 they have become a resource that13 most13 families have had access to enablingthem to travel without13 the restrictions imposed by a limited railway network and non-shy‐integrated bus transport People who have had a car throughout13 their lives often see theircars as an important13 factor in enabling them to remain independent13 and to exercise choicesrelating to where they shop and where they spend their leisure time This extends to theirspouse and to friends and neighbours that13 they might13 take with them on their variousexpeditions
Unfortunately there are incidents involving older drivers who perhaps go down amotorway in the wrong direction who are taken ill at the wheel or who are involved in anaccident13 involving no other vehicles These are small in number but13 often lead to a reactionthat13 they shouldnrsquot13 be allowed to drive lsquoat13 their agersquo Age itself is not13 an indicator ofdriving quality but13 because old age also brings more chance of having limited long termconditions and other illnesses it13 is easy to make a link between driving ability and age Thelicensing system does require continued driving to be linked with medical advice andforbids people with poor eyesight epilepsy and other conditions to hold a licence in oldage
Yet13 statistically older drivers cause far fewer accidents than younger drivers The reasonsfor this may be complex and are likely to include the fact13 that13 they drive less often covershorter distances and donrsquot13 go out13 in the dark or in poor weather However it13 does not13 wholly explain why the UKrsquos drivers aged over 70 and who represent13 some 8 of all driversare involved in only 4 of accidents that13 cause injury This compares favourably with the15 of13 drivers aged between 17 and 29 who are involved in over a third of crashes that13 result13 in injury
By 2020 the number of drivers aged over 70 on UK roads is likely to increase to over 7million This will require a new national strategy perhaps involving support13 for olderdrivers further training raising awareness of issues and making more use of adaptivetechnologies to support13 the driver in avoiding collision or forgetting to check on the statusof their vehicle Poor eyesight13 could be enhanced by camera technologies rather thanforcing people off the road if they are unable to read a licence plate
The International Longevity Centre has found that13 one in four Britons thought13 driversshould be made to switch off the ignition for good somewhere between the ages of 70 and75 The numbers may decrease as the population ages and as cars become safer Forcing
40
older people off the road may be a natural consequence of providing free bus passes andsubsidised rail fares but13 the growth in the pavement13 scooter industry demonstrates that13 older people value their independence and will do almost13 anything to get13 out13 and aboutPerhaps legislation will result13 in more regulation of electric vehicles and where they cantravel
There can be no doubt13 that13 getting out13 will be associated with better quality of life andwell-shy‐being and this is likely to be supported in the future as evidence of improvedoutcomes emerges It is to be hoped that13 positive stories will be publicised so that13 publicattitudes arenrsquot13 hardened This may be supported by more in-shy‐car monitoring of drivers andthe linking of performance with on-shy‐line driving records and licences These could throughremotely monitored ignition systems prevent13 the use of motor vehicles by people without13 a licence or without13 insurance
313 Climate change
There is a general view that13 the emissions of carbon gases are contributing to globalwarming in a manner that13 will change the UK climate in such a way that13 the climate maybecome more Mediterranean However some scientists believe that13 manrsquos impact13 on theenvironment13 may be small compared with natural variations caused for example bycyclical changes in the sunrsquos energy output13 or by the effects of volcanoes and earthquakesRecent13 evidence has suggested that13 we are going through a phase of changing extremesand that13 this is more likely to cause storms periods of excessive rainfall and unusualseasonal trends with snow and frost13 in the spring and warmer winters Considerableuncertainty remains and it13 might13 be necessary to plan for a number of different13 scenariosand for the impact13 on vulnerable people
I Colder winters UK properties are poorly insulated resulting in excess mortalitiesduring cold spells due to an increased number of people suffering from stroke aswell as bronchitis and other pulmonary diseases The cost13 of heating continues toincrease putting more households into a state of fuel poverty Any further coolingduring the winter months will result13 in more people living in unhealthy coldconditions Winter fuel payments are likely to be restricted to the poorest13 peoplebut13 this might13 exclude people who live in larger properties that13 are more difficult13 toheat
II More storms excessive winds and rain can cause flooding at any time of the yearMany UK communities are built13 close to rivers and these can surge during heavyrainfall causing houses to be filled with water and furniture and carpets lostInsurance can be problematic for properties built13 on flood plains which can blight13 properties and prevent13 owners from being able to sell and move on High winds canrip off roofs causing injury and also causing families to be left13 homeless anddependent13 on social services
III Hot13 summers Europe suffered high temperatures during the summers of 2003 and2004 leading to heat13 stroke and hypothermia The UK has not13 previously sufferedfrom such problems but13 might13 be expected to experience days of extreme
41
temperature and humidity at times Older people may not13 be prepared for suchweather Street13 dwellers may be unable to find shade and supplies of drinkingwater
Irrespective of what13 combination of weather scenarios arise it13 must13 be concluded that13 any extremes will have a major negative impact13 on vulnerable people especially if theyare not13 prepared because they havenrsquot13 received the weather warnings and advice that13 can be broadcast13 using the TV radio and online services Once again the digitallyexcluded will suffer and will pay a high cost Society will continue to pick up the bill interms of demands on social care services unless preventive actions are taken in theform of connecting these people to each other and to formal services
42
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
s13 13
13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
n13 13
13 s13
r13 n13
e13 at13
e13 y13 e13 ld13
ly13
13 e13 t13 e13
s13 er13 e13
f13
rt13 13
13 13
13
r13 13
s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
e13 g13 13
e13
13 13 ial13
13
d13
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d13 13
s13 y13
e13
13
rd13 r13 e13
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e13
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13
13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
IMAGINING THE FUTURE -shy‐ ENABLING TECHNOLOGYHOW TECHNOLOGY MIGHT AFFECT SOCIAL CARE BY 2025
1 BACKGROUND
Predicting what13 might13 change by tomorrow next13 week next13 month or even next13 year isrelatively safe But13 in 10 to 15 years there is time for the rule book to be completelyrewritten and for all accepted learning to be cast13 aside to be replaced by somethingcompletely different Some activities that13 are common today might13 have seemedimprobable fifteen years ago (in the late 1990s) for example using the video game consolesto help recover function following a stroke or a fall or ordering groceries online via13 TVscreens
Predictions must13 have both a basis in technology but13 must13 also be considered with respect13 to the likely speed of adoption and the natural resistance to change (ie culturalacceptance) By concentrating on technologies that13 are designed to improve quality of lifehelp people to perform tasks more easily or which manage the risks associated withindependence we will move some way towards understanding how social care maydevelop and how the tools available to social workers will need to change
But13 this will be only half of the story and perhaps not13 the half that13 will have the greaterimpact Technological developments in other areas -shy‐ politics culture energy nationalfinances diet ethics privacy and transport13 policy -shy‐ might13 have an even greater impact13 onpeople who are deemed to be vulnerable or needy as they might13 live on the margins andtherefore be more susceptible to relatively small changes Relatively small doses of suchinnovations might13 then become an important13 aspect13 of strategies or interventions that13 social workers are most13 likely to propose13
This project13 therefore requires a dual track13 approach that13 involves
1 a consideration of existing technological developments and2 how other changes could make a difference to people
The first part reviews technologies and trends that13 are already happening This ismoderated by how society will change both in the way that13 it13 reacts to the technology andin the way that13 its values change as a result13 of external factors such as the economic statusof the country the ability of the NHS and other organisations to deal with the needs of anageing population and various other events that13 can change attitudes either overnight13 orover the course of time
The second13 part draws on six vignettes (or case studies) as a way of helping us imagine howoutcomes might13 be different13 depending on the kinds of technology and communicationthat13 are available These case studies offer opportunities to consider
2
bull Firstly the type of person and the range of issues that13 are likely to affect13 people andfamilies
bull Secondly the likely impact13 of technology on such cases Not13 surprisingly somecases will need the same dedication of social work staff and traditional means ofsupport13 that13 they might13 require today and did require ten years ago Others might13 require a very different13 approach and outcomes that13 could depend on theavailability of and access to new technologies These represent13 perhaps the most13 exciting cases because they can show improved outcomes lower cost and greatersatisfaction for all stakeholders if the initial consultation assessment13 and prescribedservice take advantage of the relevant13 technological interventions
3
ne13
le13
ne13
2 TECHNOLOGICAL CHANGES THAT13 COULD HAVE13 A DIRECT13 IMPACT ON SOCIAL CARE
Taken as whole lsquotechnologicalrsquo developments can be overwhelming so this section breaksup technology into discrete elements and considers the likely impact13 of each In this waywe intend to make it13 easier to understand and to imagine in a real and constructive wayhow and when they might13 become significant
21 Personal computing13
In reality we absorb and integrate new technology all the time some of us a different13 ratesthan others Consider how over 40 years computers and the internet13 moved from beingobscure and specialised tools to driving commonplace consumer devices Most13 computingdevices already have more processing power than the spacecraft13 that13 landed men on themoon in 1969
1970 bull A computer was a large device (a lsquomainframersquo the size of large wardrobe) that required13 acarefully13 regulated air-shy‐conditioned roomo Information was input through punch-shy‐cardso There was no keyboard and no video display
1980s bull The first personal computers arrived but were mainly for enthusiastsbull Word processors arrived in offices allowing text editing and formattingbull By the end13 of the decade desktop PCs13 were popular but still relied on the user learning arca
commands13 (eg the Amstrad)1990s bull Email virtually unheard of at work and at home
bull The Apple Mac with its pointing device (mouse) and Graphical User Interface made it possib to use a computer without learning13 arcane13 commands
bull Microsoft followed with Windows and by the end of the decade desktop computers werecommonplace
bull In the mid 1990s the word wide web arrived and the word lsquointernetrsquo13 entered everydayvocabulary
bull lsquoDial-shy‐uprsquo access to13 the internet available at work and13 at home via a modem and13 telephone li bull First generation of mobile13 phones take13 off ndash texting unexpectedly popular
2000s bull Broadband13 replaces lsquodial-shy‐uprsquo allowing lsquoalways onrsquo internet connectionbull Smartphones allow us to connect to the13 internet on the movebull Smartphones can record videobull Youtube allows free sharing of videobull Online shopping commonplacebull Laptops increase13 in popularitybull Email widespread in personal and working lifebull Social networks part of everyday life13 (eg Facebook -shy‐ one billion13 members)bull Email widely considered a plague that needs controlling
2010s bull Tablets increasing in popularity at expense of laptopsbull Touch screensbull Video phone (skype) making face to face communication an affordable realitybull Email widely considered a plague that needs controllingbull Future13 Identities report finds lsquoPeople13 are13 accustomed to switching seamlessly between the13
internet and the physical13 world and use social13 media to conduct their lives in a way thatdissolves the divide between13 online and13 offline identitiesrsquo13 httpwwwbisgovukforesightour-shy‐workpolicy-shy‐futuresidentity
4
Accessibility acceptability and fashion
People adopt13 new technologies at different13 rates and some reject13 them completely Themobile phone might13 seem ubiquitous but13 some people refuse to have anything to do withthem
Some new devices are emerging such as an lsquoi-shy‐watchrsquo -shy‐ a kind of i-shy‐phone worn on the wristwhile a number of companies have suggested that they will use flexible electronic circuit13 boards to produce conformable devices that13 might13 be integrated into clothing or producedas a band that13 could be worn on the forearm
Google has been experimenting with heads-shy‐up displays which would allow someone to viewa display without13 having to carry a screen This approach would enable an individual toreceive real-shy‐time information as they walked around It might13 promote virtual visits todistant13 locations and virtual reality scenarios for games will increasingly interact13 with thereal world
It is likely that13 there will be an increasing choice allowing users to select13 devices most13 appropriate to their own lifestyle Ease of use may become a more important13 factor infuture designs thus enabling all citizens to enjoy ownership and applications of thetechnology
It is possible that13 not13 owning such a device or not13 being able to fully utilise it will become acharacteristic of the disadvantaged few -shy‐ and perhaps the people who will most13 need helpfrom13 social workers
22 Information generation and storage
As recently as ten years ago the amount13 of digital data13 or information we could store wasstrictly limited by the capacity and cost13 of storage media tapes floppy discs and harddrives The cost13 has fallen so much that13 today there is effectively ample space to store allthe data13 that13 we can create
The challenge is to store it securely and in such a way that it can then be retrieved quicklywhen needed and from13 any location13
We can now easily access bus and train timetables online the Kindle has created a hugemarket13 in e-shy‐books and even the Argos catalogue is expected to be available only as a digitaldownload
Cloud storage is the term used to describe a world in which we no longer keep our data13 (documents books photos video) on our own devices Instead we store them on cloudservices such as Flickr Youtube Google Drive We can even keep personal data13 such asreceipts using services such as httpwwwimmobilisecom which offers an online
5
portfolio for your personal belongings And Final Fling is an example that13 enables us to planfor our death
If entire identities are effectively digitised and stored in this way people who have not13 allowed their data13 to be created and warehoused in this way will be seriouslydisadvantaged They could be forced to join an underworld of digital refuseniks who areunable to apply for jobs for a passport for a driving licence and for welfare payments
23 Stratification13 and analytical techniques
The amount13 of data13 collected about13 each individual in society is increasing rapidly The data13 gathered by government13 and health systems tends to be highly structured which allowseasy comparisons to be made between any individualrsquos result13 and an average value forsimilar people This leads to important13 knowledge of distributions and how they might13 change over time
But13 commercial organisations such as supermarkets and online retailers also routinelygather data13 about13 our purchases our movements and our preferences This is known as BigData and analytical techniques known as Data Mining are evolving which look for trendsthat13 might13 offer some level of prediction
From an individual perspective Big Data13 can tell people how much they are like everybodyelse Indeed a personal analysis might13 tell them that13 there are another several hundredpeople just13 like them in Glasgow in Scotland in the UK in Europe or in the world How thisinformation is used is the important13 issue If it13 is used to make people feel lsquonormalrsquo then it13 can be positive but13 equally if it13 is used to stop people feeling that13 they are lsquospecialrsquo thenthis could lead to a loss of self-shy‐esteem
24 Communication13 technologies
The origins13 of social alarms lie in sheltered housing The assumption during the 1950s and1960s was that13 the people who needed to live in this type of accommodation were bothvulnerable and relatively poor As telephone lines were at that13 time a luxury whichcouldnrsquot13 be afforded by many hard-shy‐wired warden-shy‐call systems similar to the hospitalbedside call were devised Subsequently they evolved into two-shy‐way intercom systemsbetween the resident13 and a call monitoring centre rather than a local warden
These hard-shy‐wired arrangements were bespoke to each manufacturer and were thereforelimited in performance and in linking in with other peripheral devices and telecare Duringthe 1970s the telephone became less of a luxury and the number of households of allincome levels who had their own telephone lines rose rapidly
6
The 1990s saw the emergence of home computing the BBC Micro and gaming machinessuch as the Commodore 64 and the Attari Electronic mail (e-shy‐mail) until then the preserveof academic and research institutions moved into the mainstream at first13 connecting via13 (relatively slow) modems and ordinary telephone lines One drawback was that13 thetelephone could not13 be used at the same time as the computer was connected to theinternet a frequent13 cause of family friction In the late 1990s and early 2000s this problemwas solved when broadband became more widely available and cheaper allowing fasterspeeds an always-shy‐on facility and the ability to use the telephone at the same time
As broadband speed and capacity continued to increase so did the ability to use theinternet13 to access video music and all kinds of electronic commerce (for example shoppingtravel)
Perhaps even more dramatic have been the improvements made in mobilecommunications Third Generation (3G) phones allow us to use the Internet13 lsquoon the moversquovia13 smart13 phones and tablet13 devices Fourth Generation (4G) began rolling out13 in 2012offering faster access
By 2025 one can13 confidently13 predict13 that wireless13 communications13 will13 be available across13 the UK and with a bandwidth which13 can13 support13 both audio and video13 services
Effectively anyone who wants to speak to people will be able to do so and the only peoplewho will not13 be able to do this will be those who wish to hide or to avoid contact
25 The internet of things and the Quantified13 Self
The internet13 works by connecting computers around the world Each computer connectedto the internet13 has a unique address (known as an IP -shy‐ Internet13 Protocol -shy‐ number) Manydevices13 now contain some kind of microchip which makes such a device in effect acomputer
This means that13 electrical appliances from washing machines to refrigerators cancommunicate with other machines also connected to the Internet Indeed manufacturershave provided this facility for a number of years in order to monitor performance and tocheck remotely on their operational status The same principle can be applied inagriculture a cow on a farm could be identified by an IP address allowing the farmer and adairy to its monitor its milk output13 or its health
As more and more devices acquire an internet13 address we talk about13 the lsquointernet13 ofthingsrsquo lsquoequipping all objects in the world with minuscule identifying devicesrsquo(httpenwikipediaorgwikiInternet_of_Things) These things might13 include buildingsthe home healthcare and transport healthcare providers cars and emergency serviceslocations such as industrial parks hospitals car parks and police stations and devices suchas tablet13 computers and cash machines
7
The development13 of small and relatively low-shy‐cost13 medical devices for measuring relevant13 vital signs or medical parameters such as pulse rate and blood sugar level means that13 individuals can take their own measurements and then take responsibility forunderstanding their meaning (with appropriate support13 where necessary) and modifyingtheir behaviour accordingly
The availability of smart13 phones capable of running apps (specialised lsquoapplications) has ledto the development13 of new measures of well-shy‐being that13 are based on the individualinputting information on location the way that13 they feel and their interactions with othersThe smartphone can provide additional context13 automatically including location thenumber of conversations the distance travelled and external parameters such as theweather and the temperature This supports the idea13 of a life that13 can be measured in asensitive manner many times a day and without13 being seen as intrusive This leads to theconcept13 of the Quantified Self
Knowing how one feels and how one lives in a way that13 can be measured and easilycompared with other people can have both benefits and disadvantages The benefits tosociety mainly stem from an ability to identify people who are unhealthy both with respect13 to acute needs and from a predictive point13 of view those who are likely to be unwell atsome time in the future In the mental health space people who have bipolar disorder canbe monitored and supported more efficiently perhaps leading to a reduction in self-shy‐harmand suicide
There are likely to be some people who rebel against13 the need for measuring their owncondition daily and for ever They could view the measurement13 regime as being arestriction on their own lives preventing them from doing what13 they want13 to do because ofthe need to compete with their own measurements This could lead them to walk awayfrom treatment13 regimes resulting in a sudden decline in their well-shy‐being
26 Social networks
Social capital1 refers to the collective or economic benefits derived from cooperationbetween individuals and groups and highlights the importance of social networks that13 linkfamily friends neighbours and communities Wellbeing can be affected by connectivitypeople who have low social capital are likely to be lonely but13 also are more likely to reject13 public health initiatives such as flu jabs which could be beneficial to their health and well-shy‐being
The number of older people who live alone has been increasing for many decades By 2025two out13 of every five older people are likely to live alone Their quality of life may dependon them being able to build strong social networks Traditionally these networks were built13
1 lsquoJust as a screwdriver (physical capital) or a university education (cultural capital or human capital) can increase productivity (both individual and collective) so do social contacts affect theproductivity of individuals and groupsrsquo httpenwikipediaorgwikiSocial_capital
8
on neighbourhoods clubs and pubs and religious groups Meetings became social eventsand absence either signified a rejection of the group or a trigger for other members tobegin to visit But13 what13 happens when a network starts to disintegrate because of death orgeographic dispersal or because the individual loses physical capacity Can web-shy‐basedsocial networks compensate by nullifying geographic separation or by building newnetworks
Skype arguably demonstrates that13 lsquogeography is historyrsquo by making possible free real timevideo communication with family and friends thousands miles and continents apart Thebarrier of course is being able to afford a computer and a broadband connection whichmay limit13 use by lower socio-shy‐economic groups However its potential as a support13 mechanism should not13 be underestimated the technology is simple and it13 works we needonly the social economic and political will to make it13 happen In Scotland older peopleenjoy free bus travel why not13 free broadband
Social networks such as Friends Reunited and more significantly Facebook have emergedas vehicles that13 can not13 only link friends together but13 can also become a means of appealingfor associations and linkages that13 can be supported by the sharing of personal information
The inclusion of a camera13 on smartphones makes it13 easy to share photographs which canenrich communication For example proud parents may announce the arrival of a newbaby with a picture that13 everyone might13 wish to see On the other hand employers might13 also see evidence of why someone who has phoned in sick is unavailable for work on aparticular day Being aware of and able to set13 privacy levels is therefore important13 in orderto control who can see your personal information and news young people and vulnerableadults in particular may admit13 more people as lsquofriendsrsquo (or connections) than might13 beadvisable
The lifetime of major social networks is likely to be limited to a few years as new businessmodels13 emerge and new promotional strategies offer benefits to subscribers This mayoffer an opportunity for new networks to be created to deal specifically with those peoplewho are excluded in any way including those who will be referred to social services forassessment13 and support
27 Entertainment
Many people still remember the coronation of Queen Elizabeth in 1953 being shown live ontelevision This was an important13 milestone in establishing this new medium as acompetitor to radio and the cinema13 as a source of entertainment The arrival of colour TVin the late 1960s contributed to the declining popularity of cinemas and theatres many ofwhich closed
Today many homes have a TV in every room and technology has advanced to deliver highdefinition and 3D pictures on very large screens or lsquohome cinemasrsquo with surround sound
9
Paradoxically perhaps radio is more popular than ever and cinema13 has bounced back fromdecline to once again become an important13 element13 in the social lives of many people
Video images still or moving can be displayed also on laptops tablet13 devices andsmartphones which means that13 people can be entertained or informed on the move Sometrain operators have followed airlines in providing an lsquoat13 seatrsquo entertainment13 experience13 which can be offered with certain choices though many passengers prefer to use their owndevices and content In the future it13 seems likely that13 access to both audio and videoentertainment13 will be possible at any location and in a way that13 doesnrsquot13 interfere with theenvironment13 of other passengers
For those who want13 neither video nor audio (eg music) entertainment reading mayremain the entertainment13 of choice Many older people have struggled to find suitablereading materials as a result13 of the closure of local public and mobile libraries Some peoplecannot13 support13 the weight13 of a book while others lack the dexterity to turn the pagesOthers have sight13 problems which prevent13 them from reading small print All theseproblems can be overcome using either text13 to speech technologies (which are replacingtalking books) or by using e-shy‐reader devices which allow font13 sizes to be increased easily andwhich offer simple interfacing for moving pages backwards or forwards
In the future it13 must13 be assumed that13 all entertainment13 media13 will be held in the lsquocloud2rsquoand will be downloadable to an appropriate device on payment13 of a fee provided that13 acommunications contract13 is in place
The pre-shy‐requisites will bebull A device (eg PC laptop tablet Kindle)bull A contract13 with a telecoms provider (eg BT Virgin Sky) for broadbandbull A contract13 or contracts with media13 provider(s) (eg Netflix iTunes)
Those who lack any of these components may be entertainment13 excluded
28 Cash13 and13 money
Cash has been king since the abolition of the gold standard It is an expensive method oftransferring money between people and organisations and is a considerable overhead forindustry and for individuals travelling between different13 countries The highest13 denominations are lightweight13 and easily lost stolen or destroyed while the smallest13 denominations are heavy dirty and difficult13 to handle It is surprising that13 physical cashcontinues to be used It can only be a matter of time before it13 is digitised and replaced byvirtual cash
2 This means the material (book film or whatever) is stored in a remote computer (thecloud) and downloaded (or lsquostreamedrsquo) to your device on demand and possibly onlytemporarily
10
Large payments were previously made by cheque They are expensive to process by thebanks because people can write them by hand which makes them difficult13 to readelectronically and automatically Consequently they require human intervention and this isnot13 what13 modern banks wish to do so they want13 to promote greater use of debit13 and credit13 cards The latter were used initially as a cheque guarantee but13 are now being used almost13 exclusively as a means of withdrawing cash from ATMs and for making paymentselectronically UK banks wanted to do away with cheques by mid-shy‐2012 but13 they had toperform a u-shy‐turn under pressure from charities representing older people It is apparent13 that13 digital cheques and other cheque-shy‐replacement13 strategies will be introduced soon that13 satisfy the most13 pressing concerns of older people
It was difficult13 to see how cash could be replaced for payments for lower cost13 items such asnewspapers and sweets until the era13 of contactless payments Near field communicationsystems are likely to replace bar-shy‐codes to carry product13 identification information Theycan be read by electronic receivers The same technology can be two-shy‐directional allowinginformation to be passed from a smart13 phone to a reader and back again The smart13 phoneeffectively becomes a wallet13 which can be digitally filled by the owner and then emptiedwhen making purchases For small sums of money this approach is ideal and is likely to berolled out If cash disappears then begging will become difficult13 and welfare paymentsmade on a card Such cards are already used by social services as a means of providingclaimants with a means of receiving self directed care and support By restricting use of thecard to outlets that13 can provide care and support13 services opportunities for spending thecash inappropriately are restricted
It follows that13 many users of social services will need to have a smart13 phone as well as acard that13 can be used to buy services In the future smart13 phones may be provided as aloan item to claimants for social care This could include a digital wallet13 facility as well asthe communications and information ecosystem that13 would allow these people to receive awhole range of other services that13 would prevent13 their social exclusion and which could beused directly to provide them with information and access to entertainment
29 Biometrics and fraud13 prevention
Identity theft13 is used by criminals to pretend to be someone else in order to accessresources or obtain credit13 and other benefits in that13 persons name Although the concept13 has been around for centuries it13 is a growing concern in the digital world as we acquiremultiple online identities for bank accounts social networks and using public services such13 as paying tax electoral registration etc
Passwords are fraught13 with difficulty typically they are hard for humans to remember andeasy for machines to crack Efforts are therefore focused on other forms of provingidentity for example
11
bull Fingerprints have been accepted for over two thousand years to confirm identitymostly in criminal justice The technique has been applied to door-shy‐lock opening insome supported housing schemes There are practical problems associated withregistering lsquoallowedrsquo fingerprints and the useful lifetime of such products is also onlyabout13 three or four years
bull Retinal imaging and DNA analysis have been relatively slow to follow but13 only dueto the sophistication required for measurements and the time taken for testing Acombination of retinal imaging with facial gestures and blinking is possible in the labbut13 currently takes half a minute to achieve a match -shy‐ and this is achieved only withthe use of considerable computer processing power This sort13 of time makesapplications in mass people transfer impossible
Current13 research in this area13 is focusing on the uniqueness of other body parts such as earsand knees as biometric indicators The ears have great13 potential because they are usuallyexposed though hidden sometimes behind hair and other times by hats and other clothingOn the other hand the knees are rarely visible and however unique they may be there willbe cultural and religious obstacles to overcome before scanning could become a regularpart13 of identity confirmation The cameras which are central to such systems used to beexpensive but as the cost13 of high quality cameras continues to fall (there is one in nearlyevery mobile phone) it13 becomes feasible to devise identification devices that13 use multiplecameras to simultaneously recognise the eye and the ear
Movement analysis can be used to identify people by their walk gait13 and other biorhythmsprovide unique signatures It is possible to learn someone elsersquos gait13 though and injury orillness13 can have a temporary effect13 on gait
Over the next13 ten years with more sophisticated databases and image processing facilitiesthe cost13 of implementing advanced biometrics will fall enabling their application acrossmore diverse areas and in more social opportunities Potentially cameras will use cloud-shy‐technologies to provide individuals with instant13 recognition of anyone approaching them inthe street This could prompt13 a name or the occasion when they were last13 seen or spokento as a secondary method of control in much the same way as Internet13 banking seeks toavoid fraud This13 has13 the13 potential to remove13 the13 need for13 passwords13 and might13 then be13 the basis of machine-shy‐based13 communication13 either in front13 of a laptop or tablet13 device orwhen using13 a smart13 phone
There will need to be special measures introduced to support13 people with any form ofdisability as they might13 well have one or more sensory deficits Similarly people maystruggle to communicate following a stroke or a serious accident Nevertheless it13 may bereasonable to conclude that13 such systems will be both available and acceptable within thenext13 10 to 12 years
12
210 Health13 information
Health records in the form of written documents x-shy‐ray images and clinical observations arean important13 means of making all interventions efficient13 and safe Increasingly people havemany different13 conditions (comorbidities) and may be treated by several specialists Asthese physical records are moved inevitably some get13 lost estimates suggest13 that13 one inthree records is lsquolostrsquo at any one time
The best13 resource for information about13 a patient13 is his or her primary care record which isheld by the GP The UK was an early adopter of electronic primary care records and can beproud of the way that13 these have enabled population-shy‐based information to be collectedand analysed Scotland (and to a lesser extent13 Wales) has led the way in ensuring that13 allthese records are accessible through anonymised approaches that13 allow researchers toexamine trends and improve analysis of performance Fundamental to this has been theallocation of a unique identifier At13 the same time individuals can access these recordsboth to check for accuracy and to see what13 their doctor has said about13 them
This13 has13 the potential to make people more responsible for their own conditions andmight lead to better13 self-shy‐care13 and changes in behaviour13 that might reduce13 the13 incidence13 or severity13 of chronic conditions13 that are related13 to lifestyle
In the future we can expect13 the primary electronic health record to be linked with hospitaladministration systems picture archiving systems and other records held by hospitals sothat13 appropriate medical staff can have access to all relevant13 data
When the social care record is added to the mix then this will mean fewer but13 shorter andbetter assessments for social workers and for healthcare staff They will knowcircumstances and factors that13 could influence the choice of approaches This supports theidea13 of there being only one record consisting of several components all of which areaccessible by an appropriate professional at any time and in any place
The13 ambitions13 described above13 are not13 limited by technology most13 of the interoperabilityissues between rival commercial record systems have been resolved and databaseproviders are being compelled to support13 joint13 working The English NHS Mandate requiresTrusts to effectively replicate arrangements already in place in Scotland and in Wales andthis will go a long way towards achieving a genuinely paperless NHS well before 2020 Withnew biometric identification technologies individual records will be available to out-shy‐of-shy‐hours physicians and to those working in an AampE department13 irrespective of theconsciousness state of a patient
New telecare and telehealth technologies will produce significant13 more volumes of data13 which are currently held in different13 places and owned by different13 organisations rarely thepatient These data13 will also need to be shared but13 only in a manner that13 is acceptable toeveryone Patients may not13 want13 all their mental health information published in a formthat13 can be viewed by social workers GPs may not13 want13 to have access to all the data13 that13 might13 suggest13 that13 there is a domestic crisis to which they had neither the wish nor capacity
13
to respond Monitoring systems that13 support13 the lsquoquantified13 selfrsquo may also offer data13 that13 may or may not be added to the full recordThe future of health information might13 therefore be about13 providing individuals with themeans of producing relevant13 information storing it13 somewhere secure and then viewing it13 at a later time but13 in a format13 (or with advice) that13 is acceptable
See also httpmydexorg lsquoMydex gives individuals back control over their personal datarsquo
(see also Digital Scotland 2020 Achieving World-shy‐Class digital infrastructure a final report13 tothe Scottish Government13 httpwwwscotlandgovukPublications2013029054lsquoconnectivity by any device anywhere and anytimersquo)
211 The Future of Healthcare
The strains on our healthcare delivery system are becoming greater as they are in otherdeveloped countries as a result13 of an aging population rising expectations and unhealthylifestyles The necessary changes will require a significant13 shift13 in resources13 fromsecondary13 care13 where unit costs13 are high to community13 carewhere people can generallybe treated at home
The future must13 therefore necessarily involve efficiencies in hospitals and in the way that13 people can be treated in less expensive locations ultimately in their own homes Hospitalswill use more sophisticated diagnostic tools including scanners of all types to non-shy‐invasivelyprobe inside peoplersquos bodies This will result13 in more day cases and hospital stays (alreadyaveraging under a week) to even shorter periods with on-shy‐going support13 provided inintermediate care settings that13 might13 include hotels care homes or the personrsquos own homeif it13 is clean safe secure and has all the necessary amenities (include access to theInternet)
Advances in medical technology will allow more treatments to be delivered in the homeThis will mean fewer visits by clinical staff and fewer opportunities to attend primary carecentres Pharmacists will become suppliers of information as well as drugs so the balanceof care will shift13 significantly away from doctors who will work in different13 ways relying13 increasingly on telemedicine to bring the specialist13 to the patient13 for an online consultation13 For example if a patient13 complains of nausea13 and severe headaches a virtual consultationcan be offered almost13 immediately and without13 having to send a patient13 with a potentiallyserious and acute condition on a potentially long journey to a hospital
In the above example a neurologist13 may ask further questions as well as conduct13 acomplete neurological examination using videoconferencing technology Airedale GeneralHospital consultants have new contracts that13 require them all to be available for virtualconsultations The first13 benefit13 has been in reducing the need for prisoners at local jails tobe brought13 into AampE (which may need to be locked down depending on the circumstancesand the potential for violence of the individuals involved) potentially saving hundreds of
14
pounds in security costs It also avoids the need for healthcare staff to have to go into aprison environment
The principles described above are already saving lives through telestroke services whichlead to more people being thrombolysed appropriately and avoiding long term support13 that13 often follows a stroke incident Teledermatology has been practised for a number of yearsand results in rapid diagnosis and resolution of problems that13 previously required significant13 time for remedy
212 Gadgets and13 DIY13 healthcare
There are at least13 three elements to healthcare
bull Gathering information on symptoms and physiological parametersbull Interpreting the information andbull Responding to the diagnosis with treatment
Many people choose to exercise self-shy‐care because this gives them control whilst13 avoidingthe need to share their concerns and personal details with others A lsquodo It yourselfrsquoapproach might13 even be encouraged by the NHS as a viable way of using scare resources
Medical devices that monitor vital signs are mature and have been miniaturised so that13 they can be used in the home by individuals with little or no medical training Indeed bloodsugar monitors are being produced specifically for use outside the hospital and in such away that13 they can be used reliably by people with advice and training being provided onlinevia13 YouTube
Many medical monitoring devices do no more than produce a single measure which theuser may record or respond to Others link wirelessly to smart13 phones allowing data13 to bestored and entered into a personal health record where trending opportunities existingIndeed individuals can easily enter their data13 into an app running on their laptop tablet13 orsmart13 phone This trending information may be useful13 for self-shy‐care and could be passed onto a physician though the volume of data13 produced in this way and doubts about13 thequality of the data are likely to persuade GPs to discount13 data13 produced in this way
This gap in knowledge can be filled with advice information and diagnosis that13 can beobtained online using a lsquoDoctor Googlersquo approach The quality of such diagnosis may varysignificantly although there are many sources of information that13 are both supported andapproved by the NHS (and by similar sources in other countries) However with a data-shy‐richapproach and a choice of diagnosis people may be empowered to take a greater role inhealthcare
15
The final component13 for the DIY enthusiast13 is the treatment13 option Many people fear longterm use of medication produced by the big pharmaceutical industry and prefer morenatural remedies which are available over the counter More medical treatment13 devicesare available that13 stimulate blood flow and counter pain through the use of electrical andphysical stimulation
The evidence may be weak at present13 but13 might13 grow as more people use them and as theircost13 drops The13 impact13 of13 such technologies13 on vulnerable13 people13 is13 difficult13 to gauge
213 Telecare
Support13 provided at a distance to people in their own homes is known as telecare Thename implies remote monitoring and interaction and includes the monitoring of the homeenvironment13 and of the individual as well as the interaction of the individual with thisenvironment Definitions have become difficult13 due to some US medical devicemanufacturers introducing the term telehealth to describe medical telecare such as remotemeasurement13 and collection of vital signs data
In the UK telecare alarm services have matured quickly using the robust13 platform andinfrastructure of social alarm systems which were originally used by tenants in shelteredhousing schemes to seek help when they didnrsquot13 own a telephone The majority of telecareservice users today live in their own homes and use dispersed alarm units to link with amonitoring centre through the telephone network Improved assessments of needs andrisks to independence have resulted in combinations of sensors being used to support13 theoption of staying put13 rather than moving into residential care or having increasing levels ofdomiciliary support They support13 the policy of bringing care closer to home and ofencouraging people to become partners in their long term support13 arrangements
Telecare services developments over the past13 decade include standalone items such asautomatic lights which have achieved significant13 efficiencies especially for people who arefrail and prone to falling and to those suffering from mild cognitive impairment epilepsyand anxiety People who have long term conditions including chronic conditions such asdiabetes and hypertension can also be managed more effectively through telecare supportThe benefits of telecare services include a relief of stress for family caregivers enablingthem to continue to provide unpaid support13 while holding down a job and maintaining theirquality of life
New developments enable continuous monitoring of behaviour and smart13 devices that13 canfor example remotely control the cooker the water supply and door entry Such13 monitoring may detect13 incidents early and prevent13 emergencies arising Devices arebecoming smaller and easier to embed quickly within the home environment making themmore acceptable and less noticeable Longer battery life means less frequent13 maintenancevisits
16
The13 monitoring13 centre13 becomes13 an information hub13 offering13 both advice13 and a vehicle13 for checking that someone is coping especially following a trigger event such as a stay inhospital or the illness13 of an informal13 carer
New systems utilise web technology that13 allows family members to be more proactive inthe monitoring of their relatives This can lead to greater interaction with them especiallywhen the relatives live a considerable distance away (perhaps in another country) Thesenext13 generation systems might13 include video conferencing and the use of tablets smart13 phones or smart13 TVs but13 when an emergency response is required (perhaps to lift13 someoneup after a non-shy‐injurious fall) there remains a need for human intervention
The13 future13 of13 telecare13 might therefore13 include13 an increasing13 dependence13 on volunteersfrom13 the13 community to provide13 the13 required support Social networking may need to beused13 to support13 telecare technologies
214 Mobile healthcare
While telecare can support13 people effectively in their own homes it13 is now recognised that13 being able to go out13 to enjoy open spaces and to overcome the fear that13 the home is aprison is an important13 part13 of improving well being and supporting a higher quality of lifeExtending telecare technologies to operate outside the home is known as mobile healthcare(or mCare) and is based on mobile telephone networks rather than landlines
The simplest13 form of mCare requires only a basic mobile phone to deliver telephone callsvoice13 messages and SMS (text13 messages) The technology is mature and there are countlessapplications in use both in the UK and in developing countries such as Africa13 and India13 where mobile telephones have already achieved a saturation level and where fixedtelephone infrastructures are not13 likely to be established at any time Such telephones areuniversally available in the UK and are used by the vast13 majority of people including manyolder people especially if they have been introduced to the low cost13 (pound30) devices that13 have large buttons large displays and a separate large button for calling an emergencynumber
Smart13 phones are rapidly replacing basic phones and allow the use of a large range of lsquoappsrsquothat13 are being developed to provide information and for enhanced experiences In thehealthcare space Skype FaceTime Vidyo and GoToMeeting with HD Faces are all current13 examples of video conferencing software available on tablets and smartphones
The specific software will depend on the nature of the communication desired
bull Skype will13 manage a simple video phone callbull Where an AampE physician needs to share a CT scan of head with a Neurologist13 on call
from home GoToMeeting would be more appropriate
17
bull If the physician would rather have a dedicated online meeting room that13 patientsand colleagues can simply drop in for a virtual meeting a Vidyo virtual room may bemore appropriate
This technology can suit13 any form of lifestyle including many people with complex needswhose lifestyle is not13 consistent13 with a fixed address
Social care apps are available already to deal with problems of sensory deficit
bull Guiding a blind person through GPS navigation and reading signs through appslinked to the devicersquos camera13
bull The microphone can be used as a hearing aidbull Speech recognition software can be used either to replay speech at a slower speed
or for translation into a language of choicebull Speech can also be selected for people who have a stammer or who have a problem
with their larynxbull Apps are becoming contextually aware recognising situations and locations and are
thus becoming a personal assistant13 for people with disabilities
By 2020 it is therefore possible that a smartphone may13 be prescribed13 for people who13 need13 social13 care13 together with13 a range of apps that have been13 selected13 to meet13 theirassessed13 needs
Whilst13 smart13 phones tablet13 devices and apps may become an important13 part13 of anindividualrsquos personal support13 armoury the potential of mCare will be limited only by anindividualrsquos ability to make use of all its functions Each device could become a part13 of anindividualrsquos personality supporting them to improve behaviour take exercise avoidtemptation and manage their own health and well-shy‐being Potentially mCare could becomethe most13 important13 element13 of social care and support13 within 10 years
215 Artificial Sensing and Enhancement Devices
bull It is estimated that13 one in seven people has imperfect13 hearingbull The numbers who are born deaf are quite small and many of these people may
have some form of hearing restored through surgery or through technologybull Similarly while there may be nearly a million people registered as blind or having a
severe visual impairment the vast13 majority lose their sight13 during their lives as aresult13 of disease
bull New treatments will deliver sight13 recovery or restoration over the course of the next13 10 to 20 years
Fortunately technology can provide excellent13 sensing capabilities that13 are already providingpeople with external portable devices for enhancing their lives The simple hearing aid is anexcellent13 example of a device which has been improved through both miniaturisation
18
personalisation and enhanced performance Today digital hearing aids use sub-shy‐miniaturemicrophones that13 can be unidirectional or omnidirectional and which can be adjusted insensitivity over an extended range Tomorrowrsquos devices can be switched between modesby the user so that13 they can benefit13 from hearing perfectly in any environment Indeedthey can be used with adaptive filtering technologies (as used by helicopter pilot13 headsets)to eliminate some sounds so that13 the rich speech (or music) components alone remainFuture developments will be on optimising control so that13 the user can switch seamlesslybetween different13 amplification applications without13 appearing to be distracted A smart13 phone or mp3 music player may be used as either a processing unit13 or as a ubiquitousoutput13 device that13 looks cool and natural
These same technologies will also be developed for use within the home environment13 fortimes when a deaf user isnrsquot13 present13 or is asleep Acoustic signatures associated withadverse events and incidents such as the hiss of a gas leak the crackle of a fire the sound ofa smoke detector the drip or a water leak or the sound of breaking glass can be directlyassociated with programmed actions Speech will be recognised interpreted translatedsimplified or displayed so that13 an individual knows what13 is said and can be provided withclear instructions on how to respond
Video cameras have become smaller and cheaper and capable of producing high definitionimages The problem of storing and editing these large image files is being solved by thearrival of cloud computing
Electronic noses are already capable of detecting the quality of wine and fresh fruit Similartechnology will be based in smart13 phones and will be able to analyse the air to warn of13 foodthat is no longer fresh and of other indicators of danger including gases that13 have13 little13 natural13 smell These13 devices13 could support13 people with13 cognitive impairment13 -shy‐ whose13 sense of smell13 tends13 to deteriorate -shy‐ to live independently
Many older and vulnerable people are at risk of hypothermia during the winter Sensordevices can provide warnings of low temperature In the same way heat13 stress can be adanger during the summer months so sensors can alert13 people of the need to openwindows or to operate a fanFinally people who have damaged13 their fingers13 or hands will be able to wear sensorsembedded in artificial skin or in gloves that13 will enable them to identify textures and shapesand be able to dress and undress without13 the assistance of carers
216 Robotics
We may recoil at the idea13 of personal care being delivered by robotic devices but13 it13 is likelythat13 within a decade personal assistants will exist13 to assist13 with household tasks These areunlikely to be humanoid and are more likely to be machines dedicated to helping frailpeople to support13 their own weight13 and to carry trays of food around the home
19
There are four broad classes of robot13 under development13 that13 are likely to mature within 10to 12 years
1 Miniature industrial robots that13 have been programmed to perform specific taskswith precision They are likely to be relatively heavy enabling them to bear weight13 but13 still have the necessary flexibility to carry an individual over short13 distancesplacing them in a chair or on a bed They will have sensors and cameras to provideimmediate feedback and to adjust13 rapidly in response to verbal commands or cues13 from the user Some designs may build on existing assistive devices such as abathroom hoist13 or a bathing aid to become intelligent13 extensions of productsalready on the market A stair lift13 with intelligence is already being designed by a UKcompany and is aimed at providing the user with more control of the journeybetween floors of a house
2 The second group of devices might13 be described as intelligent13 furniture Beds andchairs are already available that13 adjust13 to make the user more comfortable and also13 to help them get13 into or out13 of bed The control units are fairly cumbersome andare suited to operation by a carer Voice activated controls and built-shy‐in intelligencewill give the user more control and independence Other items of furniture to whichintelligence might13 be added would be tables whose height13 can adjust13 and whichhold items of food and medicine securely The table would recognise these objectsand could provide prompts or reminders
3 Mobile robots form the third group These could be goffers that13 can either fetchand carry items such as newspapers drinks or trays or which can accompany theuser when they move between rooms providing them with support13 or prompts Thistype of robot13 could be an intelligent13 walking frame with wheels which13 could13 doubleup as a smart13 wheelchair when necessary
4 Finally there are companion robots These might13 be in the form of an electronicpet typically a cat13 or a dog though the Japanese Paro robot13 is a seal Pets canrespond to stroking and being patted they can also remind their owners that13 theyneed to take exercise and to eat drink and take their medication Various designsare already available which provide feedback but13 future models would includecameras and a screen to provide a mobile means of information and interactionwith other people over the Internet Intelligence within the device could allow themto have a personality of their own and gain knowledge by scraping data13 fromwebsites so that13 they can generate speech and have conversations about13 the newsthe weather or sports results
217 Transport and transfer technologies
Walking is good exercise and is a no-shy‐cost13 form of transport13 that13 is encouraged because of itsimpact13 on well-shy‐being For an individual with a chronic disability or suffering from theeffects of an accident13 or an injury this becomes impractical without13 an assistive technology(AT) A walking stick is the simplest13 example of AT
20
Within the home the stair lift13 has enabled people who live in conventional properties that13 are on two or more floors to continue to use facilities on different13 floors when climbing thestairs has become too difficult This is often the case for people who have arthritis a lowerlimb amputation a long term condition such as Chronic Obstructive Pulmonary Disease orpeople approaching the end of life and who have chosen to die in their own homes
Designs have improved so that13 a curved staircase is no longer an issue and the reliabilityhas reached a level where breakdown is a rare occurrence13 Through-shy‐floor lifts have been analternative proposition but13 they remain too large for most13 properties Alternativeapproaches may emerge using air pressure or water pressure as the driving force ABrazilian design already utilises a plastic tube in which a pod is moved effortlessly up anddown
Electronic wheelchairs are now available that13 allow the individual to become moreindependent13 as they allow the user to control both propulsion and steering Some modelshave the capability of mounting a pavement13 or a step or even a flight13 of stairs Personalmuscle amplification devices have been developed originally with the intention of helpingpeople who are confined to a wheelchair due to a neurological disorder to perform sometasks from a standing position Indeed the Rex walkerrsquos manufacturers claim that13 anyonewho can propel themselves in a wheelchair could walk by using Rex
Other approaches have focused on the rehabilitation of people after major accidents that13 have caused partial paralysis They quickly extend into exoskeleton designs that13 enableanyone to gain a mechanical advantage and thus to tackle physical tasks that13 would not13 otherwise be possible These suits are the focus of major research projects across theworld Some13 products such as the system developed by Honda are being tested inAssisted Living facilities and are likely to become more and more enabling over the next13 decade
Similar benefits are also occurring outside the home with a number of novel carryingsystems appearing over the past13 few years They are generally termed lsquoscootersrsquo but13 thiscovers a wide range of systems and devices ranging from the Segway a device that13 is amobile platform on which the user stands and navigates through to conventional electricvehicles that13 have been developed from golf buggies There remain a number of issuesconcerning their use on roads or on pavements but13 similar problems will need to beresolved for bicycles to play their full part13 in enabling people to get13 more exercise13 Thepotential for hybrid scooters remains
218 Smart domestic appliances and personal hygiene
The bathroom is a dangerous place and one where many older and disabled people slip andsuffer a fall Many older people recall taking a bath in a tin tub in front13 of an open fireToday the options tend to be a level access shower (ie a type of wet13 room) for anyoneunable to get13 into a bath There are various aids to help people get13 into and out13 of thebath most13 involving a seat13 that13 can be raised or lower with some bath-shy‐tubs having a door
21
There has been some research into alternative methods of keeping the body clean Sanyointroduced a machine in 1970 modelled on a clothes or dish washing machines the personsits on a seat13 inside the machine where13 they are cleaned by a set13 of water jets These havenot13 proved popular and furthermore require the individual to be transported to themachine Thus the technology may find application in nursing homes but13 are unlikely to beattractive to people living independently in the community
The washing needs of people change over time Over the past13 20 years body piercingshave appeared which have demanded additional attention to avoid the problemsassociated with poor hygiene and metals Similarly hair may be permed and dyed usingchemicals which are much stronger and which might13 damage the hair Add to this thepainting of finger and toe nails and the washing needs are rather different13 to what13 theymight13 have been even ten years ago Finally tattoos were once popular only with sailorsToday they are likely to be found on the arms backs and legs of both men and womenNew ways of cleaning these tattoos will be needed especially if they become infected orare sites at which pressure sores develop
Even if a personrsquos body is clean if their clothes are dirty they may become socially isolatedBut13 the washing of clothes can be strenuous even if a launderette is used The need toconserve water has driven research into ultrasound techniques to beat13 the dirt13 out13 ofclothing while some companies are experimenting with polymer chips These13 ldquogreenrdquo13 technologies are quickly maturing and are likely to be standard in the next 10 years
Other smart13 household appliances are already appearing on the market13 and may soonbecome common13 in UK homes13
bull Robovac devices have sensors to enable them to detect13 dirt13 on carpets and to adjust13 their operation accordingly
bull Refrigerators can read bar codes or RFID tags to identify their contents and theirldquouse byrdquo13 dates enabling them to inform the owner that13 they should use theproducts before they are out13 of date They can be linked to the Internet13 to reorderitems as they are consumed or to suggest13 menu options for the individual based ontheir preferences or according to the diet13 required to manage a condition
bull Ovens will automatically switch off if they are left13 without13 attention for too longand drying machines will set13 times automatically
Devices may be linked so that13 they are more efficient and report13 maintenance issues sothat13 they can be repaired (perhaps remotely) before they suffer a catastrophic breakdown
219 Personal and home13 security
It might13 appear perverse but13 people with very little personal wealth and property are morelikely to be the victims of crime than those who have expensive items This may be due towhere poorer people tend to live or because people who have valuable assets take greater
22
steps to protect13 them There can be no doubt13 that13 crime has a very negative effect13 onindividuals and on their families creating a fear factor that13 may be difficult13 to remove Theimpact13 on quality of life is therefore very considerable especially if it13 forces people to stayat home behind locked doors effectively isolating themselves from society
Modern policing places increasing reliance on the use of closed circuit13 television (CCTV)Town centres are covered by cameras used increasingly in the fight13 against13 crime by bothdetecting anti-shy‐social incidents and identifying the people involved They are also used tomonitor the movement13 of cars that13 may be involved in incidents of burglary and violenceand are fast13 becoming the primary mechanism of law enforcement13 agencies to solve crime
CCTV has moved into the home to record movement but13 monitoring the footage is timeconsuming and often not13 practical Cameras are now available which provide an instant13 video feed to a smart13 phone when movement13 is detected These may have intercomcapability allowing someone to remotely speak to an intruder sometimes before they havegained access to a building This may serve as a deterrent13 and when fitted alongside simpledevices that13 switch lights on randomly around the home may force burglars to goelsewhere
As the price of cameras continues to fall the option of carrying a camera13 on the body that13 continuously monitors personal space is becoming more useful Using wireless networksthe data13 collected can be sent13 continuously to the cloud for safe storage It cansubsequently be retrieved to provide evidence (video and audio) of confrontations enablingsuccessful prosecutions to be made The smart13 phone itself is becoming a valuable itemthat13 is attractive to criminals These can be tethered to personal attack buttons usingwireless technology allowing the device to be activated by the pressing of a button if theowner is being attacked The phones can then be tracked and located by the police whilebeing rendered useless to the assailant
Bogus callers are a perennial problem for vulnerable people Video door bells can beconfigured to display images and record the words of visitors before they are admittedallowing remote monitoring centres to oversee the situations and use image recognitionsoftware to confirm the bona13 fide of visitors Such13 arrangements may become13 commonplace13 over13 the13 next five13 or13 six years13 significantly13 improving the safety of peopleliving independently
220 Personal safety
The biggest13 risks to personal safety stem from fires and falls Most13 fires are the result13 ofpoor cooking practices resulting in burns or scalds Floods and gas emissions are caused bya failure to remember to close taps
The current13 approach involves detection of an emergency situation as soon as possible but13 always after a problem has already occurred This responsive approach can minimise therisks provided that13 there is a protocol in place for intervening This could increasingly be an
23
automated response such as the switching off of the gas of water or the switching on of asprinkler system or a water mist13 system
In the future monitoring systems will be more sophisticated and will have sensors and localintelligence to identify activities In this way reminders can be issued before an emergencyoccurs13 This lsquosmart kitchenrsquo approach may become13 an integral part of13 homes of13 vulnerable13 people
A prototype system has been developed at the Culture Lab in Newcastle Sensors havebeen embedded into cooking utensils enabling the kitchen to identify what13 the person istrying to cook or prepare It can provide interventions as messages on an instructionscreen
Accidents also occur out13 of doors People with dementia13 might13 become lost13 and may havepoor road safety awareness Location devices based on GPS have advanced from large andheavy receivers that13 were used on ships and boats to small battery-shy‐operated devices that13 can be carried in the hand or in a handbag The current13 generation of locators has limitedbattery life and are rather too large to be secreted about13 a personrsquos clothing while devicesthat13 are integrated into a wrist-shy‐watch are rather clunky and unattractive
Within 10 years the13 technologies13 will have13 matured and will be13 much smaller13 so that theycan be embedded in shoes in walking sticks hats or any other item of clothing Powerrequirements will have reduced so that13 energy harvesting from the movements of theindividual will be sufficient13 to keep these products working for several weeks without13 theneed for recharging The devices will not13 simply indicate to others where the individualhappens to be but13 will provide subtle guidance cues to direct13 them home
Cameras might13 also form part13 of the personal security systems that13 will protect13 people fromaccidents Data13 may be sent13 to the cloud and analysed in real time if the person is in adangerous location and can provide prompts either to the individual or broadcast13 advice toothers to clear the danger These systems may be embedded in items of clothing (such as ahat) or they may be attached to spectacles
221 Energy and13 portable power supplies
The demands of developing economies for more power will inevitably lead to higherdomestic fuel charges in the UK especially as oil and gas reserves dwindle
By 2018 UK homes should be fitted with new smart13 meters The specifications for these13 devices have yet13 to be finalised but13 will include a means of identifying wasteful use ofenergy including TV sets that13 are left13 on and unattended fridges and freezers that13 are set13 attoo low temperatures and dryers that13 are used for too long or when the weather is suitablefor using a washing line They could be an enabling factor that13 supports changes inbehaviour driven by a need to use less power but13 it13 is unlikely that13 they will offer a bigreduction in costs that13 are already a problem for many vulnerable families
24
More generally the need for power conservation will include devices that13 are moreefficient and a significant13 emphasis on heat13 retention in buildings through betterinsulation
The energy crisis may force many people to spend more time in community settingsincluding shops and public buildings where they can benefit13 from the warmth Increasingreliance on mobile communication devices will lead to increasing demand for batterycharging facilities
Greater use may be made of portable devices for generating power based on solar cellswind or hand motion
222 Smart cities and homes
The Digital City initiatives have been based on information and how it13 can be used most13 effectively to make people aware of what13 is going on around them This means bettercoordination of resources more rapid access to advice and a battery of sensors measuringevery conceivable parameter from sound and light13 levels through to air quality andtemperature fluctuations There are several Digital or Smart13 City initiatives currently beingimplemented both in the UK and across the world They may significantly impact13 the livesof the millions of people living in them but13 the timeframe for outcome benefits to influenceplanning and design elsewhere is likely to be at least13 20 years and therefore outside thetimeframe of the current13 project
Housing plays a big role in the lives of most13 people both through their aspirations to moveup in the world (usually to a bigger property with a garden) and as the heart13 of the familylife which is associated with good quality of life UK properties have a life span approaching100 years which is about13 double that13 of their European counterparts (and certainly longerthan the wooden-shy‐frame buildings built13 in North America13 for example) A shortage ofhouses has plagued improvements in social welfare for the past13 30 years There is anargument13 that13 there are enough houses but13 the wrong size and in the wrong places andthis has some basis in fact13 as demography changes lead to more people (and more olderpeople) living alone However if there are two million homes in Scotland each with alifespan of 100 years then the renewal rate needs only to be 20000 per annum to maintainthe status quo However it13 must13 be clear that13 the impact13 of smart13 house development13 willbe small The focus should therefore be on adapting existing properties to render themmore appropriate for vulnerable people
Housing adaptations are a branch of assistive technologies The technologies for providingdifferent13 forms of accessible bath and level access shower are well-shy‐established with littleresearch considering anything other than alternative building materials and methods formaintaining the temperature of the bathwater Different13 technologies for bathing will beconsidered separately
25
Thus housing technologies are not likely to impact on social work13 within the next 20years13 though13 the use of information13 technology13 to ensure that people are aware of what13 is available is likely to be commonplace well before then
26
3 BEHAVIOUR AND ATTITUDE CHANGES DUE TO TECHNOLOGICALADVANCES
Technology is only one factor that13 will affect13 the way society changes in the next13 10 or 15years This chapter will consider the context13 in which the technological developmentsoutlined in the previous chapter will be supported (or held back) by societal factors
When the impact13 of such factors has been considered we can then apply theseassumptions to a number of case studies listed in Appendix13 A13
The headings selected for this chapter are not13 arbitrary as they reflect13 the context13 in whichtechnological changes must13 be considered They must13 include consideration of factors suchas demography and long-shy‐term conditions already addressed in the introduction to thesepapers together with the aspects of workforce and citizenship considered in the parallelpapers The additional elements here focus on trends that13 are already occurring and whichmay leave people struggling with the changes that13 occur
Finally there is a need to consider the attitudes of people to technology generally andespecially to the issues of privacy and social responsibility that13 could be radically changedby technology In some cases public opinion will prevent13 some forms of technology beingdeveloped if not13 commercialised In other cases some technologies will be fast-shy‐trackedeither at the request13 of government13 or because of a clear public demand for theopportunities that13 it13 can bring
Predictions13 about the13 future13 must inevitably be13 subject to considerable13 uncertainty butthat is no reason to stop thinking what might happen
31 The Welfare State
The UK can be rightly proud of the way that13 its welfare state has developed during the past13 100 years to provide a safety net13 of financial support13 to people and to their families whenthey are unemployed destitute homeless or challenged by crises and emergencies Therange of benefits received is considerable some are complex and many people struggle tounderstand their entitlements Some are universal some are discretionary some apply onlyto parents others to anyone
The total cost13 of providing these benefits continues to rise and when the economy isstagnating there is inevitably both political pressure often supported by popular publicopinion to introduce welfare reform so that13 people who do not13 work cannot13 be better offthan they would be if they were in full-shy‐time employment This strategy requires a universalbenefit13 to be introduced so that13 it13 is easier for claimants to access support13 but13 also easierfor agencies to identify the total benefits received The idea13 of a benefits cap then becomes
27
more practical to introduce especially if all the processes involved in making a claim arehandled electronically Indeed this encourages government13 to insist13 on applications forbenefits to be made on-shy‐line Unfortunately this will marginalise those people who haveneither a computer nor access to the internet thus emphasising the digital divide in amanner which works against13 some of the most13 disadvantaged people in society
There are currently few tangible links between digital technology and welfare provisionThe most13 obvious are universal benefits such as a free television licence (worth pound14550)13 for13 everyone aged 75 or older with blind and visually impaired people entitled to a 50discount13 irrespective of their age The significance of this position is that13 6 of revenuesgenerated through licence fees are to fund BBC on-shy‐line services13 such13 as websites and i-shy‐player In Scotland the BBCrsquos Alba Gaelic language television service is predominantlyfunded13 by MG Alba an organisation funded by the Scottish Government It is thereforeconceivable that13 in the future licence fees may be used to directly subsidise access toinformation and advice through the Internet13 for vulnerable people whether it13 is throughbroadband access or through a set-shy‐top box which removes the need for a computer in thehome to access particular websites or to use e-shy‐mail services
A second age-shy‐related benefit13 available in the UK is the winter fuel subsidy People whoreceive certain benefits receive the payments automatically while others must13 make aclaim Those who are not13 eligible for benefit13 due to a lack of an address for example missout13 on these payments and also on Cold Weather payments of pound25 for each seven dayperiod of very cold weather between 1 November and 31 March
The development13 of new warm home initiatives plus the complex of subsidies that13 theelectricity supply industry and government13 offer to people with solar cells further changesthe economic arguments Global warming may lead to greater variations in weatherextremes but13 might13 also increase the amount13 of electricity that13 can be generated byalternative (green) sources such as wind and solar cells It is estimated that13 energyconsumption in the UK increased by 17 between Christmas and Easter 2013 compared toprevious years as a result13 of cold weather but13 the above subsidy scheme did not13 benefit13 older people because two of the seven day cold periods were after 31st March It must13 beassumed that13 there will be more people living in fuel poverty in the future and this will leadto more cases of cold related illness including influenza13 and stroke
32 Management of long term conditions
The management13 of long term conditions will be improved for patients who are compliant13 with their medication regime so it13 is possible that13 there may be compulsion to adhere tothe prescription Such compulsion may be monitored using technology Indeed the remotemonitoring of vital signs using telehealthcare will become commonplace as the old boxesand sensors are replaced by devices that13 can be worn continuously or which can beembedded into the fabric of homes (including furniture and bedding) or can be worn asvests or patches They will wirelessly transmit13 data13 to smartphones or tablets and mobile
28
transmission and cloud technology will enable real-shy‐time data13 collection analysis andfeedback
One of the diseases which is projected to increase most13 significantly over the comingdecade is Type 2 diabetes Whilst13 there is a hereditary susceptibility to this condition formany people including those from the Middle East13 and the Asian sub-shy‐continent it13 is also adisease which tends to affect13 those people who are overweight13 andor have a sedentarylifestyle If untreated diabetes can lead to dizziness and collapse at any time but13 can alsohave more devastating long term consequences which include kidney failure strokeblindness and in extreme cases lower limb amputations Management13 therefore includesdaily monitoring of blood glucose levels and major dietary changes such as a significant13 reduction in the consumption of carbohydrates as well as a rigid exercise regime
Many newly diagnosed diabetics follow this advice closely and can lead normal lives for 40years or more but13 some struggle to accept13 the change in lifestyle required as well asremembering which foods are allowed and how much exercise they need to takeIndividual support13 plans are now forthcoming and over the next13 ten years best13 practicewill emerge in the form of smartphone apps that13 are personalised and which can becomean individualrsquos health coach This level of support13 will be fine for some people but13 otherswill need incentives so it13 is likely that13 gaming technologies will be introduced perhapsoffering rewards for good compliance There will be a temptation for some people tocheat perhaps allowing others to perform exercise for them or changing theirconsumption details
Many of these opportunities for cheating will be removed through the use of a uniquebiometric identifier a technology that13 will be mature enough to use in place of passwordson smartphones However the biggest13 challenge may be in encouraging older people to usethe technology Many older people have multiple morbidities Indeed a survey of Scottishpatients implied that13 42 of people aged over 80 will suffer from three long termconditions It will be essential for those people to comply with treatment13 regimes if they arenot13 to have the functional deficits that13 follow
33 Finding people who13 donrsquot fit
People who have low social capital are likely to have few relatives and friends with whomthey regularly communicate and are also unlikely to be part13 of community or faithorganisations such as clubs societies and church groups They also die several yearsyounger than most13 of the population often because they donrsquot13 engage with public healthinitiatives such as vaccinations against13 flu regular checks on their blood pressure bloodsugar levels or in the case of women smear tests or mammography The most13 likelyreason for disappearing beneath the radar of such initiatives is their mobility which leadsalmost13 inevitably to them having no fixed abode and no fixed telephone line It thenbecomes very difficult13 for them to be contacted because their mobile telephones are likelyto have Pay-shy‐As-shy‐You-shy‐Go contracts that13 donrsquot13 require validated names addresses and bankaccounts
29
It follows that13 some of the most13 vulnerable people in society including those who live onthe streets are effectively unknown to both the NHS and to social work departments untilthey are referred in a crisis This could be an emergency presentation to a hospital Accident13 and Emergency Department13 where they will come into contact13 with a social worker becausedischarge may be unsafe This often highlights the importance of the prevention agenda13 and the potential for avoiding admissions to hospital by intervening at an earlier stage
The advantages of being able to locate people who are vulnerable to specific diseases willincrease as genetic testing becomes more routine It is already possible to determine whomight13 be most13 at risk of breast13 cancer and prostate cancer as a result13 of family history Addto this the evidence that13 particular diet13 and exposure to environmental factors can furtherincrease risk then it13 is evident13 that13 individuals can be identified and offered treatmentsthat13 could save their lives many years before they become ill In the case of cancersperhaps only the individual is involved but13 for infectious diseases it13 is the whole of societythat13 is at risk if someone contracts one of the new strains of influenza or if someonechooses not13 to be vaccinated against13 rubella In Chinese airports all visitors are screenedfor fever and refused entry if they tested positive in cities the public are monitored in thesame way Similar approaches may be necessary in the UK if potential carriers cannot13 otherwise be identified
34 Volunteering
It is estimated that13 72 per cent13 of people volunteered to perform a charitable act13 at least13 once during 2012 a rise from 65 per cent13 the previous year About13 four out13 of every 10volunteers offer their services formally to one or more organisations The remaindervolunteer informally by helping out13 a friend or a neighbour Around 50 per cent13 volunteered at least13 once a month in the past13 year up from 41 per cent13 on the previous13 year Most13 have retired many of them before the statutory retirement13 age Those whodonrsquot13 feel able to offer time have offered their financial support13 at a time when the fundingavailable from sources such as the National Lottery has been decreasing Despite economicausterity donations to charities have been increasing 74 per cent13 said they had given tocharity at least13 once in the previous month up from 72 per cent13 the previous year
Strikingly 78 per cent13 of people strongly believe that13 they are part13 of their localneighbourhood an increase from 70 per cent13 10 years previously Community cohesion isstronger than ever 87 per cent13 of people believe their local area13 is a place where peoplefrom different13 backgrounds get13 on well together compared to 80 per cent13 in 2003
The role of volunteers in supporting vulnerable people is therefore likely to increase overthe next13 decade perhaps exploiting the success of the army of volunteers that13 was highlysuccessful in London during the Olympic and Paralympic games The greatest13 role for suchvolunteers may be in providing informal care for older people Already the UK has someseven million informal carers whose value in monetary terms has been calculated to be
30
more than the combined budgets of the NHS and social care Maintaining or extending thisprovision will help to support13 services in the future and may be supported by technology
Whilst13 there is ample evidence to suggest13 that13 telecare services support13 informal carers asmuch as (if not13 more than) the people that13 they are caring for it13 is the potential for utilisingthe internet13 and apps to make their role easier to coordinate and hence more effectivethat13 is likely to be most13 successful moving forward
Many of these focus on particular tasks that13 informal carers can help offer to older peoplesuch as organising their medication A pillbox program is just13 one feature of an app calledBalance It also includes sections for caregiving tips notes for the doctor and the patientsappointments plus a lsquolearning sectionrsquo with articles on aspects of Alzheimers and an RSSfeed for news about13 the disease Tyze is another multi-shy‐functional app it13 allows carers to
bull Organise appointmentsbull Plan outingsbull Share storiesbull Send updates to other family members
Another application is Rally Round which helps carers to organise someone to perform littlejobs often on a temporary basis when someone has dementia physical frailty or isrecovering from accident13 or illness Similar applications are MeMaxi and Finerday
35 The High13 Street
The shape and appearance of UK shopping centres have been changing for half a centuryPeople complain that13 centres are losing their identity with one town looking like everyother both in terms of the stores and in terms of the layout But13 there are three trendswhich are having a profound impact13 on many of the most13 vulnerable people in society
bull Centres lock their doors at 6pm or in some cases 10pm -shy‐ thus denying people whosuffer from claustrophobia13 from window shopping at times when other shoppershave left
bull Out13 of town shopping malls -shy‐ these US style centres are ideal for people in carsbecause they offer free parking which is essential for people who want13 to buy largeritems but13 difficult13 for people who have no transport13 and who must13 rely on publictransport13 that13 is often deficient
bull The rise of online shopping -shy‐ which means that13 many potential shoppers only visit13 High Street13 stores to check the prices before returning home to make a purchaseonline
It is the third of these effects that13 has the greatest13 potential for changing the High Street13 forever and it13 is making life for traditional retailers increasingly difficult13 at a time when highrents are crippling stores large and small It is difficult13 to see how this trend is likely tochange because consolidation in banking and estate agencies is already forcing the closure
31
of other High Street13 players while additional pressures on pubs has led to the closure ofthousands of pubs every year
Those figures however demonstrate that13 consumers still value what13 the high street13 canoffer -shy‐ the chance to inspect13 what13 theyrsquore thinking of buying -shy‐ as well as the new opennessof the internet Customer service makes a difference to people especially if there is aproblem and goods need to be returned One of the most13 common reasons for furniture tobe returned for example is that13 when a sofa13 or a wardrobe was delivered it13 couldnrsquot13 fit13 through the front13 door or up the stairs In the future people will be able to benefit from13 visualisation technology they will upload the floor plans of their homes enabling theretailer to inform them of the problem before they try to delivery Augmented reality viewwill similarly allow customers to see what13 a new item of furniture will look like in itsintended place so that13 they can be more informed about13 the effect13 of size and colour
In terms of improving the viability of the High Street stores will have to focus on theimportance of brand which could mean that13 individual independent13 retailers will have topartner with national suppliers to support13 a local tailored offering based on products that13 are designed for a more global market This is a lsquoconnected High Streetrsquo approach whichcould be enabled by the developments in internet13 availability and smart13 phone accessdescribed in the previous section
The overall effect13 of all these changes could mean that13 town centres become smaller but13 more vibrant13 areas They could thrive if people are attracted there in large numbers whichmeans that13 retail must13 be developed alongside restaurants pubs galleries and other leisureopportunities This is possible in new shopping centres which are already being integratedwith transport13 hubs including railway and bus stations but13 may be more of a design13 challenge for older towns and cities with large Victorian buildings To ensure that13 morepeople are welcomed into the new centres they should include attention to green spacesand areas where people can relax without13 feeling that13 they are second class citizensbecause they donrsquot13 have the same buying power
3513 Privacy
To some people privacy is their right13 to live their lives without13 interference they may seethe State as a potential lsquoBig Brotherrsquo spying on their every move and judging their actions13 and activities Other people have fewer concerns about13 the role of the State but13 great13 fearof individuals interfering with and invading their privacy Some embrace the concept13 of lsquomyspacersquo an area13 of a square metre or so into which nobody can enter without13 permissionThis allows them to avoid physical contact13 and to feel safe from any form of threateningbehaviour
Yet13 this idea13 of private space and its potential violation is merely the tip of the iceberg asfar as privacy is concerned more significant13 is the idea13 of personal (and private)information being shared with anyone and everyone This could be related to identityopinion or image for an individual who wants to remain anonymous or even secretive thisis going to become an increasing problem as technology provides the means of taking
32
photographs recording conversations and capturing environment13 with something as smalland ubiquitous as a mobile phone The fact13 that13 this information can then be shared withthe rest13 of the world using e-shy‐mail Twitter and Facebook makes the problem all the moredifficult So the threat13 is no longer solely from the long lenses of the Paparazzi but13 fromanyone (and that13 means everyone) who has even the most13 basic of mobile phones
This relates to the changing views of society on what13 information should remain privateand what13 should be shared with others The success of social media13 has been based on anattitude of lsquosharing everythingrsquo with either your friends or the world This has introduced anaiumlve idea13 in the minds of some younger people (especially those known as Millennials ieaged 18-shy‐30) that13 everyone can be their friends whilst13 perhaps failing to reinforce the bondsof genuine friendship with any form of test13 or restriction Technology could play a role indefining these friendships and allowing individuals to understand what13 makes a goodfriend but13 this approach has yet13 to be developed and may be slow to overcome the needfor some people to measure their own popularity simply as the number of people that13 theycan list13 as friends on their Facebook page
It follows that13 there may be a need for a new definition of privacy that13 is in keeping withthe web and its ability to display images and opinion in an unregulated manner This needsto embrace past13 concerns about13 the ability of an individual to live without13 the threat13 ofothers being able to watch them whilst13 offering some protection from random postingsabout13 them online Perhaps this could include a right13 to be able to edit13 or remove anythingrelating to themselves on the Web including images that13 are not13 news-shy‐worthy Theownership of image rights may be an associated issue that13 needs to be addressedespecially as modern technology can remove an individual from a group (or a background)13 view provide digital touch-shy‐up or air-shy‐brushing and then republish it13 in a different13 contextHowever there is general agreement13 that13 personal information (such as contact13 details andbank codes) should not13 have a place on the web Surprisingly few people take proactivemeasures to prevent13 tracking functions being activated
It follows that13 too much privacy could lead to younger people fearing that13 they maybecome lost13 in a digital world It is not13 surprising then that13 they are prepared to make lots13 of personal information available often with no fear of how it13 might13 be used by othersWhen Google glasses and similar technologies become available during the next13 few yearsthey will have the potential to identify a stranger walking down the street and to find manyof their secrets to present13 to the wearer in a fraction of a second They could know moreabout13 them than their genuine friends know -shy‐ so who will be their friends in the future
36 Data sharing and13 protection
By lsquodata13 sharingrsquo we mean the disclosure of data13 held by one organisation on an individualto a third party organisation(s) or the sharing of data13 between different13 parts of anorganisation Some data13 sharing doesnrsquot13 involve personal data13 because it13 has beenanonymised in such a way that13 the statistics can be used for the collective good without13 theidentification of the individual The Data13 Protection Act13 (DPA) is in place to provide a legal
33
framework that13 ensures that13 organisations that13 hold personal data13 must13 act13 responsibly atall times These principles adequately describe the position of public and government13 bodies especially social services departments who are responsible for the informationconcerning the health and well-shy‐being of individuals -shy‐ and hence by implication thesensitive data13 relating to their vulnerability
The legal framework that13 applies to private and third sector organisations differs from that13 which applies to public sector organisations which may only act13 within the defined limits oftheir statutory powers However all bodies must13 comply fully with the data13 protectionprinciples and this situation is unlikely to change within the next13 10 to 15 years In someprivate sector contexts there are legal constraints on the disclosure of personal dataHowever most13 private and third sector organisations have a general ability to shareinformation provided this does not13 breach the DPA or any other law It is advisable for acompany to check its constitutional documents such as its memorandum and articles13 ofassociation to make sure there are no restrictions that13 would prevent13 it13 from sharingpersonal data13 in a particular context The type of data13 held is therefore a subject13 ofconcern as it13 may be difficult13 for legislation to keep up with the additional layers of data13 created on-shy‐line and through the Internet13 of Things
Private and third sector organisations should have regard to any industry-shy‐specific regulationor guidance about13 handling individualsrsquo information as this may affect13 the organisationrsquosability to share information They should also be aware of the legal issues that13 can arisewhen sharing personal data13 with public sector bodies This becomes more of an issue asprivate and third sector bodies are carrying out13 a wider range of traditionally public sectorfunctions Opportunities for inappropriate sharing of sensitive data13 will therefore inevitablyincrease
Public authorities must13 comply with the Human Rights Act13 (HRA) legislation in theperformance of their functions The HRA also applies to organisations in the private sectorinsofar as they carry out13 functions of a public nature which could include delivering a socialcare activity Where the HRA applies organisations must13 not13 act13 in a way that13 would beincompatible with rights under the European Convention on Human Rights Article 8 of theConvention giving everyone the right13 to respect13 for their private and family life their homeand their correspondence is especially relevant13 to sharing personal data If personal data13 isdisclosed or shared in ways that13 comply with the DPA the sharing or disclosure of that13 information is also likely to comply with the HRA The problem may still be in policing theActs and the rights of an individual if they believe that13 their personal data13 has been sharedor accessed by an inappropriate organisation or individual
A legal industry may be born to deal with such matters but13 this is unlikely to benefit13 peoplewho cannot13 afford the fees involved They would require either legal aid or to employ13 more13 lsquono win no feersquo companies Public attitudes to such costs might13 become negative unlessthey prove successful in preventing breaches of data13 security There may need to belegislation to provide a stronger basis for forcing compliance with privacy laws
34
37 Connecting with13 people
We are social creatures most13 of us rely on our friendships and interactions with friendsand families to share our happiest13 moments and experiences Research suggests that13 thishappiness is infectious at all levels and leads to a 15 increase in the happiness of a closecontact 10 for a second degree contact13 such as the friendrsquos spouse and a 6 increase fora friend of a friend It is hardly surprising that13 the success of social media13 such as Facebookis intimately related to the ability of people to quickly share their happiest13 moments with asmany of their friends and connections as possible
All this has happened during the rise of the Internet13 and the corresponding increase inopportunities for connecting online ie this is a 21st Century phenomenon which has beenfacilitated by Information and Communications Technology But13 the Internet13 remains in itsinfancy and we are only beginning to understand and exploit13 its potential In terms ofaccessing the Internet there are now perhaps two billion people who have access with99 of them having gained this during the past13 decade This number will have doubled bythe period 2020 to 2025 It is likely that13 everyone who wants to be connected in the UK willby then be connected Turning this on its head only those who donrsquot13 want13 to be online willnot13 be on the Internet13 within a decade Connecting with the unconnected will therefore bea case of identifying those people who donrsquot13 want13 to be found unfortunately these mayinclude many people who need the support13 of social care organisations It means that13 theywill be looking for support13 only when they are in crisis unless other ways of finding andormonitoring them are found
While the number of people connected via the Internet13 has exploded this might13 bedwarfed by the number of connected lsquothingsrsquo During 2009 the number of thingsconnected to the Internet13 surpassed the number of connected people at which point13 webegan to experience what13 this report13 has described as the lsquoInternet13 of Thingsrsquo Yet 99 ofall physical objects that13 could join this network are not13 yet13 connected but13 the number couldgrow by 25 every year for the next13 decade so that13 there could be 100 billion connectedobjects by 2025 some of which will be owned or used by everyone in the UK includingthose people who donrsquot13 want13 to be connected themselves We will then have an Internet13 of Everything which will be the smart13 connection of people data events and actions
With each new person object or data13 that13 comes online the connection possibilitiesbetween all these elements grows exponentially The rise of big data mobile networkingcloud storage and data13 mining technologies will all play a critical role in the Internet13 ofEverything The result13 will be new capabilities richer experiences and unprecedentedvalue for individuals businesses communities and countries everywhere The lsquonetworkeffectrsquo of the Internet13 of Everything will be a very powerful thing the true impact13 of whichwe wonrsquot13 fully understand for several years As it13 develops however those who are not13 connected will feel even more digitally and socially excluded There will be a need to reachout13 to vulnerable people unless the process of claiming requires proof of online identityand the payments to be received can only be redeemed using a chipped card or adownloaded app onto a smartphone This is of course the way that13 welfare arrangementsare already developing thus it13 might13 prove impossible to make a successful claim without13
35
already being connected to lsquothe systemrsquo either through an online presence or through theInternet13 of Things
38 Downloading everything
Sixty years ago information was discovered by reading books often in a library wherenotes had to be made because the books or journals couldnrsquot13 be removed Then in theearly 1960s the first13 office photocopying machines were introduced into the UK theyimmediately meant13 that13 pages or articles from books could be copied and taken away to beread and summarised later Within a few years photocopying became a replacement13 forreading as researchers became less adept13 at selecting a few sentences and every deskbecame a depository for reams of printed paper Paper became the means of recordingeverything from bank statements through to music
We now appreciate that13 printing everything is a waste of both the ink (or toner) used tocreate the black print13 and of paper which requires trees to be chopped down and pulpedbefore it13 can be pressed into thin sheets Saving paper is therefore seen as green and goodfor the planet Fortunately we no longer need to print13 everything because computermemory is unlimited thanks to the cloud and we can then view pages and articles onportable or fixed screens
The internet13 has everything and it13 is all available instantly for downloading providing thereis a device available to accept13 it and there is sufficient13 communication bandwidth toperform the transfer of data13 sufficiently quickly Thus we can record all text13 articles that13 are relevant13 to us including digital records of birth certificates qualifications and passportsand the need for original printed versions will decline But13 we can also do this forphotographs Most13 handheld computing devices include at least13 one camera so they cangenerate enormous number of pictures which can be kept13 for posterity without13 having toconsume inks and special papers to print13 them
But13 the materials that13 can be downloaded donrsquot13 stop at pictures software is available that13 can grab TV shows after they air and movies as soon as theyre released In the same wayit13 is possible to schedule music comic books video games and practically anything else asa download with minimal effort People will need enormous hard drives if they want13 theirown digital copies of these files so will more than likely make use of cloud storage that13 willbe available from many organisations The location of the servers may become sensitivedue to border restrictions as will the security of the data13 and the way that13 it13 is backed up sothat13 it13 is resilient13 to failures
It may be evident13 that13 application forms for all types of welfare payment13 will be availableonly for downloading so that once digitised they can be processed by computer andrecords sent13 to various servers for subsequent13 storage and processing Some people maywant13 to keep their data13 on them once it13 has been downloaded Pen drives can already holdseveral GB of data so it13 is likely that13 people will be able to carry their downloaded data13 withthem at all times irrespective of the size and complexities of the information
36
39 Health13 and13 well-shy‐being
The general health of the population is unlikely to deteriorate noticeably within 10 to 20years Indeed expectations of the population are that13 things must13 improve as surgicaltechniques mature and as pharmaceutical interventions become more personalised andpowerful However the rising demand for health services due to an ageing population andthe increasing cost13 of providing sophisticated therapies will make delivering a free anduniversal health service difficult13 without13 substantial increases in taxation This is unlikely tohappen in the UK even though spending on health services will be protected against13 thecuts facing other services
There will have to be changes in how the NHS works For twenty years hospitals have beenclosed and replaced by fewer new facilities so that13 the bed count13 is reduced This has led toa significant13 shift13 in resources to primary care and community care supporting shorter staysin hospital and speedier transfer back home for people after surgery or illness This hasbeen13 successful but13 there remain problems with demand for GP services especially out-shy‐of-shy‐hours and at weekends Indeed despite the introduction of NHS24 and similar help-shy‐linesthe demand for GP appointments continues to increase Delays are inevitable and this willincrease system failures with more unnecessary deaths and a failure for people to access adiagnosis that13 might13 lead to early interventions and ultimately lower delivery costs Over250 more patients are added to waiting lists every day
This will lead to a new model of primary care consistent13 with existing changes which haveseen surgeries move from High Street13 locations to medical centres close to bus routes andwith more parking for patients The process of making an appointment13 is changing from atelephone-shy‐based interview process dominated by a medically-shy‐unqualified receptionist13 to achoose and book approach using an online process linked to electronic patient13 records Thiswill give patients more convenience but13 will allow priority for those who have Internet13 access at the expensive of those who are digitally excluded Making the process of bookingan appointment13 quick and easy may also increase demand from people who do not13 need tobe seen as it13 will fail to identify those in greatest13 need
A greater use of telehealth and telecare technologies will be inevitable beginning with thefirst13 contact13 as an encounter using the telephone e-shy‐mail or video conferencing -shy‐ a visit13 tothe GP surgery should be a last13 resort and should involve a nurse consultation in the first13 instance This would be consistent13 with three quarters of appointments currently involvinga chronic disease or long term condition which relates to improved self-shy‐care The support13 ofthese patients at home should be prioritised through tele-shy‐ and web-shy‐based technologies andshould involve training and coaching through a network of nurse practitioners Home visitsshould generally be unnecessary through the use of these technologies but13 could besupplemented by satellite surgeries manned by nursing in community premises or inpharmacies nurseries and Internet13 cafes
The homes13 of people who13 need13 closer monitoring can then become part13 of virtual wardswith real or electronic visits by health professionals University Hospital Southampton NHSFoundation Trust13 already looks after patients who have undergone surgery such as a hip orknee13 replacements in virtual wards with high levels of satisfaction The Royal Free London
37
NHS Foundation Trust13 offers a similar service but13 plans to add the possibility of videoconsultations between patient13 and consultant
310 Attitudes to public health issues ndash obesity smoking alcohol abuse drugs
As self-shy‐care becomes the focus of the NHS the public will increasingly understand that13 thecosts and availability of services are being harmed by the poor health behaviour ofrelatively small numbers of people The link between public health initiatives today andhealthcare needs and costs in the future will become increasingly evident13 as a result13 of theway that13 information is presented Thus the overweight13 smoker who currently attractsconcern and pity when they are diagnosed with diabetes and COPD is increasingly beingseen as the victim of their own stupidity or lack of self-shy‐discipline If they continue to neglect13 medical advice and continue with an unhealthy lifestyle then the way that13 they receivetreatment13 and consume resources will become a matter for the entire population
Obesity is seen as due to a combination of poor diet13 and a sedentary lifestyle No longer isthe idea13 that13 people are lsquobig bonedrsquo acceptable Governments will respond initially byrequiring manufacturers and food processors to provide nutritional information onpackaging and on menus in restaurants But13 people can choose not13 to read the data13 and toneglect13 both the importance of food quality content13 and quantity This will increasepressure to introduce fat13 or sugar taxes and these are likely to be in force within a decade
Although the high taxes on tobacco products has forced some smokers to reduce theirconsumption or to give up altogether the impact13 has been reduced by the smuggling ofproducts from overseas and by the availability of duty-shy‐free cigarettes for people returningfrom foreign holidays and business meetings Further measures are planned to changepackaging and to include even more graphic images and warnings on cigarette packages tomake smokers aware of the effects of smoking on their health and well-shy‐being There is asyet little evidence of how successful this might13 be More effective has been the banning ofsmoking in public places including trains and aircraft Expensive medical interventions suchas heart13 transplants will be denied to individuals until they change their lifestyle behaviourSmokers might13 therefore be increasingly ostracised leading to a loss of esteem This mayhave a particular impact13 on people who already suffer from mental health problems whoare more likely to smoke
The overuse of alcohol is being recognised as a major factor in hospital admissions withNHS figures showing an increase of over 40 in such admissions over the past13 decadeLinked to this has been a 75 increase in prescriptions to treat13 alcohol dependency Fewpeople have sympathy for those who waste their limited income on booze If they havechildren or other dependents they will be the ones who suffer and who may need thesupport13 of social care
Drug users are already significant13 users of social services as their habit13 is likely to makethem unemployable They receive little sympathy from the general public because they areseen as criminals and people who waste public resources Levels of drug abuse have been
38
slowly increasing over the years but13 this trend is slowly being reversed Indeed the numberof people using drugs during the past13 year has fallen to its lowest13 level for nearly 20 years(below 9) with cannabis being most13 likely often following excessive drinking Aselectronic noses and other technologies can detect13 traces of drugs it13 seems likely that13 success in overcoming addiction can be measured objectively This may become a two-shy‐edged sword rewarding those who can turn around their lives but13 further marginalisingthose who canrsquot13 or wont13 accept13 the lsquocold turkeyrsquo
311 Attitudes to surveillance
Issues associated with privacy confidentiality and data13 security have been discussedpreviously in the context13 of information technology the World Wide Web and the ease ofcollecting recording recalling analysing and displaying data The monitoring of individualsand their methods of using this information can be regarded as surveillance As thequantities of data13 increase along with the number of devices that13 can be used to access itthe surveillance tools will also increase in their sophistication Indeed the Big Data13 approaches described in the previous section will enable the combination of structureddata13 (such as the information held in databases) to be married with unstructured data13 fromimages in such a way that13 it13 can be mined
Whilst13 the lsquodigital surveillancersquo methods described above may cause most13 concern topeople because of its impact13 on anonymity it13 is the collection and analysis of images that13 are the major concern to people as they contemplate the ways that13 lsquoBig Brotherrsquo maydevelop to restrict13 freedom Every major UK city and town centre has an array of CCTVcameras that13 continually record activities from every angle If it13 used to be true that13 nobody in London was more than 10 yards from a rat it13 is certainly the case today that13 nobody can be more than this distance from being in view of a surveillance camera Yetthey receive so much positive publicity from TV programmes where their footage is used todetect13 vehicles close to a crime scene or to monitor the movements of suspects that13 theyare now accepted by the public as a deterrent13 in the same way as lsquobobbies on the beatrsquowere seen 25 years ago There is therefore little public reaction to the expansion in the useof video surveillance except13 for the practical observation of how so many views can beinspected and recorded
Looking to the future the tumbling cost13 of video technology will surely lead to anotherincrease in the number of devices The aerial views taken from towers will besupplemented by more local views taken by devices that13 are embedded in the fabric ofbuildings or carried by individuals either on their person (for example on clothing orspectacles) or in the bags that13 they carry The time and date-shy‐stamped images as Big Datawill be recorded to lsquothe Cloudrsquo where it13 can be added to other data It can then be usedwhen an incident13 has occurred or to provide further detail of night-shy‐time activities
It follows that13 there will be no hiding place for people who simply want13 to disappear Theymay respond by wearing clothing (such as hoodies) that13 hide their faces or which make it13 difficult13 to distinguish gait13 or mannerisms from which they might13 be identified New forms
39
of clothing may be designed to make shapes more difficult13 to analyse and these might13 become the uniforms of a class of person who wants to live in a way that13 they donrsquot13 interact13 with officials from any ministry or local government13 department If they also obstruct13 services then they will be considered to be anarchists of some form sparking protests fromother sectors of society
31213 Attitudes to driving
Motor cars have been a feature of UK roads for over a century but13 it13 is only during the past13 50 years that13 they have become a resource that13 most13 families have had access to enablingthem to travel without13 the restrictions imposed by a limited railway network and non-shy‐integrated bus transport People who have had a car throughout13 their lives often see theircars as an important13 factor in enabling them to remain independent13 and to exercise choicesrelating to where they shop and where they spend their leisure time This extends to theirspouse and to friends and neighbours that13 they might13 take with them on their variousexpeditions
Unfortunately there are incidents involving older drivers who perhaps go down amotorway in the wrong direction who are taken ill at the wheel or who are involved in anaccident13 involving no other vehicles These are small in number but13 often lead to a reactionthat13 they shouldnrsquot13 be allowed to drive lsquoat13 their agersquo Age itself is not13 an indicator ofdriving quality but13 because old age also brings more chance of having limited long termconditions and other illnesses it13 is easy to make a link between driving ability and age Thelicensing system does require continued driving to be linked with medical advice andforbids people with poor eyesight epilepsy and other conditions to hold a licence in oldage
Yet13 statistically older drivers cause far fewer accidents than younger drivers The reasonsfor this may be complex and are likely to include the fact13 that13 they drive less often covershorter distances and donrsquot13 go out13 in the dark or in poor weather However it13 does not13 wholly explain why the UKrsquos drivers aged over 70 and who represent13 some 8 of all driversare involved in only 4 of accidents that13 cause injury This compares favourably with the15 of13 drivers aged between 17 and 29 who are involved in over a third of crashes that13 result13 in injury
By 2020 the number of drivers aged over 70 on UK roads is likely to increase to over 7million This will require a new national strategy perhaps involving support13 for olderdrivers further training raising awareness of issues and making more use of adaptivetechnologies to support13 the driver in avoiding collision or forgetting to check on the statusof their vehicle Poor eyesight13 could be enhanced by camera technologies rather thanforcing people off the road if they are unable to read a licence plate
The International Longevity Centre has found that13 one in four Britons thought13 driversshould be made to switch off the ignition for good somewhere between the ages of 70 and75 The numbers may decrease as the population ages and as cars become safer Forcing
40
older people off the road may be a natural consequence of providing free bus passes andsubsidised rail fares but13 the growth in the pavement13 scooter industry demonstrates that13 older people value their independence and will do almost13 anything to get13 out13 and aboutPerhaps legislation will result13 in more regulation of electric vehicles and where they cantravel
There can be no doubt13 that13 getting out13 will be associated with better quality of life andwell-shy‐being and this is likely to be supported in the future as evidence of improvedoutcomes emerges It is to be hoped that13 positive stories will be publicised so that13 publicattitudes arenrsquot13 hardened This may be supported by more in-shy‐car monitoring of drivers andthe linking of performance with on-shy‐line driving records and licences These could throughremotely monitored ignition systems prevent13 the use of motor vehicles by people without13 a licence or without13 insurance
313 Climate change
There is a general view that13 the emissions of carbon gases are contributing to globalwarming in a manner that13 will change the UK climate in such a way that13 the climate maybecome more Mediterranean However some scientists believe that13 manrsquos impact13 on theenvironment13 may be small compared with natural variations caused for example bycyclical changes in the sunrsquos energy output13 or by the effects of volcanoes and earthquakesRecent13 evidence has suggested that13 we are going through a phase of changing extremesand that13 this is more likely to cause storms periods of excessive rainfall and unusualseasonal trends with snow and frost13 in the spring and warmer winters Considerableuncertainty remains and it13 might13 be necessary to plan for a number of different13 scenariosand for the impact13 on vulnerable people
I Colder winters UK properties are poorly insulated resulting in excess mortalitiesduring cold spells due to an increased number of people suffering from stroke aswell as bronchitis and other pulmonary diseases The cost13 of heating continues toincrease putting more households into a state of fuel poverty Any further coolingduring the winter months will result13 in more people living in unhealthy coldconditions Winter fuel payments are likely to be restricted to the poorest13 peoplebut13 this might13 exclude people who live in larger properties that13 are more difficult13 toheat
II More storms excessive winds and rain can cause flooding at any time of the yearMany UK communities are built13 close to rivers and these can surge during heavyrainfall causing houses to be filled with water and furniture and carpets lostInsurance can be problematic for properties built13 on flood plains which can blight13 properties and prevent13 owners from being able to sell and move on High winds canrip off roofs causing injury and also causing families to be left13 homeless anddependent13 on social services
III Hot13 summers Europe suffered high temperatures during the summers of 2003 and2004 leading to heat13 stroke and hypothermia The UK has not13 previously sufferedfrom such problems but13 might13 be expected to experience days of extreme
41
temperature and humidity at times Older people may not13 be prepared for suchweather Street13 dwellers may be unable to find shade and supplies of drinkingwater
Irrespective of what13 combination of weather scenarios arise it13 must13 be concluded that13 any extremes will have a major negative impact13 on vulnerable people especially if theyare not13 prepared because they havenrsquot13 received the weather warnings and advice that13 can be broadcast13 using the TV radio and online services Once again the digitallyexcluded will suffer and will pay a high cost Society will continue to pick up the bill interms of demands on social care services unless preventive actions are taken in theform of connecting these people to each other and to formal services
42
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
s13 13
13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
n13 13
13 s13
r13 n13
e13 at13
e13 y13 e13 ld13
ly13
13 e13 t13 e13
s13 er13 e13
f13
rt13 13
13 13
13
r13 13
s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
e13 g13 13
e13
13 13 ial13
13
d13
13 d13 h13 r13
d13 13
s13 y13
e13
13
rd13 r13 e13
13
13
13
e13
e13
d13 13
13
13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
bull Firstly the type of person and the range of issues that13 are likely to affect13 people andfamilies
bull Secondly the likely impact13 of technology on such cases Not13 surprisingly somecases will need the same dedication of social work staff and traditional means ofsupport13 that13 they might13 require today and did require ten years ago Others might13 require a very different13 approach and outcomes that13 could depend on theavailability of and access to new technologies These represent13 perhaps the most13 exciting cases because they can show improved outcomes lower cost and greatersatisfaction for all stakeholders if the initial consultation assessment13 and prescribedservice take advantage of the relevant13 technological interventions
3
ne13
le13
ne13
2 TECHNOLOGICAL CHANGES THAT13 COULD HAVE13 A DIRECT13 IMPACT ON SOCIAL CARE
Taken as whole lsquotechnologicalrsquo developments can be overwhelming so this section breaksup technology into discrete elements and considers the likely impact13 of each In this waywe intend to make it13 easier to understand and to imagine in a real and constructive wayhow and when they might13 become significant
21 Personal computing13
In reality we absorb and integrate new technology all the time some of us a different13 ratesthan others Consider how over 40 years computers and the internet13 moved from beingobscure and specialised tools to driving commonplace consumer devices Most13 computingdevices already have more processing power than the spacecraft13 that13 landed men on themoon in 1969
1970 bull A computer was a large device (a lsquomainframersquo the size of large wardrobe) that required13 acarefully13 regulated air-shy‐conditioned roomo Information was input through punch-shy‐cardso There was no keyboard and no video display
1980s bull The first personal computers arrived but were mainly for enthusiastsbull Word processors arrived in offices allowing text editing and formattingbull By the end13 of the decade desktop PCs13 were popular but still relied on the user learning arca
commands13 (eg the Amstrad)1990s bull Email virtually unheard of at work and at home
bull The Apple Mac with its pointing device (mouse) and Graphical User Interface made it possib to use a computer without learning13 arcane13 commands
bull Microsoft followed with Windows and by the end of the decade desktop computers werecommonplace
bull In the mid 1990s the word wide web arrived and the word lsquointernetrsquo13 entered everydayvocabulary
bull lsquoDial-shy‐uprsquo access to13 the internet available at work and13 at home via a modem and13 telephone li bull First generation of mobile13 phones take13 off ndash texting unexpectedly popular
2000s bull Broadband13 replaces lsquodial-shy‐uprsquo allowing lsquoalways onrsquo internet connectionbull Smartphones allow us to connect to the13 internet on the movebull Smartphones can record videobull Youtube allows free sharing of videobull Online shopping commonplacebull Laptops increase13 in popularitybull Email widespread in personal and working lifebull Social networks part of everyday life13 (eg Facebook -shy‐ one billion13 members)bull Email widely considered a plague that needs controlling
2010s bull Tablets increasing in popularity at expense of laptopsbull Touch screensbull Video phone (skype) making face to face communication an affordable realitybull Email widely considered a plague that needs controllingbull Future13 Identities report finds lsquoPeople13 are13 accustomed to switching seamlessly between the13
internet and the physical13 world and use social13 media to conduct their lives in a way thatdissolves the divide between13 online and13 offline identitiesrsquo13 httpwwwbisgovukforesightour-shy‐workpolicy-shy‐futuresidentity
4
Accessibility acceptability and fashion
People adopt13 new technologies at different13 rates and some reject13 them completely Themobile phone might13 seem ubiquitous but13 some people refuse to have anything to do withthem
Some new devices are emerging such as an lsquoi-shy‐watchrsquo -shy‐ a kind of i-shy‐phone worn on the wristwhile a number of companies have suggested that they will use flexible electronic circuit13 boards to produce conformable devices that13 might13 be integrated into clothing or producedas a band that13 could be worn on the forearm
Google has been experimenting with heads-shy‐up displays which would allow someone to viewa display without13 having to carry a screen This approach would enable an individual toreceive real-shy‐time information as they walked around It might13 promote virtual visits todistant13 locations and virtual reality scenarios for games will increasingly interact13 with thereal world
It is likely that13 there will be an increasing choice allowing users to select13 devices most13 appropriate to their own lifestyle Ease of use may become a more important13 factor infuture designs thus enabling all citizens to enjoy ownership and applications of thetechnology
It is possible that13 not13 owning such a device or not13 being able to fully utilise it will become acharacteristic of the disadvantaged few -shy‐ and perhaps the people who will most13 need helpfrom13 social workers
22 Information generation and storage
As recently as ten years ago the amount13 of digital data13 or information we could store wasstrictly limited by the capacity and cost13 of storage media tapes floppy discs and harddrives The cost13 has fallen so much that13 today there is effectively ample space to store allthe data13 that13 we can create
The challenge is to store it securely and in such a way that it can then be retrieved quicklywhen needed and from13 any location13
We can now easily access bus and train timetables online the Kindle has created a hugemarket13 in e-shy‐books and even the Argos catalogue is expected to be available only as a digitaldownload
Cloud storage is the term used to describe a world in which we no longer keep our data13 (documents books photos video) on our own devices Instead we store them on cloudservices such as Flickr Youtube Google Drive We can even keep personal data13 such asreceipts using services such as httpwwwimmobilisecom which offers an online
5
portfolio for your personal belongings And Final Fling is an example that13 enables us to planfor our death
If entire identities are effectively digitised and stored in this way people who have not13 allowed their data13 to be created and warehoused in this way will be seriouslydisadvantaged They could be forced to join an underworld of digital refuseniks who areunable to apply for jobs for a passport for a driving licence and for welfare payments
23 Stratification13 and analytical techniques
The amount13 of data13 collected about13 each individual in society is increasing rapidly The data13 gathered by government13 and health systems tends to be highly structured which allowseasy comparisons to be made between any individualrsquos result13 and an average value forsimilar people This leads to important13 knowledge of distributions and how they might13 change over time
But13 commercial organisations such as supermarkets and online retailers also routinelygather data13 about13 our purchases our movements and our preferences This is known as BigData and analytical techniques known as Data Mining are evolving which look for trendsthat13 might13 offer some level of prediction
From an individual perspective Big Data13 can tell people how much they are like everybodyelse Indeed a personal analysis might13 tell them that13 there are another several hundredpeople just13 like them in Glasgow in Scotland in the UK in Europe or in the world How thisinformation is used is the important13 issue If it13 is used to make people feel lsquonormalrsquo then it13 can be positive but13 equally if it13 is used to stop people feeling that13 they are lsquospecialrsquo thenthis could lead to a loss of self-shy‐esteem
24 Communication13 technologies
The origins13 of social alarms lie in sheltered housing The assumption during the 1950s and1960s was that13 the people who needed to live in this type of accommodation were bothvulnerable and relatively poor As telephone lines were at that13 time a luxury whichcouldnrsquot13 be afforded by many hard-shy‐wired warden-shy‐call systems similar to the hospitalbedside call were devised Subsequently they evolved into two-shy‐way intercom systemsbetween the resident13 and a call monitoring centre rather than a local warden
These hard-shy‐wired arrangements were bespoke to each manufacturer and were thereforelimited in performance and in linking in with other peripheral devices and telecare Duringthe 1970s the telephone became less of a luxury and the number of households of allincome levels who had their own telephone lines rose rapidly
6
The 1990s saw the emergence of home computing the BBC Micro and gaming machinessuch as the Commodore 64 and the Attari Electronic mail (e-shy‐mail) until then the preserveof academic and research institutions moved into the mainstream at first13 connecting via13 (relatively slow) modems and ordinary telephone lines One drawback was that13 thetelephone could not13 be used at the same time as the computer was connected to theinternet a frequent13 cause of family friction In the late 1990s and early 2000s this problemwas solved when broadband became more widely available and cheaper allowing fasterspeeds an always-shy‐on facility and the ability to use the telephone at the same time
As broadband speed and capacity continued to increase so did the ability to use theinternet13 to access video music and all kinds of electronic commerce (for example shoppingtravel)
Perhaps even more dramatic have been the improvements made in mobilecommunications Third Generation (3G) phones allow us to use the Internet13 lsquoon the moversquovia13 smart13 phones and tablet13 devices Fourth Generation (4G) began rolling out13 in 2012offering faster access
By 2025 one can13 confidently13 predict13 that wireless13 communications13 will13 be available across13 the UK and with a bandwidth which13 can13 support13 both audio and video13 services
Effectively anyone who wants to speak to people will be able to do so and the only peoplewho will not13 be able to do this will be those who wish to hide or to avoid contact
25 The internet of things and the Quantified13 Self
The internet13 works by connecting computers around the world Each computer connectedto the internet13 has a unique address (known as an IP -shy‐ Internet13 Protocol -shy‐ number) Manydevices13 now contain some kind of microchip which makes such a device in effect acomputer
This means that13 electrical appliances from washing machines to refrigerators cancommunicate with other machines also connected to the Internet Indeed manufacturershave provided this facility for a number of years in order to monitor performance and tocheck remotely on their operational status The same principle can be applied inagriculture a cow on a farm could be identified by an IP address allowing the farmer and adairy to its monitor its milk output13 or its health
As more and more devices acquire an internet13 address we talk about13 the lsquointernet13 ofthingsrsquo lsquoequipping all objects in the world with minuscule identifying devicesrsquo(httpenwikipediaorgwikiInternet_of_Things) These things might13 include buildingsthe home healthcare and transport healthcare providers cars and emergency serviceslocations such as industrial parks hospitals car parks and police stations and devices suchas tablet13 computers and cash machines
7
The development13 of small and relatively low-shy‐cost13 medical devices for measuring relevant13 vital signs or medical parameters such as pulse rate and blood sugar level means that13 individuals can take their own measurements and then take responsibility forunderstanding their meaning (with appropriate support13 where necessary) and modifyingtheir behaviour accordingly
The availability of smart13 phones capable of running apps (specialised lsquoapplications) has ledto the development13 of new measures of well-shy‐being that13 are based on the individualinputting information on location the way that13 they feel and their interactions with othersThe smartphone can provide additional context13 automatically including location thenumber of conversations the distance travelled and external parameters such as theweather and the temperature This supports the idea13 of a life that13 can be measured in asensitive manner many times a day and without13 being seen as intrusive This leads to theconcept13 of the Quantified Self
Knowing how one feels and how one lives in a way that13 can be measured and easilycompared with other people can have both benefits and disadvantages The benefits tosociety mainly stem from an ability to identify people who are unhealthy both with respect13 to acute needs and from a predictive point13 of view those who are likely to be unwell atsome time in the future In the mental health space people who have bipolar disorder canbe monitored and supported more efficiently perhaps leading to a reduction in self-shy‐harmand suicide
There are likely to be some people who rebel against13 the need for measuring their owncondition daily and for ever They could view the measurement13 regime as being arestriction on their own lives preventing them from doing what13 they want13 to do because ofthe need to compete with their own measurements This could lead them to walk awayfrom treatment13 regimes resulting in a sudden decline in their well-shy‐being
26 Social networks
Social capital1 refers to the collective or economic benefits derived from cooperationbetween individuals and groups and highlights the importance of social networks that13 linkfamily friends neighbours and communities Wellbeing can be affected by connectivitypeople who have low social capital are likely to be lonely but13 also are more likely to reject13 public health initiatives such as flu jabs which could be beneficial to their health and well-shy‐being
The number of older people who live alone has been increasing for many decades By 2025two out13 of every five older people are likely to live alone Their quality of life may dependon them being able to build strong social networks Traditionally these networks were built13
1 lsquoJust as a screwdriver (physical capital) or a university education (cultural capital or human capital) can increase productivity (both individual and collective) so do social contacts affect theproductivity of individuals and groupsrsquo httpenwikipediaorgwikiSocial_capital
8
on neighbourhoods clubs and pubs and religious groups Meetings became social eventsand absence either signified a rejection of the group or a trigger for other members tobegin to visit But13 what13 happens when a network starts to disintegrate because of death orgeographic dispersal or because the individual loses physical capacity Can web-shy‐basedsocial networks compensate by nullifying geographic separation or by building newnetworks
Skype arguably demonstrates that13 lsquogeography is historyrsquo by making possible free real timevideo communication with family and friends thousands miles and continents apart Thebarrier of course is being able to afford a computer and a broadband connection whichmay limit13 use by lower socio-shy‐economic groups However its potential as a support13 mechanism should not13 be underestimated the technology is simple and it13 works we needonly the social economic and political will to make it13 happen In Scotland older peopleenjoy free bus travel why not13 free broadband
Social networks such as Friends Reunited and more significantly Facebook have emergedas vehicles that13 can not13 only link friends together but13 can also become a means of appealingfor associations and linkages that13 can be supported by the sharing of personal information
The inclusion of a camera13 on smartphones makes it13 easy to share photographs which canenrich communication For example proud parents may announce the arrival of a newbaby with a picture that13 everyone might13 wish to see On the other hand employers might13 also see evidence of why someone who has phoned in sick is unavailable for work on aparticular day Being aware of and able to set13 privacy levels is therefore important13 in orderto control who can see your personal information and news young people and vulnerableadults in particular may admit13 more people as lsquofriendsrsquo (or connections) than might13 beadvisable
The lifetime of major social networks is likely to be limited to a few years as new businessmodels13 emerge and new promotional strategies offer benefits to subscribers This mayoffer an opportunity for new networks to be created to deal specifically with those peoplewho are excluded in any way including those who will be referred to social services forassessment13 and support
27 Entertainment
Many people still remember the coronation of Queen Elizabeth in 1953 being shown live ontelevision This was an important13 milestone in establishing this new medium as acompetitor to radio and the cinema13 as a source of entertainment The arrival of colour TVin the late 1960s contributed to the declining popularity of cinemas and theatres many ofwhich closed
Today many homes have a TV in every room and technology has advanced to deliver highdefinition and 3D pictures on very large screens or lsquohome cinemasrsquo with surround sound
9
Paradoxically perhaps radio is more popular than ever and cinema13 has bounced back fromdecline to once again become an important13 element13 in the social lives of many people
Video images still or moving can be displayed also on laptops tablet13 devices andsmartphones which means that13 people can be entertained or informed on the move Sometrain operators have followed airlines in providing an lsquoat13 seatrsquo entertainment13 experience13 which can be offered with certain choices though many passengers prefer to use their owndevices and content In the future it13 seems likely that13 access to both audio and videoentertainment13 will be possible at any location and in a way that13 doesnrsquot13 interfere with theenvironment13 of other passengers
For those who want13 neither video nor audio (eg music) entertainment reading mayremain the entertainment13 of choice Many older people have struggled to find suitablereading materials as a result13 of the closure of local public and mobile libraries Some peoplecannot13 support13 the weight13 of a book while others lack the dexterity to turn the pagesOthers have sight13 problems which prevent13 them from reading small print All theseproblems can be overcome using either text13 to speech technologies (which are replacingtalking books) or by using e-shy‐reader devices which allow font13 sizes to be increased easily andwhich offer simple interfacing for moving pages backwards or forwards
In the future it13 must13 be assumed that13 all entertainment13 media13 will be held in the lsquocloud2rsquoand will be downloadable to an appropriate device on payment13 of a fee provided that13 acommunications contract13 is in place
The pre-shy‐requisites will bebull A device (eg PC laptop tablet Kindle)bull A contract13 with a telecoms provider (eg BT Virgin Sky) for broadbandbull A contract13 or contracts with media13 provider(s) (eg Netflix iTunes)
Those who lack any of these components may be entertainment13 excluded
28 Cash13 and13 money
Cash has been king since the abolition of the gold standard It is an expensive method oftransferring money between people and organisations and is a considerable overhead forindustry and for individuals travelling between different13 countries The highest13 denominations are lightweight13 and easily lost stolen or destroyed while the smallest13 denominations are heavy dirty and difficult13 to handle It is surprising that13 physical cashcontinues to be used It can only be a matter of time before it13 is digitised and replaced byvirtual cash
2 This means the material (book film or whatever) is stored in a remote computer (thecloud) and downloaded (or lsquostreamedrsquo) to your device on demand and possibly onlytemporarily
10
Large payments were previously made by cheque They are expensive to process by thebanks because people can write them by hand which makes them difficult13 to readelectronically and automatically Consequently they require human intervention and this isnot13 what13 modern banks wish to do so they want13 to promote greater use of debit13 and credit13 cards The latter were used initially as a cheque guarantee but13 are now being used almost13 exclusively as a means of withdrawing cash from ATMs and for making paymentselectronically UK banks wanted to do away with cheques by mid-shy‐2012 but13 they had toperform a u-shy‐turn under pressure from charities representing older people It is apparent13 that13 digital cheques and other cheque-shy‐replacement13 strategies will be introduced soon that13 satisfy the most13 pressing concerns of older people
It was difficult13 to see how cash could be replaced for payments for lower cost13 items such asnewspapers and sweets until the era13 of contactless payments Near field communicationsystems are likely to replace bar-shy‐codes to carry product13 identification information Theycan be read by electronic receivers The same technology can be two-shy‐directional allowinginformation to be passed from a smart13 phone to a reader and back again The smart13 phoneeffectively becomes a wallet13 which can be digitally filled by the owner and then emptiedwhen making purchases For small sums of money this approach is ideal and is likely to berolled out If cash disappears then begging will become difficult13 and welfare paymentsmade on a card Such cards are already used by social services as a means of providingclaimants with a means of receiving self directed care and support By restricting use of thecard to outlets that13 can provide care and support13 services opportunities for spending thecash inappropriately are restricted
It follows that13 many users of social services will need to have a smart13 phone as well as acard that13 can be used to buy services In the future smart13 phones may be provided as aloan item to claimants for social care This could include a digital wallet13 facility as well asthe communications and information ecosystem that13 would allow these people to receive awhole range of other services that13 would prevent13 their social exclusion and which could beused directly to provide them with information and access to entertainment
29 Biometrics and fraud13 prevention
Identity theft13 is used by criminals to pretend to be someone else in order to accessresources or obtain credit13 and other benefits in that13 persons name Although the concept13 has been around for centuries it13 is a growing concern in the digital world as we acquiremultiple online identities for bank accounts social networks and using public services such13 as paying tax electoral registration etc
Passwords are fraught13 with difficulty typically they are hard for humans to remember andeasy for machines to crack Efforts are therefore focused on other forms of provingidentity for example
11
bull Fingerprints have been accepted for over two thousand years to confirm identitymostly in criminal justice The technique has been applied to door-shy‐lock opening insome supported housing schemes There are practical problems associated withregistering lsquoallowedrsquo fingerprints and the useful lifetime of such products is also onlyabout13 three or four years
bull Retinal imaging and DNA analysis have been relatively slow to follow but13 only dueto the sophistication required for measurements and the time taken for testing Acombination of retinal imaging with facial gestures and blinking is possible in the labbut13 currently takes half a minute to achieve a match -shy‐ and this is achieved only withthe use of considerable computer processing power This sort13 of time makesapplications in mass people transfer impossible
Current13 research in this area13 is focusing on the uniqueness of other body parts such as earsand knees as biometric indicators The ears have great13 potential because they are usuallyexposed though hidden sometimes behind hair and other times by hats and other clothingOn the other hand the knees are rarely visible and however unique they may be there willbe cultural and religious obstacles to overcome before scanning could become a regularpart13 of identity confirmation The cameras which are central to such systems used to beexpensive but as the cost13 of high quality cameras continues to fall (there is one in nearlyevery mobile phone) it13 becomes feasible to devise identification devices that13 use multiplecameras to simultaneously recognise the eye and the ear
Movement analysis can be used to identify people by their walk gait13 and other biorhythmsprovide unique signatures It is possible to learn someone elsersquos gait13 though and injury orillness13 can have a temporary effect13 on gait
Over the next13 ten years with more sophisticated databases and image processing facilitiesthe cost13 of implementing advanced biometrics will fall enabling their application acrossmore diverse areas and in more social opportunities Potentially cameras will use cloud-shy‐technologies to provide individuals with instant13 recognition of anyone approaching them inthe street This could prompt13 a name or the occasion when they were last13 seen or spokento as a secondary method of control in much the same way as Internet13 banking seeks toavoid fraud This13 has13 the13 potential to remove13 the13 need for13 passwords13 and might13 then be13 the basis of machine-shy‐based13 communication13 either in front13 of a laptop or tablet13 device orwhen using13 a smart13 phone
There will need to be special measures introduced to support13 people with any form ofdisability as they might13 well have one or more sensory deficits Similarly people maystruggle to communicate following a stroke or a serious accident Nevertheless it13 may bereasonable to conclude that13 such systems will be both available and acceptable within thenext13 10 to 12 years
12
210 Health13 information
Health records in the form of written documents x-shy‐ray images and clinical observations arean important13 means of making all interventions efficient13 and safe Increasingly people havemany different13 conditions (comorbidities) and may be treated by several specialists Asthese physical records are moved inevitably some get13 lost estimates suggest13 that13 one inthree records is lsquolostrsquo at any one time
The best13 resource for information about13 a patient13 is his or her primary care record which isheld by the GP The UK was an early adopter of electronic primary care records and can beproud of the way that13 these have enabled population-shy‐based information to be collectedand analysed Scotland (and to a lesser extent13 Wales) has led the way in ensuring that13 allthese records are accessible through anonymised approaches that13 allow researchers toexamine trends and improve analysis of performance Fundamental to this has been theallocation of a unique identifier At13 the same time individuals can access these recordsboth to check for accuracy and to see what13 their doctor has said about13 them
This13 has13 the potential to make people more responsible for their own conditions andmight lead to better13 self-shy‐care13 and changes in behaviour13 that might reduce13 the13 incidence13 or severity13 of chronic conditions13 that are related13 to lifestyle
In the future we can expect13 the primary electronic health record to be linked with hospitaladministration systems picture archiving systems and other records held by hospitals sothat13 appropriate medical staff can have access to all relevant13 data
When the social care record is added to the mix then this will mean fewer but13 shorter andbetter assessments for social workers and for healthcare staff They will knowcircumstances and factors that13 could influence the choice of approaches This supports theidea13 of there being only one record consisting of several components all of which areaccessible by an appropriate professional at any time and in any place
The13 ambitions13 described above13 are not13 limited by technology most13 of the interoperabilityissues between rival commercial record systems have been resolved and databaseproviders are being compelled to support13 joint13 working The English NHS Mandate requiresTrusts to effectively replicate arrangements already in place in Scotland and in Wales andthis will go a long way towards achieving a genuinely paperless NHS well before 2020 Withnew biometric identification technologies individual records will be available to out-shy‐of-shy‐hours physicians and to those working in an AampE department13 irrespective of theconsciousness state of a patient
New telecare and telehealth technologies will produce significant13 more volumes of data13 which are currently held in different13 places and owned by different13 organisations rarely thepatient These data13 will also need to be shared but13 only in a manner that13 is acceptable toeveryone Patients may not13 want13 all their mental health information published in a formthat13 can be viewed by social workers GPs may not13 want13 to have access to all the data13 that13 might13 suggest13 that13 there is a domestic crisis to which they had neither the wish nor capacity
13
to respond Monitoring systems that13 support13 the lsquoquantified13 selfrsquo may also offer data13 that13 may or may not be added to the full recordThe future of health information might13 therefore be about13 providing individuals with themeans of producing relevant13 information storing it13 somewhere secure and then viewing it13 at a later time but13 in a format13 (or with advice) that13 is acceptable
See also httpmydexorg lsquoMydex gives individuals back control over their personal datarsquo
(see also Digital Scotland 2020 Achieving World-shy‐Class digital infrastructure a final report13 tothe Scottish Government13 httpwwwscotlandgovukPublications2013029054lsquoconnectivity by any device anywhere and anytimersquo)
211 The Future of Healthcare
The strains on our healthcare delivery system are becoming greater as they are in otherdeveloped countries as a result13 of an aging population rising expectations and unhealthylifestyles The necessary changes will require a significant13 shift13 in resources13 fromsecondary13 care13 where unit costs13 are high to community13 carewhere people can generallybe treated at home
The future must13 therefore necessarily involve efficiencies in hospitals and in the way that13 people can be treated in less expensive locations ultimately in their own homes Hospitalswill use more sophisticated diagnostic tools including scanners of all types to non-shy‐invasivelyprobe inside peoplersquos bodies This will result13 in more day cases and hospital stays (alreadyaveraging under a week) to even shorter periods with on-shy‐going support13 provided inintermediate care settings that13 might13 include hotels care homes or the personrsquos own homeif it13 is clean safe secure and has all the necessary amenities (include access to theInternet)
Advances in medical technology will allow more treatments to be delivered in the homeThis will mean fewer visits by clinical staff and fewer opportunities to attend primary carecentres Pharmacists will become suppliers of information as well as drugs so the balanceof care will shift13 significantly away from doctors who will work in different13 ways relying13 increasingly on telemedicine to bring the specialist13 to the patient13 for an online consultation13 For example if a patient13 complains of nausea13 and severe headaches a virtual consultationcan be offered almost13 immediately and without13 having to send a patient13 with a potentiallyserious and acute condition on a potentially long journey to a hospital
In the above example a neurologist13 may ask further questions as well as conduct13 acomplete neurological examination using videoconferencing technology Airedale GeneralHospital consultants have new contracts that13 require them all to be available for virtualconsultations The first13 benefit13 has been in reducing the need for prisoners at local jails tobe brought13 into AampE (which may need to be locked down depending on the circumstancesand the potential for violence of the individuals involved) potentially saving hundreds of
14
pounds in security costs It also avoids the need for healthcare staff to have to go into aprison environment
The principles described above are already saving lives through telestroke services whichlead to more people being thrombolysed appropriately and avoiding long term support13 that13 often follows a stroke incident Teledermatology has been practised for a number of yearsand results in rapid diagnosis and resolution of problems that13 previously required significant13 time for remedy
212 Gadgets and13 DIY13 healthcare
There are at least13 three elements to healthcare
bull Gathering information on symptoms and physiological parametersbull Interpreting the information andbull Responding to the diagnosis with treatment
Many people choose to exercise self-shy‐care because this gives them control whilst13 avoidingthe need to share their concerns and personal details with others A lsquodo It yourselfrsquoapproach might13 even be encouraged by the NHS as a viable way of using scare resources
Medical devices that monitor vital signs are mature and have been miniaturised so that13 they can be used in the home by individuals with little or no medical training Indeed bloodsugar monitors are being produced specifically for use outside the hospital and in such away that13 they can be used reliably by people with advice and training being provided onlinevia13 YouTube
Many medical monitoring devices do no more than produce a single measure which theuser may record or respond to Others link wirelessly to smart13 phones allowing data13 to bestored and entered into a personal health record where trending opportunities existingIndeed individuals can easily enter their data13 into an app running on their laptop tablet13 orsmart13 phone This trending information may be useful13 for self-shy‐care and could be passed onto a physician though the volume of data13 produced in this way and doubts about13 thequality of the data are likely to persuade GPs to discount13 data13 produced in this way
This gap in knowledge can be filled with advice information and diagnosis that13 can beobtained online using a lsquoDoctor Googlersquo approach The quality of such diagnosis may varysignificantly although there are many sources of information that13 are both supported andapproved by the NHS (and by similar sources in other countries) However with a data-shy‐richapproach and a choice of diagnosis people may be empowered to take a greater role inhealthcare
15
The final component13 for the DIY enthusiast13 is the treatment13 option Many people fear longterm use of medication produced by the big pharmaceutical industry and prefer morenatural remedies which are available over the counter More medical treatment13 devicesare available that13 stimulate blood flow and counter pain through the use of electrical andphysical stimulation
The evidence may be weak at present13 but13 might13 grow as more people use them and as theircost13 drops The13 impact13 of13 such technologies13 on vulnerable13 people13 is13 difficult13 to gauge
213 Telecare
Support13 provided at a distance to people in their own homes is known as telecare Thename implies remote monitoring and interaction and includes the monitoring of the homeenvironment13 and of the individual as well as the interaction of the individual with thisenvironment Definitions have become difficult13 due to some US medical devicemanufacturers introducing the term telehealth to describe medical telecare such as remotemeasurement13 and collection of vital signs data
In the UK telecare alarm services have matured quickly using the robust13 platform andinfrastructure of social alarm systems which were originally used by tenants in shelteredhousing schemes to seek help when they didnrsquot13 own a telephone The majority of telecareservice users today live in their own homes and use dispersed alarm units to link with amonitoring centre through the telephone network Improved assessments of needs andrisks to independence have resulted in combinations of sensors being used to support13 theoption of staying put13 rather than moving into residential care or having increasing levels ofdomiciliary support They support13 the policy of bringing care closer to home and ofencouraging people to become partners in their long term support13 arrangements
Telecare services developments over the past13 decade include standalone items such asautomatic lights which have achieved significant13 efficiencies especially for people who arefrail and prone to falling and to those suffering from mild cognitive impairment epilepsyand anxiety People who have long term conditions including chronic conditions such asdiabetes and hypertension can also be managed more effectively through telecare supportThe benefits of telecare services include a relief of stress for family caregivers enablingthem to continue to provide unpaid support13 while holding down a job and maintaining theirquality of life
New developments enable continuous monitoring of behaviour and smart13 devices that13 canfor example remotely control the cooker the water supply and door entry Such13 monitoring may detect13 incidents early and prevent13 emergencies arising Devices arebecoming smaller and easier to embed quickly within the home environment making themmore acceptable and less noticeable Longer battery life means less frequent13 maintenancevisits
16
The13 monitoring13 centre13 becomes13 an information hub13 offering13 both advice13 and a vehicle13 for checking that someone is coping especially following a trigger event such as a stay inhospital or the illness13 of an informal13 carer
New systems utilise web technology that13 allows family members to be more proactive inthe monitoring of their relatives This can lead to greater interaction with them especiallywhen the relatives live a considerable distance away (perhaps in another country) Thesenext13 generation systems might13 include video conferencing and the use of tablets smart13 phones or smart13 TVs but13 when an emergency response is required (perhaps to lift13 someoneup after a non-shy‐injurious fall) there remains a need for human intervention
The13 future13 of13 telecare13 might therefore13 include13 an increasing13 dependence13 on volunteersfrom13 the13 community to provide13 the13 required support Social networking may need to beused13 to support13 telecare technologies
214 Mobile healthcare
While telecare can support13 people effectively in their own homes it13 is now recognised that13 being able to go out13 to enjoy open spaces and to overcome the fear that13 the home is aprison is an important13 part13 of improving well being and supporting a higher quality of lifeExtending telecare technologies to operate outside the home is known as mobile healthcare(or mCare) and is based on mobile telephone networks rather than landlines
The simplest13 form of mCare requires only a basic mobile phone to deliver telephone callsvoice13 messages and SMS (text13 messages) The technology is mature and there are countlessapplications in use both in the UK and in developing countries such as Africa13 and India13 where mobile telephones have already achieved a saturation level and where fixedtelephone infrastructures are not13 likely to be established at any time Such telephones areuniversally available in the UK and are used by the vast13 majority of people including manyolder people especially if they have been introduced to the low cost13 (pound30) devices that13 have large buttons large displays and a separate large button for calling an emergencynumber
Smart13 phones are rapidly replacing basic phones and allow the use of a large range of lsquoappsrsquothat13 are being developed to provide information and for enhanced experiences In thehealthcare space Skype FaceTime Vidyo and GoToMeeting with HD Faces are all current13 examples of video conferencing software available on tablets and smartphones
The specific software will depend on the nature of the communication desired
bull Skype will13 manage a simple video phone callbull Where an AampE physician needs to share a CT scan of head with a Neurologist13 on call
from home GoToMeeting would be more appropriate
17
bull If the physician would rather have a dedicated online meeting room that13 patientsand colleagues can simply drop in for a virtual meeting a Vidyo virtual room may bemore appropriate
This technology can suit13 any form of lifestyle including many people with complex needswhose lifestyle is not13 consistent13 with a fixed address
Social care apps are available already to deal with problems of sensory deficit
bull Guiding a blind person through GPS navigation and reading signs through appslinked to the devicersquos camera13
bull The microphone can be used as a hearing aidbull Speech recognition software can be used either to replay speech at a slower speed
or for translation into a language of choicebull Speech can also be selected for people who have a stammer or who have a problem
with their larynxbull Apps are becoming contextually aware recognising situations and locations and are
thus becoming a personal assistant13 for people with disabilities
By 2020 it is therefore possible that a smartphone may13 be prescribed13 for people who13 need13 social13 care13 together with13 a range of apps that have been13 selected13 to meet13 theirassessed13 needs
Whilst13 smart13 phones tablet13 devices and apps may become an important13 part13 of anindividualrsquos personal support13 armoury the potential of mCare will be limited only by anindividualrsquos ability to make use of all its functions Each device could become a part13 of anindividualrsquos personality supporting them to improve behaviour take exercise avoidtemptation and manage their own health and well-shy‐being Potentially mCare could becomethe most13 important13 element13 of social care and support13 within 10 years
215 Artificial Sensing and Enhancement Devices
bull It is estimated that13 one in seven people has imperfect13 hearingbull The numbers who are born deaf are quite small and many of these people may
have some form of hearing restored through surgery or through technologybull Similarly while there may be nearly a million people registered as blind or having a
severe visual impairment the vast13 majority lose their sight13 during their lives as aresult13 of disease
bull New treatments will deliver sight13 recovery or restoration over the course of the next13 10 to 20 years
Fortunately technology can provide excellent13 sensing capabilities that13 are already providingpeople with external portable devices for enhancing their lives The simple hearing aid is anexcellent13 example of a device which has been improved through both miniaturisation
18
personalisation and enhanced performance Today digital hearing aids use sub-shy‐miniaturemicrophones that13 can be unidirectional or omnidirectional and which can be adjusted insensitivity over an extended range Tomorrowrsquos devices can be switched between modesby the user so that13 they can benefit13 from hearing perfectly in any environment Indeedthey can be used with adaptive filtering technologies (as used by helicopter pilot13 headsets)to eliminate some sounds so that13 the rich speech (or music) components alone remainFuture developments will be on optimising control so that13 the user can switch seamlesslybetween different13 amplification applications without13 appearing to be distracted A smart13 phone or mp3 music player may be used as either a processing unit13 or as a ubiquitousoutput13 device that13 looks cool and natural
These same technologies will also be developed for use within the home environment13 fortimes when a deaf user isnrsquot13 present13 or is asleep Acoustic signatures associated withadverse events and incidents such as the hiss of a gas leak the crackle of a fire the sound ofa smoke detector the drip or a water leak or the sound of breaking glass can be directlyassociated with programmed actions Speech will be recognised interpreted translatedsimplified or displayed so that13 an individual knows what13 is said and can be provided withclear instructions on how to respond
Video cameras have become smaller and cheaper and capable of producing high definitionimages The problem of storing and editing these large image files is being solved by thearrival of cloud computing
Electronic noses are already capable of detecting the quality of wine and fresh fruit Similartechnology will be based in smart13 phones and will be able to analyse the air to warn of13 foodthat is no longer fresh and of other indicators of danger including gases that13 have13 little13 natural13 smell These13 devices13 could support13 people with13 cognitive impairment13 -shy‐ whose13 sense of smell13 tends13 to deteriorate -shy‐ to live independently
Many older and vulnerable people are at risk of hypothermia during the winter Sensordevices can provide warnings of low temperature In the same way heat13 stress can be adanger during the summer months so sensors can alert13 people of the need to openwindows or to operate a fanFinally people who have damaged13 their fingers13 or hands will be able to wear sensorsembedded in artificial skin or in gloves that13 will enable them to identify textures and shapesand be able to dress and undress without13 the assistance of carers
216 Robotics
We may recoil at the idea13 of personal care being delivered by robotic devices but13 it13 is likelythat13 within a decade personal assistants will exist13 to assist13 with household tasks These areunlikely to be humanoid and are more likely to be machines dedicated to helping frailpeople to support13 their own weight13 and to carry trays of food around the home
19
There are four broad classes of robot13 under development13 that13 are likely to mature within 10to 12 years
1 Miniature industrial robots that13 have been programmed to perform specific taskswith precision They are likely to be relatively heavy enabling them to bear weight13 but13 still have the necessary flexibility to carry an individual over short13 distancesplacing them in a chair or on a bed They will have sensors and cameras to provideimmediate feedback and to adjust13 rapidly in response to verbal commands or cues13 from the user Some designs may build on existing assistive devices such as abathroom hoist13 or a bathing aid to become intelligent13 extensions of productsalready on the market A stair lift13 with intelligence is already being designed by a UKcompany and is aimed at providing the user with more control of the journeybetween floors of a house
2 The second group of devices might13 be described as intelligent13 furniture Beds andchairs are already available that13 adjust13 to make the user more comfortable and also13 to help them get13 into or out13 of bed The control units are fairly cumbersome andare suited to operation by a carer Voice activated controls and built-shy‐in intelligencewill give the user more control and independence Other items of furniture to whichintelligence might13 be added would be tables whose height13 can adjust13 and whichhold items of food and medicine securely The table would recognise these objectsand could provide prompts or reminders
3 Mobile robots form the third group These could be goffers that13 can either fetchand carry items such as newspapers drinks or trays or which can accompany theuser when they move between rooms providing them with support13 or prompts Thistype of robot13 could be an intelligent13 walking frame with wheels which13 could13 doubleup as a smart13 wheelchair when necessary
4 Finally there are companion robots These might13 be in the form of an electronicpet typically a cat13 or a dog though the Japanese Paro robot13 is a seal Pets canrespond to stroking and being patted they can also remind their owners that13 theyneed to take exercise and to eat drink and take their medication Various designsare already available which provide feedback but13 future models would includecameras and a screen to provide a mobile means of information and interactionwith other people over the Internet Intelligence within the device could allow themto have a personality of their own and gain knowledge by scraping data13 fromwebsites so that13 they can generate speech and have conversations about13 the newsthe weather or sports results
217 Transport and transfer technologies
Walking is good exercise and is a no-shy‐cost13 form of transport13 that13 is encouraged because of itsimpact13 on well-shy‐being For an individual with a chronic disability or suffering from theeffects of an accident13 or an injury this becomes impractical without13 an assistive technology(AT) A walking stick is the simplest13 example of AT
20
Within the home the stair lift13 has enabled people who live in conventional properties that13 are on two or more floors to continue to use facilities on different13 floors when climbing thestairs has become too difficult This is often the case for people who have arthritis a lowerlimb amputation a long term condition such as Chronic Obstructive Pulmonary Disease orpeople approaching the end of life and who have chosen to die in their own homes
Designs have improved so that13 a curved staircase is no longer an issue and the reliabilityhas reached a level where breakdown is a rare occurrence13 Through-shy‐floor lifts have been analternative proposition but13 they remain too large for most13 properties Alternativeapproaches may emerge using air pressure or water pressure as the driving force ABrazilian design already utilises a plastic tube in which a pod is moved effortlessly up anddown
Electronic wheelchairs are now available that13 allow the individual to become moreindependent13 as they allow the user to control both propulsion and steering Some modelshave the capability of mounting a pavement13 or a step or even a flight13 of stairs Personalmuscle amplification devices have been developed originally with the intention of helpingpeople who are confined to a wheelchair due to a neurological disorder to perform sometasks from a standing position Indeed the Rex walkerrsquos manufacturers claim that13 anyonewho can propel themselves in a wheelchair could walk by using Rex
Other approaches have focused on the rehabilitation of people after major accidents that13 have caused partial paralysis They quickly extend into exoskeleton designs that13 enableanyone to gain a mechanical advantage and thus to tackle physical tasks that13 would not13 otherwise be possible These suits are the focus of major research projects across theworld Some13 products such as the system developed by Honda are being tested inAssisted Living facilities and are likely to become more and more enabling over the next13 decade
Similar benefits are also occurring outside the home with a number of novel carryingsystems appearing over the past13 few years They are generally termed lsquoscootersrsquo but13 thiscovers a wide range of systems and devices ranging from the Segway a device that13 is amobile platform on which the user stands and navigates through to conventional electricvehicles that13 have been developed from golf buggies There remain a number of issuesconcerning their use on roads or on pavements but13 similar problems will need to beresolved for bicycles to play their full part13 in enabling people to get13 more exercise13 Thepotential for hybrid scooters remains
218 Smart domestic appliances and personal hygiene
The bathroom is a dangerous place and one where many older and disabled people slip andsuffer a fall Many older people recall taking a bath in a tin tub in front13 of an open fireToday the options tend to be a level access shower (ie a type of wet13 room) for anyoneunable to get13 into a bath There are various aids to help people get13 into and out13 of thebath most13 involving a seat13 that13 can be raised or lower with some bath-shy‐tubs having a door
21
There has been some research into alternative methods of keeping the body clean Sanyointroduced a machine in 1970 modelled on a clothes or dish washing machines the personsits on a seat13 inside the machine where13 they are cleaned by a set13 of water jets These havenot13 proved popular and furthermore require the individual to be transported to themachine Thus the technology may find application in nursing homes but13 are unlikely to beattractive to people living independently in the community
The washing needs of people change over time Over the past13 20 years body piercingshave appeared which have demanded additional attention to avoid the problemsassociated with poor hygiene and metals Similarly hair may be permed and dyed usingchemicals which are much stronger and which might13 damage the hair Add to this thepainting of finger and toe nails and the washing needs are rather different13 to what13 theymight13 have been even ten years ago Finally tattoos were once popular only with sailorsToday they are likely to be found on the arms backs and legs of both men and womenNew ways of cleaning these tattoos will be needed especially if they become infected orare sites at which pressure sores develop
Even if a personrsquos body is clean if their clothes are dirty they may become socially isolatedBut13 the washing of clothes can be strenuous even if a launderette is used The need toconserve water has driven research into ultrasound techniques to beat13 the dirt13 out13 ofclothing while some companies are experimenting with polymer chips These13 ldquogreenrdquo13 technologies are quickly maturing and are likely to be standard in the next 10 years
Other smart13 household appliances are already appearing on the market13 and may soonbecome common13 in UK homes13
bull Robovac devices have sensors to enable them to detect13 dirt13 on carpets and to adjust13 their operation accordingly
bull Refrigerators can read bar codes or RFID tags to identify their contents and theirldquouse byrdquo13 dates enabling them to inform the owner that13 they should use theproducts before they are out13 of date They can be linked to the Internet13 to reorderitems as they are consumed or to suggest13 menu options for the individual based ontheir preferences or according to the diet13 required to manage a condition
bull Ovens will automatically switch off if they are left13 without13 attention for too longand drying machines will set13 times automatically
Devices may be linked so that13 they are more efficient and report13 maintenance issues sothat13 they can be repaired (perhaps remotely) before they suffer a catastrophic breakdown
219 Personal and home13 security
It might13 appear perverse but13 people with very little personal wealth and property are morelikely to be the victims of crime than those who have expensive items This may be due towhere poorer people tend to live or because people who have valuable assets take greater
22
steps to protect13 them There can be no doubt13 that13 crime has a very negative effect13 onindividuals and on their families creating a fear factor that13 may be difficult13 to remove Theimpact13 on quality of life is therefore very considerable especially if it13 forces people to stayat home behind locked doors effectively isolating themselves from society
Modern policing places increasing reliance on the use of closed circuit13 television (CCTV)Town centres are covered by cameras used increasingly in the fight13 against13 crime by bothdetecting anti-shy‐social incidents and identifying the people involved They are also used tomonitor the movement13 of cars that13 may be involved in incidents of burglary and violenceand are fast13 becoming the primary mechanism of law enforcement13 agencies to solve crime
CCTV has moved into the home to record movement but13 monitoring the footage is timeconsuming and often not13 practical Cameras are now available which provide an instant13 video feed to a smart13 phone when movement13 is detected These may have intercomcapability allowing someone to remotely speak to an intruder sometimes before they havegained access to a building This may serve as a deterrent13 and when fitted alongside simpledevices that13 switch lights on randomly around the home may force burglars to goelsewhere
As the price of cameras continues to fall the option of carrying a camera13 on the body that13 continuously monitors personal space is becoming more useful Using wireless networksthe data13 collected can be sent13 continuously to the cloud for safe storage It cansubsequently be retrieved to provide evidence (video and audio) of confrontations enablingsuccessful prosecutions to be made The smart13 phone itself is becoming a valuable itemthat13 is attractive to criminals These can be tethered to personal attack buttons usingwireless technology allowing the device to be activated by the pressing of a button if theowner is being attacked The phones can then be tracked and located by the police whilebeing rendered useless to the assailant
Bogus callers are a perennial problem for vulnerable people Video door bells can beconfigured to display images and record the words of visitors before they are admittedallowing remote monitoring centres to oversee the situations and use image recognitionsoftware to confirm the bona13 fide of visitors Such13 arrangements may become13 commonplace13 over13 the13 next five13 or13 six years13 significantly13 improving the safety of peopleliving independently
220 Personal safety
The biggest13 risks to personal safety stem from fires and falls Most13 fires are the result13 ofpoor cooking practices resulting in burns or scalds Floods and gas emissions are caused bya failure to remember to close taps
The current13 approach involves detection of an emergency situation as soon as possible but13 always after a problem has already occurred This responsive approach can minimise therisks provided that13 there is a protocol in place for intervening This could increasingly be an
23
automated response such as the switching off of the gas of water or the switching on of asprinkler system or a water mist13 system
In the future monitoring systems will be more sophisticated and will have sensors and localintelligence to identify activities In this way reminders can be issued before an emergencyoccurs13 This lsquosmart kitchenrsquo approach may become13 an integral part of13 homes of13 vulnerable13 people
A prototype system has been developed at the Culture Lab in Newcastle Sensors havebeen embedded into cooking utensils enabling the kitchen to identify what13 the person istrying to cook or prepare It can provide interventions as messages on an instructionscreen
Accidents also occur out13 of doors People with dementia13 might13 become lost13 and may havepoor road safety awareness Location devices based on GPS have advanced from large andheavy receivers that13 were used on ships and boats to small battery-shy‐operated devices that13 can be carried in the hand or in a handbag The current13 generation of locators has limitedbattery life and are rather too large to be secreted about13 a personrsquos clothing while devicesthat13 are integrated into a wrist-shy‐watch are rather clunky and unattractive
Within 10 years the13 technologies13 will have13 matured and will be13 much smaller13 so that theycan be embedded in shoes in walking sticks hats or any other item of clothing Powerrequirements will have reduced so that13 energy harvesting from the movements of theindividual will be sufficient13 to keep these products working for several weeks without13 theneed for recharging The devices will not13 simply indicate to others where the individualhappens to be but13 will provide subtle guidance cues to direct13 them home
Cameras might13 also form part13 of the personal security systems that13 will protect13 people fromaccidents Data13 may be sent13 to the cloud and analysed in real time if the person is in adangerous location and can provide prompts either to the individual or broadcast13 advice toothers to clear the danger These systems may be embedded in items of clothing (such as ahat) or they may be attached to spectacles
221 Energy and13 portable power supplies
The demands of developing economies for more power will inevitably lead to higherdomestic fuel charges in the UK especially as oil and gas reserves dwindle
By 2018 UK homes should be fitted with new smart13 meters The specifications for these13 devices have yet13 to be finalised but13 will include a means of identifying wasteful use ofenergy including TV sets that13 are left13 on and unattended fridges and freezers that13 are set13 attoo low temperatures and dryers that13 are used for too long or when the weather is suitablefor using a washing line They could be an enabling factor that13 supports changes inbehaviour driven by a need to use less power but13 it13 is unlikely that13 they will offer a bigreduction in costs that13 are already a problem for many vulnerable families
24
More generally the need for power conservation will include devices that13 are moreefficient and a significant13 emphasis on heat13 retention in buildings through betterinsulation
The energy crisis may force many people to spend more time in community settingsincluding shops and public buildings where they can benefit13 from the warmth Increasingreliance on mobile communication devices will lead to increasing demand for batterycharging facilities
Greater use may be made of portable devices for generating power based on solar cellswind or hand motion
222 Smart cities and homes
The Digital City initiatives have been based on information and how it13 can be used most13 effectively to make people aware of what13 is going on around them This means bettercoordination of resources more rapid access to advice and a battery of sensors measuringevery conceivable parameter from sound and light13 levels through to air quality andtemperature fluctuations There are several Digital or Smart13 City initiatives currently beingimplemented both in the UK and across the world They may significantly impact13 the livesof the millions of people living in them but13 the timeframe for outcome benefits to influenceplanning and design elsewhere is likely to be at least13 20 years and therefore outside thetimeframe of the current13 project
Housing plays a big role in the lives of most13 people both through their aspirations to moveup in the world (usually to a bigger property with a garden) and as the heart13 of the familylife which is associated with good quality of life UK properties have a life span approaching100 years which is about13 double that13 of their European counterparts (and certainly longerthan the wooden-shy‐frame buildings built13 in North America13 for example) A shortage ofhouses has plagued improvements in social welfare for the past13 30 years There is anargument13 that13 there are enough houses but13 the wrong size and in the wrong places andthis has some basis in fact13 as demography changes lead to more people (and more olderpeople) living alone However if there are two million homes in Scotland each with alifespan of 100 years then the renewal rate needs only to be 20000 per annum to maintainthe status quo However it13 must13 be clear that13 the impact13 of smart13 house development13 willbe small The focus should therefore be on adapting existing properties to render themmore appropriate for vulnerable people
Housing adaptations are a branch of assistive technologies The technologies for providingdifferent13 forms of accessible bath and level access shower are well-shy‐established with littleresearch considering anything other than alternative building materials and methods formaintaining the temperature of the bathwater Different13 technologies for bathing will beconsidered separately
25
Thus housing technologies are not likely to impact on social work13 within the next 20years13 though13 the use of information13 technology13 to ensure that people are aware of what13 is available is likely to be commonplace well before then
26
3 BEHAVIOUR AND ATTITUDE CHANGES DUE TO TECHNOLOGICALADVANCES
Technology is only one factor that13 will affect13 the way society changes in the next13 10 or 15years This chapter will consider the context13 in which the technological developmentsoutlined in the previous chapter will be supported (or held back) by societal factors
When the impact13 of such factors has been considered we can then apply theseassumptions to a number of case studies listed in Appendix13 A13
The headings selected for this chapter are not13 arbitrary as they reflect13 the context13 in whichtechnological changes must13 be considered They must13 include consideration of factors suchas demography and long-shy‐term conditions already addressed in the introduction to thesepapers together with the aspects of workforce and citizenship considered in the parallelpapers The additional elements here focus on trends that13 are already occurring and whichmay leave people struggling with the changes that13 occur
Finally there is a need to consider the attitudes of people to technology generally andespecially to the issues of privacy and social responsibility that13 could be radically changedby technology In some cases public opinion will prevent13 some forms of technology beingdeveloped if not13 commercialised In other cases some technologies will be fast-shy‐trackedeither at the request13 of government13 or because of a clear public demand for theopportunities that13 it13 can bring
Predictions13 about the13 future13 must inevitably be13 subject to considerable13 uncertainty butthat is no reason to stop thinking what might happen
31 The Welfare State
The UK can be rightly proud of the way that13 its welfare state has developed during the past13 100 years to provide a safety net13 of financial support13 to people and to their families whenthey are unemployed destitute homeless or challenged by crises and emergencies Therange of benefits received is considerable some are complex and many people struggle tounderstand their entitlements Some are universal some are discretionary some apply onlyto parents others to anyone
The total cost13 of providing these benefits continues to rise and when the economy isstagnating there is inevitably both political pressure often supported by popular publicopinion to introduce welfare reform so that13 people who do not13 work cannot13 be better offthan they would be if they were in full-shy‐time employment This strategy requires a universalbenefit13 to be introduced so that13 it13 is easier for claimants to access support13 but13 also easierfor agencies to identify the total benefits received The idea13 of a benefits cap then becomes
27
more practical to introduce especially if all the processes involved in making a claim arehandled electronically Indeed this encourages government13 to insist13 on applications forbenefits to be made on-shy‐line Unfortunately this will marginalise those people who haveneither a computer nor access to the internet thus emphasising the digital divide in amanner which works against13 some of the most13 disadvantaged people in society
There are currently few tangible links between digital technology and welfare provisionThe most13 obvious are universal benefits such as a free television licence (worth pound14550)13 for13 everyone aged 75 or older with blind and visually impaired people entitled to a 50discount13 irrespective of their age The significance of this position is that13 6 of revenuesgenerated through licence fees are to fund BBC on-shy‐line services13 such13 as websites and i-shy‐player In Scotland the BBCrsquos Alba Gaelic language television service is predominantlyfunded13 by MG Alba an organisation funded by the Scottish Government It is thereforeconceivable that13 in the future licence fees may be used to directly subsidise access toinformation and advice through the Internet13 for vulnerable people whether it13 is throughbroadband access or through a set-shy‐top box which removes the need for a computer in thehome to access particular websites or to use e-shy‐mail services
A second age-shy‐related benefit13 available in the UK is the winter fuel subsidy People whoreceive certain benefits receive the payments automatically while others must13 make aclaim Those who are not13 eligible for benefit13 due to a lack of an address for example missout13 on these payments and also on Cold Weather payments of pound25 for each seven dayperiod of very cold weather between 1 November and 31 March
The development13 of new warm home initiatives plus the complex of subsidies that13 theelectricity supply industry and government13 offer to people with solar cells further changesthe economic arguments Global warming may lead to greater variations in weatherextremes but13 might13 also increase the amount13 of electricity that13 can be generated byalternative (green) sources such as wind and solar cells It is estimated that13 energyconsumption in the UK increased by 17 between Christmas and Easter 2013 compared toprevious years as a result13 of cold weather but13 the above subsidy scheme did not13 benefit13 older people because two of the seven day cold periods were after 31st March It must13 beassumed that13 there will be more people living in fuel poverty in the future and this will leadto more cases of cold related illness including influenza13 and stroke
32 Management of long term conditions
The management13 of long term conditions will be improved for patients who are compliant13 with their medication regime so it13 is possible that13 there may be compulsion to adhere tothe prescription Such compulsion may be monitored using technology Indeed the remotemonitoring of vital signs using telehealthcare will become commonplace as the old boxesand sensors are replaced by devices that13 can be worn continuously or which can beembedded into the fabric of homes (including furniture and bedding) or can be worn asvests or patches They will wirelessly transmit13 data13 to smartphones or tablets and mobile
28
transmission and cloud technology will enable real-shy‐time data13 collection analysis andfeedback
One of the diseases which is projected to increase most13 significantly over the comingdecade is Type 2 diabetes Whilst13 there is a hereditary susceptibility to this condition formany people including those from the Middle East13 and the Asian sub-shy‐continent it13 is also adisease which tends to affect13 those people who are overweight13 andor have a sedentarylifestyle If untreated diabetes can lead to dizziness and collapse at any time but13 can alsohave more devastating long term consequences which include kidney failure strokeblindness and in extreme cases lower limb amputations Management13 therefore includesdaily monitoring of blood glucose levels and major dietary changes such as a significant13 reduction in the consumption of carbohydrates as well as a rigid exercise regime
Many newly diagnosed diabetics follow this advice closely and can lead normal lives for 40years or more but13 some struggle to accept13 the change in lifestyle required as well asremembering which foods are allowed and how much exercise they need to takeIndividual support13 plans are now forthcoming and over the next13 ten years best13 practicewill emerge in the form of smartphone apps that13 are personalised and which can becomean individualrsquos health coach This level of support13 will be fine for some people but13 otherswill need incentives so it13 is likely that13 gaming technologies will be introduced perhapsoffering rewards for good compliance There will be a temptation for some people tocheat perhaps allowing others to perform exercise for them or changing theirconsumption details
Many of these opportunities for cheating will be removed through the use of a uniquebiometric identifier a technology that13 will be mature enough to use in place of passwordson smartphones However the biggest13 challenge may be in encouraging older people to usethe technology Many older people have multiple morbidities Indeed a survey of Scottishpatients implied that13 42 of people aged over 80 will suffer from three long termconditions It will be essential for those people to comply with treatment13 regimes if they arenot13 to have the functional deficits that13 follow
33 Finding people who13 donrsquot fit
People who have low social capital are likely to have few relatives and friends with whomthey regularly communicate and are also unlikely to be part13 of community or faithorganisations such as clubs societies and church groups They also die several yearsyounger than most13 of the population often because they donrsquot13 engage with public healthinitiatives such as vaccinations against13 flu regular checks on their blood pressure bloodsugar levels or in the case of women smear tests or mammography The most13 likelyreason for disappearing beneath the radar of such initiatives is their mobility which leadsalmost13 inevitably to them having no fixed abode and no fixed telephone line It thenbecomes very difficult13 for them to be contacted because their mobile telephones are likelyto have Pay-shy‐As-shy‐You-shy‐Go contracts that13 donrsquot13 require validated names addresses and bankaccounts
29
It follows that13 some of the most13 vulnerable people in society including those who live onthe streets are effectively unknown to both the NHS and to social work departments untilthey are referred in a crisis This could be an emergency presentation to a hospital Accident13 and Emergency Department13 where they will come into contact13 with a social worker becausedischarge may be unsafe This often highlights the importance of the prevention agenda13 and the potential for avoiding admissions to hospital by intervening at an earlier stage
The advantages of being able to locate people who are vulnerable to specific diseases willincrease as genetic testing becomes more routine It is already possible to determine whomight13 be most13 at risk of breast13 cancer and prostate cancer as a result13 of family history Addto this the evidence that13 particular diet13 and exposure to environmental factors can furtherincrease risk then it13 is evident13 that13 individuals can be identified and offered treatmentsthat13 could save their lives many years before they become ill In the case of cancersperhaps only the individual is involved but13 for infectious diseases it13 is the whole of societythat13 is at risk if someone contracts one of the new strains of influenza or if someonechooses not13 to be vaccinated against13 rubella In Chinese airports all visitors are screenedfor fever and refused entry if they tested positive in cities the public are monitored in thesame way Similar approaches may be necessary in the UK if potential carriers cannot13 otherwise be identified
34 Volunteering
It is estimated that13 72 per cent13 of people volunteered to perform a charitable act13 at least13 once during 2012 a rise from 65 per cent13 the previous year About13 four out13 of every 10volunteers offer their services formally to one or more organisations The remaindervolunteer informally by helping out13 a friend or a neighbour Around 50 per cent13 volunteered at least13 once a month in the past13 year up from 41 per cent13 on the previous13 year Most13 have retired many of them before the statutory retirement13 age Those whodonrsquot13 feel able to offer time have offered their financial support13 at a time when the fundingavailable from sources such as the National Lottery has been decreasing Despite economicausterity donations to charities have been increasing 74 per cent13 said they had given tocharity at least13 once in the previous month up from 72 per cent13 the previous year
Strikingly 78 per cent13 of people strongly believe that13 they are part13 of their localneighbourhood an increase from 70 per cent13 10 years previously Community cohesion isstronger than ever 87 per cent13 of people believe their local area13 is a place where peoplefrom different13 backgrounds get13 on well together compared to 80 per cent13 in 2003
The role of volunteers in supporting vulnerable people is therefore likely to increase overthe next13 decade perhaps exploiting the success of the army of volunteers that13 was highlysuccessful in London during the Olympic and Paralympic games The greatest13 role for suchvolunteers may be in providing informal care for older people Already the UK has someseven million informal carers whose value in monetary terms has been calculated to be
30
more than the combined budgets of the NHS and social care Maintaining or extending thisprovision will help to support13 services in the future and may be supported by technology
Whilst13 there is ample evidence to suggest13 that13 telecare services support13 informal carers asmuch as (if not13 more than) the people that13 they are caring for it13 is the potential for utilisingthe internet13 and apps to make their role easier to coordinate and hence more effectivethat13 is likely to be most13 successful moving forward
Many of these focus on particular tasks that13 informal carers can help offer to older peoplesuch as organising their medication A pillbox program is just13 one feature of an app calledBalance It also includes sections for caregiving tips notes for the doctor and the patientsappointments plus a lsquolearning sectionrsquo with articles on aspects of Alzheimers and an RSSfeed for news about13 the disease Tyze is another multi-shy‐functional app it13 allows carers to
bull Organise appointmentsbull Plan outingsbull Share storiesbull Send updates to other family members
Another application is Rally Round which helps carers to organise someone to perform littlejobs often on a temporary basis when someone has dementia physical frailty or isrecovering from accident13 or illness Similar applications are MeMaxi and Finerday
35 The High13 Street
The shape and appearance of UK shopping centres have been changing for half a centuryPeople complain that13 centres are losing their identity with one town looking like everyother both in terms of the stores and in terms of the layout But13 there are three trendswhich are having a profound impact13 on many of the most13 vulnerable people in society
bull Centres lock their doors at 6pm or in some cases 10pm -shy‐ thus denying people whosuffer from claustrophobia13 from window shopping at times when other shoppershave left
bull Out13 of town shopping malls -shy‐ these US style centres are ideal for people in carsbecause they offer free parking which is essential for people who want13 to buy largeritems but13 difficult13 for people who have no transport13 and who must13 rely on publictransport13 that13 is often deficient
bull The rise of online shopping -shy‐ which means that13 many potential shoppers only visit13 High Street13 stores to check the prices before returning home to make a purchaseonline
It is the third of these effects that13 has the greatest13 potential for changing the High Street13 forever and it13 is making life for traditional retailers increasingly difficult13 at a time when highrents are crippling stores large and small It is difficult13 to see how this trend is likely tochange because consolidation in banking and estate agencies is already forcing the closure
31
of other High Street13 players while additional pressures on pubs has led to the closure ofthousands of pubs every year
Those figures however demonstrate that13 consumers still value what13 the high street13 canoffer -shy‐ the chance to inspect13 what13 theyrsquore thinking of buying -shy‐ as well as the new opennessof the internet Customer service makes a difference to people especially if there is aproblem and goods need to be returned One of the most13 common reasons for furniture tobe returned for example is that13 when a sofa13 or a wardrobe was delivered it13 couldnrsquot13 fit13 through the front13 door or up the stairs In the future people will be able to benefit from13 visualisation technology they will upload the floor plans of their homes enabling theretailer to inform them of the problem before they try to delivery Augmented reality viewwill similarly allow customers to see what13 a new item of furniture will look like in itsintended place so that13 they can be more informed about13 the effect13 of size and colour
In terms of improving the viability of the High Street stores will have to focus on theimportance of brand which could mean that13 individual independent13 retailers will have topartner with national suppliers to support13 a local tailored offering based on products that13 are designed for a more global market This is a lsquoconnected High Streetrsquo approach whichcould be enabled by the developments in internet13 availability and smart13 phone accessdescribed in the previous section
The overall effect13 of all these changes could mean that13 town centres become smaller but13 more vibrant13 areas They could thrive if people are attracted there in large numbers whichmeans that13 retail must13 be developed alongside restaurants pubs galleries and other leisureopportunities This is possible in new shopping centres which are already being integratedwith transport13 hubs including railway and bus stations but13 may be more of a design13 challenge for older towns and cities with large Victorian buildings To ensure that13 morepeople are welcomed into the new centres they should include attention to green spacesand areas where people can relax without13 feeling that13 they are second class citizensbecause they donrsquot13 have the same buying power
3513 Privacy
To some people privacy is their right13 to live their lives without13 interference they may seethe State as a potential lsquoBig Brotherrsquo spying on their every move and judging their actions13 and activities Other people have fewer concerns about13 the role of the State but13 great13 fearof individuals interfering with and invading their privacy Some embrace the concept13 of lsquomyspacersquo an area13 of a square metre or so into which nobody can enter without13 permissionThis allows them to avoid physical contact13 and to feel safe from any form of threateningbehaviour
Yet13 this idea13 of private space and its potential violation is merely the tip of the iceberg asfar as privacy is concerned more significant13 is the idea13 of personal (and private)information being shared with anyone and everyone This could be related to identityopinion or image for an individual who wants to remain anonymous or even secretive thisis going to become an increasing problem as technology provides the means of taking
32
photographs recording conversations and capturing environment13 with something as smalland ubiquitous as a mobile phone The fact13 that13 this information can then be shared withthe rest13 of the world using e-shy‐mail Twitter and Facebook makes the problem all the moredifficult So the threat13 is no longer solely from the long lenses of the Paparazzi but13 fromanyone (and that13 means everyone) who has even the most13 basic of mobile phones
This relates to the changing views of society on what13 information should remain privateand what13 should be shared with others The success of social media13 has been based on anattitude of lsquosharing everythingrsquo with either your friends or the world This has introduced anaiumlve idea13 in the minds of some younger people (especially those known as Millennials ieaged 18-shy‐30) that13 everyone can be their friends whilst13 perhaps failing to reinforce the bondsof genuine friendship with any form of test13 or restriction Technology could play a role indefining these friendships and allowing individuals to understand what13 makes a goodfriend but13 this approach has yet13 to be developed and may be slow to overcome the needfor some people to measure their own popularity simply as the number of people that13 theycan list13 as friends on their Facebook page
It follows that13 there may be a need for a new definition of privacy that13 is in keeping withthe web and its ability to display images and opinion in an unregulated manner This needsto embrace past13 concerns about13 the ability of an individual to live without13 the threat13 ofothers being able to watch them whilst13 offering some protection from random postingsabout13 them online Perhaps this could include a right13 to be able to edit13 or remove anythingrelating to themselves on the Web including images that13 are not13 news-shy‐worthy Theownership of image rights may be an associated issue that13 needs to be addressedespecially as modern technology can remove an individual from a group (or a background)13 view provide digital touch-shy‐up or air-shy‐brushing and then republish it13 in a different13 contextHowever there is general agreement13 that13 personal information (such as contact13 details andbank codes) should not13 have a place on the web Surprisingly few people take proactivemeasures to prevent13 tracking functions being activated
It follows that13 too much privacy could lead to younger people fearing that13 they maybecome lost13 in a digital world It is not13 surprising then that13 they are prepared to make lots13 of personal information available often with no fear of how it13 might13 be used by othersWhen Google glasses and similar technologies become available during the next13 few yearsthey will have the potential to identify a stranger walking down the street and to find manyof their secrets to present13 to the wearer in a fraction of a second They could know moreabout13 them than their genuine friends know -shy‐ so who will be their friends in the future
36 Data sharing and13 protection
By lsquodata13 sharingrsquo we mean the disclosure of data13 held by one organisation on an individualto a third party organisation(s) or the sharing of data13 between different13 parts of anorganisation Some data13 sharing doesnrsquot13 involve personal data13 because it13 has beenanonymised in such a way that13 the statistics can be used for the collective good without13 theidentification of the individual The Data13 Protection Act13 (DPA) is in place to provide a legal
33
framework that13 ensures that13 organisations that13 hold personal data13 must13 act13 responsibly atall times These principles adequately describe the position of public and government13 bodies especially social services departments who are responsible for the informationconcerning the health and well-shy‐being of individuals -shy‐ and hence by implication thesensitive data13 relating to their vulnerability
The legal framework that13 applies to private and third sector organisations differs from that13 which applies to public sector organisations which may only act13 within the defined limits oftheir statutory powers However all bodies must13 comply fully with the data13 protectionprinciples and this situation is unlikely to change within the next13 10 to 15 years In someprivate sector contexts there are legal constraints on the disclosure of personal dataHowever most13 private and third sector organisations have a general ability to shareinformation provided this does not13 breach the DPA or any other law It is advisable for acompany to check its constitutional documents such as its memorandum and articles13 ofassociation to make sure there are no restrictions that13 would prevent13 it13 from sharingpersonal data13 in a particular context The type of data13 held is therefore a subject13 ofconcern as it13 may be difficult13 for legislation to keep up with the additional layers of data13 created on-shy‐line and through the Internet13 of Things
Private and third sector organisations should have regard to any industry-shy‐specific regulationor guidance about13 handling individualsrsquo information as this may affect13 the organisationrsquosability to share information They should also be aware of the legal issues that13 can arisewhen sharing personal data13 with public sector bodies This becomes more of an issue asprivate and third sector bodies are carrying out13 a wider range of traditionally public sectorfunctions Opportunities for inappropriate sharing of sensitive data13 will therefore inevitablyincrease
Public authorities must13 comply with the Human Rights Act13 (HRA) legislation in theperformance of their functions The HRA also applies to organisations in the private sectorinsofar as they carry out13 functions of a public nature which could include delivering a socialcare activity Where the HRA applies organisations must13 not13 act13 in a way that13 would beincompatible with rights under the European Convention on Human Rights Article 8 of theConvention giving everyone the right13 to respect13 for their private and family life their homeand their correspondence is especially relevant13 to sharing personal data If personal data13 isdisclosed or shared in ways that13 comply with the DPA the sharing or disclosure of that13 information is also likely to comply with the HRA The problem may still be in policing theActs and the rights of an individual if they believe that13 their personal data13 has been sharedor accessed by an inappropriate organisation or individual
A legal industry may be born to deal with such matters but13 this is unlikely to benefit13 peoplewho cannot13 afford the fees involved They would require either legal aid or to employ13 more13 lsquono win no feersquo companies Public attitudes to such costs might13 become negative unlessthey prove successful in preventing breaches of data13 security There may need to belegislation to provide a stronger basis for forcing compliance with privacy laws
34
37 Connecting with13 people
We are social creatures most13 of us rely on our friendships and interactions with friendsand families to share our happiest13 moments and experiences Research suggests that13 thishappiness is infectious at all levels and leads to a 15 increase in the happiness of a closecontact 10 for a second degree contact13 such as the friendrsquos spouse and a 6 increase fora friend of a friend It is hardly surprising that13 the success of social media13 such as Facebookis intimately related to the ability of people to quickly share their happiest13 moments with asmany of their friends and connections as possible
All this has happened during the rise of the Internet13 and the corresponding increase inopportunities for connecting online ie this is a 21st Century phenomenon which has beenfacilitated by Information and Communications Technology But13 the Internet13 remains in itsinfancy and we are only beginning to understand and exploit13 its potential In terms ofaccessing the Internet there are now perhaps two billion people who have access with99 of them having gained this during the past13 decade This number will have doubled bythe period 2020 to 2025 It is likely that13 everyone who wants to be connected in the UK willby then be connected Turning this on its head only those who donrsquot13 want13 to be online willnot13 be on the Internet13 within a decade Connecting with the unconnected will therefore bea case of identifying those people who donrsquot13 want13 to be found unfortunately these mayinclude many people who need the support13 of social care organisations It means that13 theywill be looking for support13 only when they are in crisis unless other ways of finding andormonitoring them are found
While the number of people connected via the Internet13 has exploded this might13 bedwarfed by the number of connected lsquothingsrsquo During 2009 the number of thingsconnected to the Internet13 surpassed the number of connected people at which point13 webegan to experience what13 this report13 has described as the lsquoInternet13 of Thingsrsquo Yet 99 ofall physical objects that13 could join this network are not13 yet13 connected but13 the number couldgrow by 25 every year for the next13 decade so that13 there could be 100 billion connectedobjects by 2025 some of which will be owned or used by everyone in the UK includingthose people who donrsquot13 want13 to be connected themselves We will then have an Internet13 of Everything which will be the smart13 connection of people data events and actions
With each new person object or data13 that13 comes online the connection possibilitiesbetween all these elements grows exponentially The rise of big data mobile networkingcloud storage and data13 mining technologies will all play a critical role in the Internet13 ofEverything The result13 will be new capabilities richer experiences and unprecedentedvalue for individuals businesses communities and countries everywhere The lsquonetworkeffectrsquo of the Internet13 of Everything will be a very powerful thing the true impact13 of whichwe wonrsquot13 fully understand for several years As it13 develops however those who are not13 connected will feel even more digitally and socially excluded There will be a need to reachout13 to vulnerable people unless the process of claiming requires proof of online identityand the payments to be received can only be redeemed using a chipped card or adownloaded app onto a smartphone This is of course the way that13 welfare arrangementsare already developing thus it13 might13 prove impossible to make a successful claim without13
35
already being connected to lsquothe systemrsquo either through an online presence or through theInternet13 of Things
38 Downloading everything
Sixty years ago information was discovered by reading books often in a library wherenotes had to be made because the books or journals couldnrsquot13 be removed Then in theearly 1960s the first13 office photocopying machines were introduced into the UK theyimmediately meant13 that13 pages or articles from books could be copied and taken away to beread and summarised later Within a few years photocopying became a replacement13 forreading as researchers became less adept13 at selecting a few sentences and every deskbecame a depository for reams of printed paper Paper became the means of recordingeverything from bank statements through to music
We now appreciate that13 printing everything is a waste of both the ink (or toner) used tocreate the black print13 and of paper which requires trees to be chopped down and pulpedbefore it13 can be pressed into thin sheets Saving paper is therefore seen as green and goodfor the planet Fortunately we no longer need to print13 everything because computermemory is unlimited thanks to the cloud and we can then view pages and articles onportable or fixed screens
The internet13 has everything and it13 is all available instantly for downloading providing thereis a device available to accept13 it and there is sufficient13 communication bandwidth toperform the transfer of data13 sufficiently quickly Thus we can record all text13 articles that13 are relevant13 to us including digital records of birth certificates qualifications and passportsand the need for original printed versions will decline But13 we can also do this forphotographs Most13 handheld computing devices include at least13 one camera so they cangenerate enormous number of pictures which can be kept13 for posterity without13 having toconsume inks and special papers to print13 them
But13 the materials that13 can be downloaded donrsquot13 stop at pictures software is available that13 can grab TV shows after they air and movies as soon as theyre released In the same wayit13 is possible to schedule music comic books video games and practically anything else asa download with minimal effort People will need enormous hard drives if they want13 theirown digital copies of these files so will more than likely make use of cloud storage that13 willbe available from many organisations The location of the servers may become sensitivedue to border restrictions as will the security of the data13 and the way that13 it13 is backed up sothat13 it13 is resilient13 to failures
It may be evident13 that13 application forms for all types of welfare payment13 will be availableonly for downloading so that once digitised they can be processed by computer andrecords sent13 to various servers for subsequent13 storage and processing Some people maywant13 to keep their data13 on them once it13 has been downloaded Pen drives can already holdseveral GB of data so it13 is likely that13 people will be able to carry their downloaded data13 withthem at all times irrespective of the size and complexities of the information
36
39 Health13 and13 well-shy‐being
The general health of the population is unlikely to deteriorate noticeably within 10 to 20years Indeed expectations of the population are that13 things must13 improve as surgicaltechniques mature and as pharmaceutical interventions become more personalised andpowerful However the rising demand for health services due to an ageing population andthe increasing cost13 of providing sophisticated therapies will make delivering a free anduniversal health service difficult13 without13 substantial increases in taxation This is unlikely tohappen in the UK even though spending on health services will be protected against13 thecuts facing other services
There will have to be changes in how the NHS works For twenty years hospitals have beenclosed and replaced by fewer new facilities so that13 the bed count13 is reduced This has led toa significant13 shift13 in resources to primary care and community care supporting shorter staysin hospital and speedier transfer back home for people after surgery or illness This hasbeen13 successful but13 there remain problems with demand for GP services especially out-shy‐of-shy‐hours and at weekends Indeed despite the introduction of NHS24 and similar help-shy‐linesthe demand for GP appointments continues to increase Delays are inevitable and this willincrease system failures with more unnecessary deaths and a failure for people to access adiagnosis that13 might13 lead to early interventions and ultimately lower delivery costs Over250 more patients are added to waiting lists every day
This will lead to a new model of primary care consistent13 with existing changes which haveseen surgeries move from High Street13 locations to medical centres close to bus routes andwith more parking for patients The process of making an appointment13 is changing from atelephone-shy‐based interview process dominated by a medically-shy‐unqualified receptionist13 to achoose and book approach using an online process linked to electronic patient13 records Thiswill give patients more convenience but13 will allow priority for those who have Internet13 access at the expensive of those who are digitally excluded Making the process of bookingan appointment13 quick and easy may also increase demand from people who do not13 need tobe seen as it13 will fail to identify those in greatest13 need
A greater use of telehealth and telecare technologies will be inevitable beginning with thefirst13 contact13 as an encounter using the telephone e-shy‐mail or video conferencing -shy‐ a visit13 tothe GP surgery should be a last13 resort and should involve a nurse consultation in the first13 instance This would be consistent13 with three quarters of appointments currently involvinga chronic disease or long term condition which relates to improved self-shy‐care The support13 ofthese patients at home should be prioritised through tele-shy‐ and web-shy‐based technologies andshould involve training and coaching through a network of nurse practitioners Home visitsshould generally be unnecessary through the use of these technologies but13 could besupplemented by satellite surgeries manned by nursing in community premises or inpharmacies nurseries and Internet13 cafes
The homes13 of people who13 need13 closer monitoring can then become part13 of virtual wardswith real or electronic visits by health professionals University Hospital Southampton NHSFoundation Trust13 already looks after patients who have undergone surgery such as a hip orknee13 replacements in virtual wards with high levels of satisfaction The Royal Free London
37
NHS Foundation Trust13 offers a similar service but13 plans to add the possibility of videoconsultations between patient13 and consultant
310 Attitudes to public health issues ndash obesity smoking alcohol abuse drugs
As self-shy‐care becomes the focus of the NHS the public will increasingly understand that13 thecosts and availability of services are being harmed by the poor health behaviour ofrelatively small numbers of people The link between public health initiatives today andhealthcare needs and costs in the future will become increasingly evident13 as a result13 of theway that13 information is presented Thus the overweight13 smoker who currently attractsconcern and pity when they are diagnosed with diabetes and COPD is increasingly beingseen as the victim of their own stupidity or lack of self-shy‐discipline If they continue to neglect13 medical advice and continue with an unhealthy lifestyle then the way that13 they receivetreatment13 and consume resources will become a matter for the entire population
Obesity is seen as due to a combination of poor diet13 and a sedentary lifestyle No longer isthe idea13 that13 people are lsquobig bonedrsquo acceptable Governments will respond initially byrequiring manufacturers and food processors to provide nutritional information onpackaging and on menus in restaurants But13 people can choose not13 to read the data13 and toneglect13 both the importance of food quality content13 and quantity This will increasepressure to introduce fat13 or sugar taxes and these are likely to be in force within a decade
Although the high taxes on tobacco products has forced some smokers to reduce theirconsumption or to give up altogether the impact13 has been reduced by the smuggling ofproducts from overseas and by the availability of duty-shy‐free cigarettes for people returningfrom foreign holidays and business meetings Further measures are planned to changepackaging and to include even more graphic images and warnings on cigarette packages tomake smokers aware of the effects of smoking on their health and well-shy‐being There is asyet little evidence of how successful this might13 be More effective has been the banning ofsmoking in public places including trains and aircraft Expensive medical interventions suchas heart13 transplants will be denied to individuals until they change their lifestyle behaviourSmokers might13 therefore be increasingly ostracised leading to a loss of esteem This mayhave a particular impact13 on people who already suffer from mental health problems whoare more likely to smoke
The overuse of alcohol is being recognised as a major factor in hospital admissions withNHS figures showing an increase of over 40 in such admissions over the past13 decadeLinked to this has been a 75 increase in prescriptions to treat13 alcohol dependency Fewpeople have sympathy for those who waste their limited income on booze If they havechildren or other dependents they will be the ones who suffer and who may need thesupport13 of social care
Drug users are already significant13 users of social services as their habit13 is likely to makethem unemployable They receive little sympathy from the general public because they areseen as criminals and people who waste public resources Levels of drug abuse have been
38
slowly increasing over the years but13 this trend is slowly being reversed Indeed the numberof people using drugs during the past13 year has fallen to its lowest13 level for nearly 20 years(below 9) with cannabis being most13 likely often following excessive drinking Aselectronic noses and other technologies can detect13 traces of drugs it13 seems likely that13 success in overcoming addiction can be measured objectively This may become a two-shy‐edged sword rewarding those who can turn around their lives but13 further marginalisingthose who canrsquot13 or wont13 accept13 the lsquocold turkeyrsquo
311 Attitudes to surveillance
Issues associated with privacy confidentiality and data13 security have been discussedpreviously in the context13 of information technology the World Wide Web and the ease ofcollecting recording recalling analysing and displaying data The monitoring of individualsand their methods of using this information can be regarded as surveillance As thequantities of data13 increase along with the number of devices that13 can be used to access itthe surveillance tools will also increase in their sophistication Indeed the Big Data13 approaches described in the previous section will enable the combination of structureddata13 (such as the information held in databases) to be married with unstructured data13 fromimages in such a way that13 it13 can be mined
Whilst13 the lsquodigital surveillancersquo methods described above may cause most13 concern topeople because of its impact13 on anonymity it13 is the collection and analysis of images that13 are the major concern to people as they contemplate the ways that13 lsquoBig Brotherrsquo maydevelop to restrict13 freedom Every major UK city and town centre has an array of CCTVcameras that13 continually record activities from every angle If it13 used to be true that13 nobody in London was more than 10 yards from a rat it13 is certainly the case today that13 nobody can be more than this distance from being in view of a surveillance camera Yetthey receive so much positive publicity from TV programmes where their footage is used todetect13 vehicles close to a crime scene or to monitor the movements of suspects that13 theyare now accepted by the public as a deterrent13 in the same way as lsquobobbies on the beatrsquowere seen 25 years ago There is therefore little public reaction to the expansion in the useof video surveillance except13 for the practical observation of how so many views can beinspected and recorded
Looking to the future the tumbling cost13 of video technology will surely lead to anotherincrease in the number of devices The aerial views taken from towers will besupplemented by more local views taken by devices that13 are embedded in the fabric ofbuildings or carried by individuals either on their person (for example on clothing orspectacles) or in the bags that13 they carry The time and date-shy‐stamped images as Big Datawill be recorded to lsquothe Cloudrsquo where it13 can be added to other data It can then be usedwhen an incident13 has occurred or to provide further detail of night-shy‐time activities
It follows that13 there will be no hiding place for people who simply want13 to disappear Theymay respond by wearing clothing (such as hoodies) that13 hide their faces or which make it13 difficult13 to distinguish gait13 or mannerisms from which they might13 be identified New forms
39
of clothing may be designed to make shapes more difficult13 to analyse and these might13 become the uniforms of a class of person who wants to live in a way that13 they donrsquot13 interact13 with officials from any ministry or local government13 department If they also obstruct13 services then they will be considered to be anarchists of some form sparking protests fromother sectors of society
31213 Attitudes to driving
Motor cars have been a feature of UK roads for over a century but13 it13 is only during the past13 50 years that13 they have become a resource that13 most13 families have had access to enablingthem to travel without13 the restrictions imposed by a limited railway network and non-shy‐integrated bus transport People who have had a car throughout13 their lives often see theircars as an important13 factor in enabling them to remain independent13 and to exercise choicesrelating to where they shop and where they spend their leisure time This extends to theirspouse and to friends and neighbours that13 they might13 take with them on their variousexpeditions
Unfortunately there are incidents involving older drivers who perhaps go down amotorway in the wrong direction who are taken ill at the wheel or who are involved in anaccident13 involving no other vehicles These are small in number but13 often lead to a reactionthat13 they shouldnrsquot13 be allowed to drive lsquoat13 their agersquo Age itself is not13 an indicator ofdriving quality but13 because old age also brings more chance of having limited long termconditions and other illnesses it13 is easy to make a link between driving ability and age Thelicensing system does require continued driving to be linked with medical advice andforbids people with poor eyesight epilepsy and other conditions to hold a licence in oldage
Yet13 statistically older drivers cause far fewer accidents than younger drivers The reasonsfor this may be complex and are likely to include the fact13 that13 they drive less often covershorter distances and donrsquot13 go out13 in the dark or in poor weather However it13 does not13 wholly explain why the UKrsquos drivers aged over 70 and who represent13 some 8 of all driversare involved in only 4 of accidents that13 cause injury This compares favourably with the15 of13 drivers aged between 17 and 29 who are involved in over a third of crashes that13 result13 in injury
By 2020 the number of drivers aged over 70 on UK roads is likely to increase to over 7million This will require a new national strategy perhaps involving support13 for olderdrivers further training raising awareness of issues and making more use of adaptivetechnologies to support13 the driver in avoiding collision or forgetting to check on the statusof their vehicle Poor eyesight13 could be enhanced by camera technologies rather thanforcing people off the road if they are unable to read a licence plate
The International Longevity Centre has found that13 one in four Britons thought13 driversshould be made to switch off the ignition for good somewhere between the ages of 70 and75 The numbers may decrease as the population ages and as cars become safer Forcing
40
older people off the road may be a natural consequence of providing free bus passes andsubsidised rail fares but13 the growth in the pavement13 scooter industry demonstrates that13 older people value their independence and will do almost13 anything to get13 out13 and aboutPerhaps legislation will result13 in more regulation of electric vehicles and where they cantravel
There can be no doubt13 that13 getting out13 will be associated with better quality of life andwell-shy‐being and this is likely to be supported in the future as evidence of improvedoutcomes emerges It is to be hoped that13 positive stories will be publicised so that13 publicattitudes arenrsquot13 hardened This may be supported by more in-shy‐car monitoring of drivers andthe linking of performance with on-shy‐line driving records and licences These could throughremotely monitored ignition systems prevent13 the use of motor vehicles by people without13 a licence or without13 insurance
313 Climate change
There is a general view that13 the emissions of carbon gases are contributing to globalwarming in a manner that13 will change the UK climate in such a way that13 the climate maybecome more Mediterranean However some scientists believe that13 manrsquos impact13 on theenvironment13 may be small compared with natural variations caused for example bycyclical changes in the sunrsquos energy output13 or by the effects of volcanoes and earthquakesRecent13 evidence has suggested that13 we are going through a phase of changing extremesand that13 this is more likely to cause storms periods of excessive rainfall and unusualseasonal trends with snow and frost13 in the spring and warmer winters Considerableuncertainty remains and it13 might13 be necessary to plan for a number of different13 scenariosand for the impact13 on vulnerable people
I Colder winters UK properties are poorly insulated resulting in excess mortalitiesduring cold spells due to an increased number of people suffering from stroke aswell as bronchitis and other pulmonary diseases The cost13 of heating continues toincrease putting more households into a state of fuel poverty Any further coolingduring the winter months will result13 in more people living in unhealthy coldconditions Winter fuel payments are likely to be restricted to the poorest13 peoplebut13 this might13 exclude people who live in larger properties that13 are more difficult13 toheat
II More storms excessive winds and rain can cause flooding at any time of the yearMany UK communities are built13 close to rivers and these can surge during heavyrainfall causing houses to be filled with water and furniture and carpets lostInsurance can be problematic for properties built13 on flood plains which can blight13 properties and prevent13 owners from being able to sell and move on High winds canrip off roofs causing injury and also causing families to be left13 homeless anddependent13 on social services
III Hot13 summers Europe suffered high temperatures during the summers of 2003 and2004 leading to heat13 stroke and hypothermia The UK has not13 previously sufferedfrom such problems but13 might13 be expected to experience days of extreme
41
temperature and humidity at times Older people may not13 be prepared for suchweather Street13 dwellers may be unable to find shade and supplies of drinkingwater
Irrespective of what13 combination of weather scenarios arise it13 must13 be concluded that13 any extremes will have a major negative impact13 on vulnerable people especially if theyare not13 prepared because they havenrsquot13 received the weather warnings and advice that13 can be broadcast13 using the TV radio and online services Once again the digitallyexcluded will suffer and will pay a high cost Society will continue to pick up the bill interms of demands on social care services unless preventive actions are taken in theform of connecting these people to each other and to formal services
42
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
s13 13
13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
n13 13
13 s13
r13 n13
e13 at13
e13 y13 e13 ld13
ly13
13 e13 t13 e13
s13 er13 e13
f13
rt13 13
13 13
13
r13 13
s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
e13 g13 13
e13
13 13 ial13
13
d13
13 d13 h13 r13
d13 13
s13 y13
e13
13
rd13 r13 e13
13
13
13
e13
e13
d13 13
13
13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
ne13
le13
ne13
2 TECHNOLOGICAL CHANGES THAT13 COULD HAVE13 A DIRECT13 IMPACT ON SOCIAL CARE
Taken as whole lsquotechnologicalrsquo developments can be overwhelming so this section breaksup technology into discrete elements and considers the likely impact13 of each In this waywe intend to make it13 easier to understand and to imagine in a real and constructive wayhow and when they might13 become significant
21 Personal computing13
In reality we absorb and integrate new technology all the time some of us a different13 ratesthan others Consider how over 40 years computers and the internet13 moved from beingobscure and specialised tools to driving commonplace consumer devices Most13 computingdevices already have more processing power than the spacecraft13 that13 landed men on themoon in 1969
1970 bull A computer was a large device (a lsquomainframersquo the size of large wardrobe) that required13 acarefully13 regulated air-shy‐conditioned roomo Information was input through punch-shy‐cardso There was no keyboard and no video display
1980s bull The first personal computers arrived but were mainly for enthusiastsbull Word processors arrived in offices allowing text editing and formattingbull By the end13 of the decade desktop PCs13 were popular but still relied on the user learning arca
commands13 (eg the Amstrad)1990s bull Email virtually unheard of at work and at home
bull The Apple Mac with its pointing device (mouse) and Graphical User Interface made it possib to use a computer without learning13 arcane13 commands
bull Microsoft followed with Windows and by the end of the decade desktop computers werecommonplace
bull In the mid 1990s the word wide web arrived and the word lsquointernetrsquo13 entered everydayvocabulary
bull lsquoDial-shy‐uprsquo access to13 the internet available at work and13 at home via a modem and13 telephone li bull First generation of mobile13 phones take13 off ndash texting unexpectedly popular
2000s bull Broadband13 replaces lsquodial-shy‐uprsquo allowing lsquoalways onrsquo internet connectionbull Smartphones allow us to connect to the13 internet on the movebull Smartphones can record videobull Youtube allows free sharing of videobull Online shopping commonplacebull Laptops increase13 in popularitybull Email widespread in personal and working lifebull Social networks part of everyday life13 (eg Facebook -shy‐ one billion13 members)bull Email widely considered a plague that needs controlling
2010s bull Tablets increasing in popularity at expense of laptopsbull Touch screensbull Video phone (skype) making face to face communication an affordable realitybull Email widely considered a plague that needs controllingbull Future13 Identities report finds lsquoPeople13 are13 accustomed to switching seamlessly between the13
internet and the physical13 world and use social13 media to conduct their lives in a way thatdissolves the divide between13 online and13 offline identitiesrsquo13 httpwwwbisgovukforesightour-shy‐workpolicy-shy‐futuresidentity
4
Accessibility acceptability and fashion
People adopt13 new technologies at different13 rates and some reject13 them completely Themobile phone might13 seem ubiquitous but13 some people refuse to have anything to do withthem
Some new devices are emerging such as an lsquoi-shy‐watchrsquo -shy‐ a kind of i-shy‐phone worn on the wristwhile a number of companies have suggested that they will use flexible electronic circuit13 boards to produce conformable devices that13 might13 be integrated into clothing or producedas a band that13 could be worn on the forearm
Google has been experimenting with heads-shy‐up displays which would allow someone to viewa display without13 having to carry a screen This approach would enable an individual toreceive real-shy‐time information as they walked around It might13 promote virtual visits todistant13 locations and virtual reality scenarios for games will increasingly interact13 with thereal world
It is likely that13 there will be an increasing choice allowing users to select13 devices most13 appropriate to their own lifestyle Ease of use may become a more important13 factor infuture designs thus enabling all citizens to enjoy ownership and applications of thetechnology
It is possible that13 not13 owning such a device or not13 being able to fully utilise it will become acharacteristic of the disadvantaged few -shy‐ and perhaps the people who will most13 need helpfrom13 social workers
22 Information generation and storage
As recently as ten years ago the amount13 of digital data13 or information we could store wasstrictly limited by the capacity and cost13 of storage media tapes floppy discs and harddrives The cost13 has fallen so much that13 today there is effectively ample space to store allthe data13 that13 we can create
The challenge is to store it securely and in such a way that it can then be retrieved quicklywhen needed and from13 any location13
We can now easily access bus and train timetables online the Kindle has created a hugemarket13 in e-shy‐books and even the Argos catalogue is expected to be available only as a digitaldownload
Cloud storage is the term used to describe a world in which we no longer keep our data13 (documents books photos video) on our own devices Instead we store them on cloudservices such as Flickr Youtube Google Drive We can even keep personal data13 such asreceipts using services such as httpwwwimmobilisecom which offers an online
5
portfolio for your personal belongings And Final Fling is an example that13 enables us to planfor our death
If entire identities are effectively digitised and stored in this way people who have not13 allowed their data13 to be created and warehoused in this way will be seriouslydisadvantaged They could be forced to join an underworld of digital refuseniks who areunable to apply for jobs for a passport for a driving licence and for welfare payments
23 Stratification13 and analytical techniques
The amount13 of data13 collected about13 each individual in society is increasing rapidly The data13 gathered by government13 and health systems tends to be highly structured which allowseasy comparisons to be made between any individualrsquos result13 and an average value forsimilar people This leads to important13 knowledge of distributions and how they might13 change over time
But13 commercial organisations such as supermarkets and online retailers also routinelygather data13 about13 our purchases our movements and our preferences This is known as BigData and analytical techniques known as Data Mining are evolving which look for trendsthat13 might13 offer some level of prediction
From an individual perspective Big Data13 can tell people how much they are like everybodyelse Indeed a personal analysis might13 tell them that13 there are another several hundredpeople just13 like them in Glasgow in Scotland in the UK in Europe or in the world How thisinformation is used is the important13 issue If it13 is used to make people feel lsquonormalrsquo then it13 can be positive but13 equally if it13 is used to stop people feeling that13 they are lsquospecialrsquo thenthis could lead to a loss of self-shy‐esteem
24 Communication13 technologies
The origins13 of social alarms lie in sheltered housing The assumption during the 1950s and1960s was that13 the people who needed to live in this type of accommodation were bothvulnerable and relatively poor As telephone lines were at that13 time a luxury whichcouldnrsquot13 be afforded by many hard-shy‐wired warden-shy‐call systems similar to the hospitalbedside call were devised Subsequently they evolved into two-shy‐way intercom systemsbetween the resident13 and a call monitoring centre rather than a local warden
These hard-shy‐wired arrangements were bespoke to each manufacturer and were thereforelimited in performance and in linking in with other peripheral devices and telecare Duringthe 1970s the telephone became less of a luxury and the number of households of allincome levels who had their own telephone lines rose rapidly
6
The 1990s saw the emergence of home computing the BBC Micro and gaming machinessuch as the Commodore 64 and the Attari Electronic mail (e-shy‐mail) until then the preserveof academic and research institutions moved into the mainstream at first13 connecting via13 (relatively slow) modems and ordinary telephone lines One drawback was that13 thetelephone could not13 be used at the same time as the computer was connected to theinternet a frequent13 cause of family friction In the late 1990s and early 2000s this problemwas solved when broadband became more widely available and cheaper allowing fasterspeeds an always-shy‐on facility and the ability to use the telephone at the same time
As broadband speed and capacity continued to increase so did the ability to use theinternet13 to access video music and all kinds of electronic commerce (for example shoppingtravel)
Perhaps even more dramatic have been the improvements made in mobilecommunications Third Generation (3G) phones allow us to use the Internet13 lsquoon the moversquovia13 smart13 phones and tablet13 devices Fourth Generation (4G) began rolling out13 in 2012offering faster access
By 2025 one can13 confidently13 predict13 that wireless13 communications13 will13 be available across13 the UK and with a bandwidth which13 can13 support13 both audio and video13 services
Effectively anyone who wants to speak to people will be able to do so and the only peoplewho will not13 be able to do this will be those who wish to hide or to avoid contact
25 The internet of things and the Quantified13 Self
The internet13 works by connecting computers around the world Each computer connectedto the internet13 has a unique address (known as an IP -shy‐ Internet13 Protocol -shy‐ number) Manydevices13 now contain some kind of microchip which makes such a device in effect acomputer
This means that13 electrical appliances from washing machines to refrigerators cancommunicate with other machines also connected to the Internet Indeed manufacturershave provided this facility for a number of years in order to monitor performance and tocheck remotely on their operational status The same principle can be applied inagriculture a cow on a farm could be identified by an IP address allowing the farmer and adairy to its monitor its milk output13 or its health
As more and more devices acquire an internet13 address we talk about13 the lsquointernet13 ofthingsrsquo lsquoequipping all objects in the world with minuscule identifying devicesrsquo(httpenwikipediaorgwikiInternet_of_Things) These things might13 include buildingsthe home healthcare and transport healthcare providers cars and emergency serviceslocations such as industrial parks hospitals car parks and police stations and devices suchas tablet13 computers and cash machines
7
The development13 of small and relatively low-shy‐cost13 medical devices for measuring relevant13 vital signs or medical parameters such as pulse rate and blood sugar level means that13 individuals can take their own measurements and then take responsibility forunderstanding their meaning (with appropriate support13 where necessary) and modifyingtheir behaviour accordingly
The availability of smart13 phones capable of running apps (specialised lsquoapplications) has ledto the development13 of new measures of well-shy‐being that13 are based on the individualinputting information on location the way that13 they feel and their interactions with othersThe smartphone can provide additional context13 automatically including location thenumber of conversations the distance travelled and external parameters such as theweather and the temperature This supports the idea13 of a life that13 can be measured in asensitive manner many times a day and without13 being seen as intrusive This leads to theconcept13 of the Quantified Self
Knowing how one feels and how one lives in a way that13 can be measured and easilycompared with other people can have both benefits and disadvantages The benefits tosociety mainly stem from an ability to identify people who are unhealthy both with respect13 to acute needs and from a predictive point13 of view those who are likely to be unwell atsome time in the future In the mental health space people who have bipolar disorder canbe monitored and supported more efficiently perhaps leading to a reduction in self-shy‐harmand suicide
There are likely to be some people who rebel against13 the need for measuring their owncondition daily and for ever They could view the measurement13 regime as being arestriction on their own lives preventing them from doing what13 they want13 to do because ofthe need to compete with their own measurements This could lead them to walk awayfrom treatment13 regimes resulting in a sudden decline in their well-shy‐being
26 Social networks
Social capital1 refers to the collective or economic benefits derived from cooperationbetween individuals and groups and highlights the importance of social networks that13 linkfamily friends neighbours and communities Wellbeing can be affected by connectivitypeople who have low social capital are likely to be lonely but13 also are more likely to reject13 public health initiatives such as flu jabs which could be beneficial to their health and well-shy‐being
The number of older people who live alone has been increasing for many decades By 2025two out13 of every five older people are likely to live alone Their quality of life may dependon them being able to build strong social networks Traditionally these networks were built13
1 lsquoJust as a screwdriver (physical capital) or a university education (cultural capital or human capital) can increase productivity (both individual and collective) so do social contacts affect theproductivity of individuals and groupsrsquo httpenwikipediaorgwikiSocial_capital
8
on neighbourhoods clubs and pubs and religious groups Meetings became social eventsand absence either signified a rejection of the group or a trigger for other members tobegin to visit But13 what13 happens when a network starts to disintegrate because of death orgeographic dispersal or because the individual loses physical capacity Can web-shy‐basedsocial networks compensate by nullifying geographic separation or by building newnetworks
Skype arguably demonstrates that13 lsquogeography is historyrsquo by making possible free real timevideo communication with family and friends thousands miles and continents apart Thebarrier of course is being able to afford a computer and a broadband connection whichmay limit13 use by lower socio-shy‐economic groups However its potential as a support13 mechanism should not13 be underestimated the technology is simple and it13 works we needonly the social economic and political will to make it13 happen In Scotland older peopleenjoy free bus travel why not13 free broadband
Social networks such as Friends Reunited and more significantly Facebook have emergedas vehicles that13 can not13 only link friends together but13 can also become a means of appealingfor associations and linkages that13 can be supported by the sharing of personal information
The inclusion of a camera13 on smartphones makes it13 easy to share photographs which canenrich communication For example proud parents may announce the arrival of a newbaby with a picture that13 everyone might13 wish to see On the other hand employers might13 also see evidence of why someone who has phoned in sick is unavailable for work on aparticular day Being aware of and able to set13 privacy levels is therefore important13 in orderto control who can see your personal information and news young people and vulnerableadults in particular may admit13 more people as lsquofriendsrsquo (or connections) than might13 beadvisable
The lifetime of major social networks is likely to be limited to a few years as new businessmodels13 emerge and new promotional strategies offer benefits to subscribers This mayoffer an opportunity for new networks to be created to deal specifically with those peoplewho are excluded in any way including those who will be referred to social services forassessment13 and support
27 Entertainment
Many people still remember the coronation of Queen Elizabeth in 1953 being shown live ontelevision This was an important13 milestone in establishing this new medium as acompetitor to radio and the cinema13 as a source of entertainment The arrival of colour TVin the late 1960s contributed to the declining popularity of cinemas and theatres many ofwhich closed
Today many homes have a TV in every room and technology has advanced to deliver highdefinition and 3D pictures on very large screens or lsquohome cinemasrsquo with surround sound
9
Paradoxically perhaps radio is more popular than ever and cinema13 has bounced back fromdecline to once again become an important13 element13 in the social lives of many people
Video images still or moving can be displayed also on laptops tablet13 devices andsmartphones which means that13 people can be entertained or informed on the move Sometrain operators have followed airlines in providing an lsquoat13 seatrsquo entertainment13 experience13 which can be offered with certain choices though many passengers prefer to use their owndevices and content In the future it13 seems likely that13 access to both audio and videoentertainment13 will be possible at any location and in a way that13 doesnrsquot13 interfere with theenvironment13 of other passengers
For those who want13 neither video nor audio (eg music) entertainment reading mayremain the entertainment13 of choice Many older people have struggled to find suitablereading materials as a result13 of the closure of local public and mobile libraries Some peoplecannot13 support13 the weight13 of a book while others lack the dexterity to turn the pagesOthers have sight13 problems which prevent13 them from reading small print All theseproblems can be overcome using either text13 to speech technologies (which are replacingtalking books) or by using e-shy‐reader devices which allow font13 sizes to be increased easily andwhich offer simple interfacing for moving pages backwards or forwards
In the future it13 must13 be assumed that13 all entertainment13 media13 will be held in the lsquocloud2rsquoand will be downloadable to an appropriate device on payment13 of a fee provided that13 acommunications contract13 is in place
The pre-shy‐requisites will bebull A device (eg PC laptop tablet Kindle)bull A contract13 with a telecoms provider (eg BT Virgin Sky) for broadbandbull A contract13 or contracts with media13 provider(s) (eg Netflix iTunes)
Those who lack any of these components may be entertainment13 excluded
28 Cash13 and13 money
Cash has been king since the abolition of the gold standard It is an expensive method oftransferring money between people and organisations and is a considerable overhead forindustry and for individuals travelling between different13 countries The highest13 denominations are lightweight13 and easily lost stolen or destroyed while the smallest13 denominations are heavy dirty and difficult13 to handle It is surprising that13 physical cashcontinues to be used It can only be a matter of time before it13 is digitised and replaced byvirtual cash
2 This means the material (book film or whatever) is stored in a remote computer (thecloud) and downloaded (or lsquostreamedrsquo) to your device on demand and possibly onlytemporarily
10
Large payments were previously made by cheque They are expensive to process by thebanks because people can write them by hand which makes them difficult13 to readelectronically and automatically Consequently they require human intervention and this isnot13 what13 modern banks wish to do so they want13 to promote greater use of debit13 and credit13 cards The latter were used initially as a cheque guarantee but13 are now being used almost13 exclusively as a means of withdrawing cash from ATMs and for making paymentselectronically UK banks wanted to do away with cheques by mid-shy‐2012 but13 they had toperform a u-shy‐turn under pressure from charities representing older people It is apparent13 that13 digital cheques and other cheque-shy‐replacement13 strategies will be introduced soon that13 satisfy the most13 pressing concerns of older people
It was difficult13 to see how cash could be replaced for payments for lower cost13 items such asnewspapers and sweets until the era13 of contactless payments Near field communicationsystems are likely to replace bar-shy‐codes to carry product13 identification information Theycan be read by electronic receivers The same technology can be two-shy‐directional allowinginformation to be passed from a smart13 phone to a reader and back again The smart13 phoneeffectively becomes a wallet13 which can be digitally filled by the owner and then emptiedwhen making purchases For small sums of money this approach is ideal and is likely to berolled out If cash disappears then begging will become difficult13 and welfare paymentsmade on a card Such cards are already used by social services as a means of providingclaimants with a means of receiving self directed care and support By restricting use of thecard to outlets that13 can provide care and support13 services opportunities for spending thecash inappropriately are restricted
It follows that13 many users of social services will need to have a smart13 phone as well as acard that13 can be used to buy services In the future smart13 phones may be provided as aloan item to claimants for social care This could include a digital wallet13 facility as well asthe communications and information ecosystem that13 would allow these people to receive awhole range of other services that13 would prevent13 their social exclusion and which could beused directly to provide them with information and access to entertainment
29 Biometrics and fraud13 prevention
Identity theft13 is used by criminals to pretend to be someone else in order to accessresources or obtain credit13 and other benefits in that13 persons name Although the concept13 has been around for centuries it13 is a growing concern in the digital world as we acquiremultiple online identities for bank accounts social networks and using public services such13 as paying tax electoral registration etc
Passwords are fraught13 with difficulty typically they are hard for humans to remember andeasy for machines to crack Efforts are therefore focused on other forms of provingidentity for example
11
bull Fingerprints have been accepted for over two thousand years to confirm identitymostly in criminal justice The technique has been applied to door-shy‐lock opening insome supported housing schemes There are practical problems associated withregistering lsquoallowedrsquo fingerprints and the useful lifetime of such products is also onlyabout13 three or four years
bull Retinal imaging and DNA analysis have been relatively slow to follow but13 only dueto the sophistication required for measurements and the time taken for testing Acombination of retinal imaging with facial gestures and blinking is possible in the labbut13 currently takes half a minute to achieve a match -shy‐ and this is achieved only withthe use of considerable computer processing power This sort13 of time makesapplications in mass people transfer impossible
Current13 research in this area13 is focusing on the uniqueness of other body parts such as earsand knees as biometric indicators The ears have great13 potential because they are usuallyexposed though hidden sometimes behind hair and other times by hats and other clothingOn the other hand the knees are rarely visible and however unique they may be there willbe cultural and religious obstacles to overcome before scanning could become a regularpart13 of identity confirmation The cameras which are central to such systems used to beexpensive but as the cost13 of high quality cameras continues to fall (there is one in nearlyevery mobile phone) it13 becomes feasible to devise identification devices that13 use multiplecameras to simultaneously recognise the eye and the ear
Movement analysis can be used to identify people by their walk gait13 and other biorhythmsprovide unique signatures It is possible to learn someone elsersquos gait13 though and injury orillness13 can have a temporary effect13 on gait
Over the next13 ten years with more sophisticated databases and image processing facilitiesthe cost13 of implementing advanced biometrics will fall enabling their application acrossmore diverse areas and in more social opportunities Potentially cameras will use cloud-shy‐technologies to provide individuals with instant13 recognition of anyone approaching them inthe street This could prompt13 a name or the occasion when they were last13 seen or spokento as a secondary method of control in much the same way as Internet13 banking seeks toavoid fraud This13 has13 the13 potential to remove13 the13 need for13 passwords13 and might13 then be13 the basis of machine-shy‐based13 communication13 either in front13 of a laptop or tablet13 device orwhen using13 a smart13 phone
There will need to be special measures introduced to support13 people with any form ofdisability as they might13 well have one or more sensory deficits Similarly people maystruggle to communicate following a stroke or a serious accident Nevertheless it13 may bereasonable to conclude that13 such systems will be both available and acceptable within thenext13 10 to 12 years
12
210 Health13 information
Health records in the form of written documents x-shy‐ray images and clinical observations arean important13 means of making all interventions efficient13 and safe Increasingly people havemany different13 conditions (comorbidities) and may be treated by several specialists Asthese physical records are moved inevitably some get13 lost estimates suggest13 that13 one inthree records is lsquolostrsquo at any one time
The best13 resource for information about13 a patient13 is his or her primary care record which isheld by the GP The UK was an early adopter of electronic primary care records and can beproud of the way that13 these have enabled population-shy‐based information to be collectedand analysed Scotland (and to a lesser extent13 Wales) has led the way in ensuring that13 allthese records are accessible through anonymised approaches that13 allow researchers toexamine trends and improve analysis of performance Fundamental to this has been theallocation of a unique identifier At13 the same time individuals can access these recordsboth to check for accuracy and to see what13 their doctor has said about13 them
This13 has13 the potential to make people more responsible for their own conditions andmight lead to better13 self-shy‐care13 and changes in behaviour13 that might reduce13 the13 incidence13 or severity13 of chronic conditions13 that are related13 to lifestyle
In the future we can expect13 the primary electronic health record to be linked with hospitaladministration systems picture archiving systems and other records held by hospitals sothat13 appropriate medical staff can have access to all relevant13 data
When the social care record is added to the mix then this will mean fewer but13 shorter andbetter assessments for social workers and for healthcare staff They will knowcircumstances and factors that13 could influence the choice of approaches This supports theidea13 of there being only one record consisting of several components all of which areaccessible by an appropriate professional at any time and in any place
The13 ambitions13 described above13 are not13 limited by technology most13 of the interoperabilityissues between rival commercial record systems have been resolved and databaseproviders are being compelled to support13 joint13 working The English NHS Mandate requiresTrusts to effectively replicate arrangements already in place in Scotland and in Wales andthis will go a long way towards achieving a genuinely paperless NHS well before 2020 Withnew biometric identification technologies individual records will be available to out-shy‐of-shy‐hours physicians and to those working in an AampE department13 irrespective of theconsciousness state of a patient
New telecare and telehealth technologies will produce significant13 more volumes of data13 which are currently held in different13 places and owned by different13 organisations rarely thepatient These data13 will also need to be shared but13 only in a manner that13 is acceptable toeveryone Patients may not13 want13 all their mental health information published in a formthat13 can be viewed by social workers GPs may not13 want13 to have access to all the data13 that13 might13 suggest13 that13 there is a domestic crisis to which they had neither the wish nor capacity
13
to respond Monitoring systems that13 support13 the lsquoquantified13 selfrsquo may also offer data13 that13 may or may not be added to the full recordThe future of health information might13 therefore be about13 providing individuals with themeans of producing relevant13 information storing it13 somewhere secure and then viewing it13 at a later time but13 in a format13 (or with advice) that13 is acceptable
See also httpmydexorg lsquoMydex gives individuals back control over their personal datarsquo
(see also Digital Scotland 2020 Achieving World-shy‐Class digital infrastructure a final report13 tothe Scottish Government13 httpwwwscotlandgovukPublications2013029054lsquoconnectivity by any device anywhere and anytimersquo)
211 The Future of Healthcare
The strains on our healthcare delivery system are becoming greater as they are in otherdeveloped countries as a result13 of an aging population rising expectations and unhealthylifestyles The necessary changes will require a significant13 shift13 in resources13 fromsecondary13 care13 where unit costs13 are high to community13 carewhere people can generallybe treated at home
The future must13 therefore necessarily involve efficiencies in hospitals and in the way that13 people can be treated in less expensive locations ultimately in their own homes Hospitalswill use more sophisticated diagnostic tools including scanners of all types to non-shy‐invasivelyprobe inside peoplersquos bodies This will result13 in more day cases and hospital stays (alreadyaveraging under a week) to even shorter periods with on-shy‐going support13 provided inintermediate care settings that13 might13 include hotels care homes or the personrsquos own homeif it13 is clean safe secure and has all the necessary amenities (include access to theInternet)
Advances in medical technology will allow more treatments to be delivered in the homeThis will mean fewer visits by clinical staff and fewer opportunities to attend primary carecentres Pharmacists will become suppliers of information as well as drugs so the balanceof care will shift13 significantly away from doctors who will work in different13 ways relying13 increasingly on telemedicine to bring the specialist13 to the patient13 for an online consultation13 For example if a patient13 complains of nausea13 and severe headaches a virtual consultationcan be offered almost13 immediately and without13 having to send a patient13 with a potentiallyserious and acute condition on a potentially long journey to a hospital
In the above example a neurologist13 may ask further questions as well as conduct13 acomplete neurological examination using videoconferencing technology Airedale GeneralHospital consultants have new contracts that13 require them all to be available for virtualconsultations The first13 benefit13 has been in reducing the need for prisoners at local jails tobe brought13 into AampE (which may need to be locked down depending on the circumstancesand the potential for violence of the individuals involved) potentially saving hundreds of
14
pounds in security costs It also avoids the need for healthcare staff to have to go into aprison environment
The principles described above are already saving lives through telestroke services whichlead to more people being thrombolysed appropriately and avoiding long term support13 that13 often follows a stroke incident Teledermatology has been practised for a number of yearsand results in rapid diagnosis and resolution of problems that13 previously required significant13 time for remedy
212 Gadgets and13 DIY13 healthcare
There are at least13 three elements to healthcare
bull Gathering information on symptoms and physiological parametersbull Interpreting the information andbull Responding to the diagnosis with treatment
Many people choose to exercise self-shy‐care because this gives them control whilst13 avoidingthe need to share their concerns and personal details with others A lsquodo It yourselfrsquoapproach might13 even be encouraged by the NHS as a viable way of using scare resources
Medical devices that monitor vital signs are mature and have been miniaturised so that13 they can be used in the home by individuals with little or no medical training Indeed bloodsugar monitors are being produced specifically for use outside the hospital and in such away that13 they can be used reliably by people with advice and training being provided onlinevia13 YouTube
Many medical monitoring devices do no more than produce a single measure which theuser may record or respond to Others link wirelessly to smart13 phones allowing data13 to bestored and entered into a personal health record where trending opportunities existingIndeed individuals can easily enter their data13 into an app running on their laptop tablet13 orsmart13 phone This trending information may be useful13 for self-shy‐care and could be passed onto a physician though the volume of data13 produced in this way and doubts about13 thequality of the data are likely to persuade GPs to discount13 data13 produced in this way
This gap in knowledge can be filled with advice information and diagnosis that13 can beobtained online using a lsquoDoctor Googlersquo approach The quality of such diagnosis may varysignificantly although there are many sources of information that13 are both supported andapproved by the NHS (and by similar sources in other countries) However with a data-shy‐richapproach and a choice of diagnosis people may be empowered to take a greater role inhealthcare
15
The final component13 for the DIY enthusiast13 is the treatment13 option Many people fear longterm use of medication produced by the big pharmaceutical industry and prefer morenatural remedies which are available over the counter More medical treatment13 devicesare available that13 stimulate blood flow and counter pain through the use of electrical andphysical stimulation
The evidence may be weak at present13 but13 might13 grow as more people use them and as theircost13 drops The13 impact13 of13 such technologies13 on vulnerable13 people13 is13 difficult13 to gauge
213 Telecare
Support13 provided at a distance to people in their own homes is known as telecare Thename implies remote monitoring and interaction and includes the monitoring of the homeenvironment13 and of the individual as well as the interaction of the individual with thisenvironment Definitions have become difficult13 due to some US medical devicemanufacturers introducing the term telehealth to describe medical telecare such as remotemeasurement13 and collection of vital signs data
In the UK telecare alarm services have matured quickly using the robust13 platform andinfrastructure of social alarm systems which were originally used by tenants in shelteredhousing schemes to seek help when they didnrsquot13 own a telephone The majority of telecareservice users today live in their own homes and use dispersed alarm units to link with amonitoring centre through the telephone network Improved assessments of needs andrisks to independence have resulted in combinations of sensors being used to support13 theoption of staying put13 rather than moving into residential care or having increasing levels ofdomiciliary support They support13 the policy of bringing care closer to home and ofencouraging people to become partners in their long term support13 arrangements
Telecare services developments over the past13 decade include standalone items such asautomatic lights which have achieved significant13 efficiencies especially for people who arefrail and prone to falling and to those suffering from mild cognitive impairment epilepsyand anxiety People who have long term conditions including chronic conditions such asdiabetes and hypertension can also be managed more effectively through telecare supportThe benefits of telecare services include a relief of stress for family caregivers enablingthem to continue to provide unpaid support13 while holding down a job and maintaining theirquality of life
New developments enable continuous monitoring of behaviour and smart13 devices that13 canfor example remotely control the cooker the water supply and door entry Such13 monitoring may detect13 incidents early and prevent13 emergencies arising Devices arebecoming smaller and easier to embed quickly within the home environment making themmore acceptable and less noticeable Longer battery life means less frequent13 maintenancevisits
16
The13 monitoring13 centre13 becomes13 an information hub13 offering13 both advice13 and a vehicle13 for checking that someone is coping especially following a trigger event such as a stay inhospital or the illness13 of an informal13 carer
New systems utilise web technology that13 allows family members to be more proactive inthe monitoring of their relatives This can lead to greater interaction with them especiallywhen the relatives live a considerable distance away (perhaps in another country) Thesenext13 generation systems might13 include video conferencing and the use of tablets smart13 phones or smart13 TVs but13 when an emergency response is required (perhaps to lift13 someoneup after a non-shy‐injurious fall) there remains a need for human intervention
The13 future13 of13 telecare13 might therefore13 include13 an increasing13 dependence13 on volunteersfrom13 the13 community to provide13 the13 required support Social networking may need to beused13 to support13 telecare technologies
214 Mobile healthcare
While telecare can support13 people effectively in their own homes it13 is now recognised that13 being able to go out13 to enjoy open spaces and to overcome the fear that13 the home is aprison is an important13 part13 of improving well being and supporting a higher quality of lifeExtending telecare technologies to operate outside the home is known as mobile healthcare(or mCare) and is based on mobile telephone networks rather than landlines
The simplest13 form of mCare requires only a basic mobile phone to deliver telephone callsvoice13 messages and SMS (text13 messages) The technology is mature and there are countlessapplications in use both in the UK and in developing countries such as Africa13 and India13 where mobile telephones have already achieved a saturation level and where fixedtelephone infrastructures are not13 likely to be established at any time Such telephones areuniversally available in the UK and are used by the vast13 majority of people including manyolder people especially if they have been introduced to the low cost13 (pound30) devices that13 have large buttons large displays and a separate large button for calling an emergencynumber
Smart13 phones are rapidly replacing basic phones and allow the use of a large range of lsquoappsrsquothat13 are being developed to provide information and for enhanced experiences In thehealthcare space Skype FaceTime Vidyo and GoToMeeting with HD Faces are all current13 examples of video conferencing software available on tablets and smartphones
The specific software will depend on the nature of the communication desired
bull Skype will13 manage a simple video phone callbull Where an AampE physician needs to share a CT scan of head with a Neurologist13 on call
from home GoToMeeting would be more appropriate
17
bull If the physician would rather have a dedicated online meeting room that13 patientsand colleagues can simply drop in for a virtual meeting a Vidyo virtual room may bemore appropriate
This technology can suit13 any form of lifestyle including many people with complex needswhose lifestyle is not13 consistent13 with a fixed address
Social care apps are available already to deal with problems of sensory deficit
bull Guiding a blind person through GPS navigation and reading signs through appslinked to the devicersquos camera13
bull The microphone can be used as a hearing aidbull Speech recognition software can be used either to replay speech at a slower speed
or for translation into a language of choicebull Speech can also be selected for people who have a stammer or who have a problem
with their larynxbull Apps are becoming contextually aware recognising situations and locations and are
thus becoming a personal assistant13 for people with disabilities
By 2020 it is therefore possible that a smartphone may13 be prescribed13 for people who13 need13 social13 care13 together with13 a range of apps that have been13 selected13 to meet13 theirassessed13 needs
Whilst13 smart13 phones tablet13 devices and apps may become an important13 part13 of anindividualrsquos personal support13 armoury the potential of mCare will be limited only by anindividualrsquos ability to make use of all its functions Each device could become a part13 of anindividualrsquos personality supporting them to improve behaviour take exercise avoidtemptation and manage their own health and well-shy‐being Potentially mCare could becomethe most13 important13 element13 of social care and support13 within 10 years
215 Artificial Sensing and Enhancement Devices
bull It is estimated that13 one in seven people has imperfect13 hearingbull The numbers who are born deaf are quite small and many of these people may
have some form of hearing restored through surgery or through technologybull Similarly while there may be nearly a million people registered as blind or having a
severe visual impairment the vast13 majority lose their sight13 during their lives as aresult13 of disease
bull New treatments will deliver sight13 recovery or restoration over the course of the next13 10 to 20 years
Fortunately technology can provide excellent13 sensing capabilities that13 are already providingpeople with external portable devices for enhancing their lives The simple hearing aid is anexcellent13 example of a device which has been improved through both miniaturisation
18
personalisation and enhanced performance Today digital hearing aids use sub-shy‐miniaturemicrophones that13 can be unidirectional or omnidirectional and which can be adjusted insensitivity over an extended range Tomorrowrsquos devices can be switched between modesby the user so that13 they can benefit13 from hearing perfectly in any environment Indeedthey can be used with adaptive filtering technologies (as used by helicopter pilot13 headsets)to eliminate some sounds so that13 the rich speech (or music) components alone remainFuture developments will be on optimising control so that13 the user can switch seamlesslybetween different13 amplification applications without13 appearing to be distracted A smart13 phone or mp3 music player may be used as either a processing unit13 or as a ubiquitousoutput13 device that13 looks cool and natural
These same technologies will also be developed for use within the home environment13 fortimes when a deaf user isnrsquot13 present13 or is asleep Acoustic signatures associated withadverse events and incidents such as the hiss of a gas leak the crackle of a fire the sound ofa smoke detector the drip or a water leak or the sound of breaking glass can be directlyassociated with programmed actions Speech will be recognised interpreted translatedsimplified or displayed so that13 an individual knows what13 is said and can be provided withclear instructions on how to respond
Video cameras have become smaller and cheaper and capable of producing high definitionimages The problem of storing and editing these large image files is being solved by thearrival of cloud computing
Electronic noses are already capable of detecting the quality of wine and fresh fruit Similartechnology will be based in smart13 phones and will be able to analyse the air to warn of13 foodthat is no longer fresh and of other indicators of danger including gases that13 have13 little13 natural13 smell These13 devices13 could support13 people with13 cognitive impairment13 -shy‐ whose13 sense of smell13 tends13 to deteriorate -shy‐ to live independently
Many older and vulnerable people are at risk of hypothermia during the winter Sensordevices can provide warnings of low temperature In the same way heat13 stress can be adanger during the summer months so sensors can alert13 people of the need to openwindows or to operate a fanFinally people who have damaged13 their fingers13 or hands will be able to wear sensorsembedded in artificial skin or in gloves that13 will enable them to identify textures and shapesand be able to dress and undress without13 the assistance of carers
216 Robotics
We may recoil at the idea13 of personal care being delivered by robotic devices but13 it13 is likelythat13 within a decade personal assistants will exist13 to assist13 with household tasks These areunlikely to be humanoid and are more likely to be machines dedicated to helping frailpeople to support13 their own weight13 and to carry trays of food around the home
19
There are four broad classes of robot13 under development13 that13 are likely to mature within 10to 12 years
1 Miniature industrial robots that13 have been programmed to perform specific taskswith precision They are likely to be relatively heavy enabling them to bear weight13 but13 still have the necessary flexibility to carry an individual over short13 distancesplacing them in a chair or on a bed They will have sensors and cameras to provideimmediate feedback and to adjust13 rapidly in response to verbal commands or cues13 from the user Some designs may build on existing assistive devices such as abathroom hoist13 or a bathing aid to become intelligent13 extensions of productsalready on the market A stair lift13 with intelligence is already being designed by a UKcompany and is aimed at providing the user with more control of the journeybetween floors of a house
2 The second group of devices might13 be described as intelligent13 furniture Beds andchairs are already available that13 adjust13 to make the user more comfortable and also13 to help them get13 into or out13 of bed The control units are fairly cumbersome andare suited to operation by a carer Voice activated controls and built-shy‐in intelligencewill give the user more control and independence Other items of furniture to whichintelligence might13 be added would be tables whose height13 can adjust13 and whichhold items of food and medicine securely The table would recognise these objectsand could provide prompts or reminders
3 Mobile robots form the third group These could be goffers that13 can either fetchand carry items such as newspapers drinks or trays or which can accompany theuser when they move between rooms providing them with support13 or prompts Thistype of robot13 could be an intelligent13 walking frame with wheels which13 could13 doubleup as a smart13 wheelchair when necessary
4 Finally there are companion robots These might13 be in the form of an electronicpet typically a cat13 or a dog though the Japanese Paro robot13 is a seal Pets canrespond to stroking and being patted they can also remind their owners that13 theyneed to take exercise and to eat drink and take their medication Various designsare already available which provide feedback but13 future models would includecameras and a screen to provide a mobile means of information and interactionwith other people over the Internet Intelligence within the device could allow themto have a personality of their own and gain knowledge by scraping data13 fromwebsites so that13 they can generate speech and have conversations about13 the newsthe weather or sports results
217 Transport and transfer technologies
Walking is good exercise and is a no-shy‐cost13 form of transport13 that13 is encouraged because of itsimpact13 on well-shy‐being For an individual with a chronic disability or suffering from theeffects of an accident13 or an injury this becomes impractical without13 an assistive technology(AT) A walking stick is the simplest13 example of AT
20
Within the home the stair lift13 has enabled people who live in conventional properties that13 are on two or more floors to continue to use facilities on different13 floors when climbing thestairs has become too difficult This is often the case for people who have arthritis a lowerlimb amputation a long term condition such as Chronic Obstructive Pulmonary Disease orpeople approaching the end of life and who have chosen to die in their own homes
Designs have improved so that13 a curved staircase is no longer an issue and the reliabilityhas reached a level where breakdown is a rare occurrence13 Through-shy‐floor lifts have been analternative proposition but13 they remain too large for most13 properties Alternativeapproaches may emerge using air pressure or water pressure as the driving force ABrazilian design already utilises a plastic tube in which a pod is moved effortlessly up anddown
Electronic wheelchairs are now available that13 allow the individual to become moreindependent13 as they allow the user to control both propulsion and steering Some modelshave the capability of mounting a pavement13 or a step or even a flight13 of stairs Personalmuscle amplification devices have been developed originally with the intention of helpingpeople who are confined to a wheelchair due to a neurological disorder to perform sometasks from a standing position Indeed the Rex walkerrsquos manufacturers claim that13 anyonewho can propel themselves in a wheelchair could walk by using Rex
Other approaches have focused on the rehabilitation of people after major accidents that13 have caused partial paralysis They quickly extend into exoskeleton designs that13 enableanyone to gain a mechanical advantage and thus to tackle physical tasks that13 would not13 otherwise be possible These suits are the focus of major research projects across theworld Some13 products such as the system developed by Honda are being tested inAssisted Living facilities and are likely to become more and more enabling over the next13 decade
Similar benefits are also occurring outside the home with a number of novel carryingsystems appearing over the past13 few years They are generally termed lsquoscootersrsquo but13 thiscovers a wide range of systems and devices ranging from the Segway a device that13 is amobile platform on which the user stands and navigates through to conventional electricvehicles that13 have been developed from golf buggies There remain a number of issuesconcerning their use on roads or on pavements but13 similar problems will need to beresolved for bicycles to play their full part13 in enabling people to get13 more exercise13 Thepotential for hybrid scooters remains
218 Smart domestic appliances and personal hygiene
The bathroom is a dangerous place and one where many older and disabled people slip andsuffer a fall Many older people recall taking a bath in a tin tub in front13 of an open fireToday the options tend to be a level access shower (ie a type of wet13 room) for anyoneunable to get13 into a bath There are various aids to help people get13 into and out13 of thebath most13 involving a seat13 that13 can be raised or lower with some bath-shy‐tubs having a door
21
There has been some research into alternative methods of keeping the body clean Sanyointroduced a machine in 1970 modelled on a clothes or dish washing machines the personsits on a seat13 inside the machine where13 they are cleaned by a set13 of water jets These havenot13 proved popular and furthermore require the individual to be transported to themachine Thus the technology may find application in nursing homes but13 are unlikely to beattractive to people living independently in the community
The washing needs of people change over time Over the past13 20 years body piercingshave appeared which have demanded additional attention to avoid the problemsassociated with poor hygiene and metals Similarly hair may be permed and dyed usingchemicals which are much stronger and which might13 damage the hair Add to this thepainting of finger and toe nails and the washing needs are rather different13 to what13 theymight13 have been even ten years ago Finally tattoos were once popular only with sailorsToday they are likely to be found on the arms backs and legs of both men and womenNew ways of cleaning these tattoos will be needed especially if they become infected orare sites at which pressure sores develop
Even if a personrsquos body is clean if their clothes are dirty they may become socially isolatedBut13 the washing of clothes can be strenuous even if a launderette is used The need toconserve water has driven research into ultrasound techniques to beat13 the dirt13 out13 ofclothing while some companies are experimenting with polymer chips These13 ldquogreenrdquo13 technologies are quickly maturing and are likely to be standard in the next 10 years
Other smart13 household appliances are already appearing on the market13 and may soonbecome common13 in UK homes13
bull Robovac devices have sensors to enable them to detect13 dirt13 on carpets and to adjust13 their operation accordingly
bull Refrigerators can read bar codes or RFID tags to identify their contents and theirldquouse byrdquo13 dates enabling them to inform the owner that13 they should use theproducts before they are out13 of date They can be linked to the Internet13 to reorderitems as they are consumed or to suggest13 menu options for the individual based ontheir preferences or according to the diet13 required to manage a condition
bull Ovens will automatically switch off if they are left13 without13 attention for too longand drying machines will set13 times automatically
Devices may be linked so that13 they are more efficient and report13 maintenance issues sothat13 they can be repaired (perhaps remotely) before they suffer a catastrophic breakdown
219 Personal and home13 security
It might13 appear perverse but13 people with very little personal wealth and property are morelikely to be the victims of crime than those who have expensive items This may be due towhere poorer people tend to live or because people who have valuable assets take greater
22
steps to protect13 them There can be no doubt13 that13 crime has a very negative effect13 onindividuals and on their families creating a fear factor that13 may be difficult13 to remove Theimpact13 on quality of life is therefore very considerable especially if it13 forces people to stayat home behind locked doors effectively isolating themselves from society
Modern policing places increasing reliance on the use of closed circuit13 television (CCTV)Town centres are covered by cameras used increasingly in the fight13 against13 crime by bothdetecting anti-shy‐social incidents and identifying the people involved They are also used tomonitor the movement13 of cars that13 may be involved in incidents of burglary and violenceand are fast13 becoming the primary mechanism of law enforcement13 agencies to solve crime
CCTV has moved into the home to record movement but13 monitoring the footage is timeconsuming and often not13 practical Cameras are now available which provide an instant13 video feed to a smart13 phone when movement13 is detected These may have intercomcapability allowing someone to remotely speak to an intruder sometimes before they havegained access to a building This may serve as a deterrent13 and when fitted alongside simpledevices that13 switch lights on randomly around the home may force burglars to goelsewhere
As the price of cameras continues to fall the option of carrying a camera13 on the body that13 continuously monitors personal space is becoming more useful Using wireless networksthe data13 collected can be sent13 continuously to the cloud for safe storage It cansubsequently be retrieved to provide evidence (video and audio) of confrontations enablingsuccessful prosecutions to be made The smart13 phone itself is becoming a valuable itemthat13 is attractive to criminals These can be tethered to personal attack buttons usingwireless technology allowing the device to be activated by the pressing of a button if theowner is being attacked The phones can then be tracked and located by the police whilebeing rendered useless to the assailant
Bogus callers are a perennial problem for vulnerable people Video door bells can beconfigured to display images and record the words of visitors before they are admittedallowing remote monitoring centres to oversee the situations and use image recognitionsoftware to confirm the bona13 fide of visitors Such13 arrangements may become13 commonplace13 over13 the13 next five13 or13 six years13 significantly13 improving the safety of peopleliving independently
220 Personal safety
The biggest13 risks to personal safety stem from fires and falls Most13 fires are the result13 ofpoor cooking practices resulting in burns or scalds Floods and gas emissions are caused bya failure to remember to close taps
The current13 approach involves detection of an emergency situation as soon as possible but13 always after a problem has already occurred This responsive approach can minimise therisks provided that13 there is a protocol in place for intervening This could increasingly be an
23
automated response such as the switching off of the gas of water or the switching on of asprinkler system or a water mist13 system
In the future monitoring systems will be more sophisticated and will have sensors and localintelligence to identify activities In this way reminders can be issued before an emergencyoccurs13 This lsquosmart kitchenrsquo approach may become13 an integral part of13 homes of13 vulnerable13 people
A prototype system has been developed at the Culture Lab in Newcastle Sensors havebeen embedded into cooking utensils enabling the kitchen to identify what13 the person istrying to cook or prepare It can provide interventions as messages on an instructionscreen
Accidents also occur out13 of doors People with dementia13 might13 become lost13 and may havepoor road safety awareness Location devices based on GPS have advanced from large andheavy receivers that13 were used on ships and boats to small battery-shy‐operated devices that13 can be carried in the hand or in a handbag The current13 generation of locators has limitedbattery life and are rather too large to be secreted about13 a personrsquos clothing while devicesthat13 are integrated into a wrist-shy‐watch are rather clunky and unattractive
Within 10 years the13 technologies13 will have13 matured and will be13 much smaller13 so that theycan be embedded in shoes in walking sticks hats or any other item of clothing Powerrequirements will have reduced so that13 energy harvesting from the movements of theindividual will be sufficient13 to keep these products working for several weeks without13 theneed for recharging The devices will not13 simply indicate to others where the individualhappens to be but13 will provide subtle guidance cues to direct13 them home
Cameras might13 also form part13 of the personal security systems that13 will protect13 people fromaccidents Data13 may be sent13 to the cloud and analysed in real time if the person is in adangerous location and can provide prompts either to the individual or broadcast13 advice toothers to clear the danger These systems may be embedded in items of clothing (such as ahat) or they may be attached to spectacles
221 Energy and13 portable power supplies
The demands of developing economies for more power will inevitably lead to higherdomestic fuel charges in the UK especially as oil and gas reserves dwindle
By 2018 UK homes should be fitted with new smart13 meters The specifications for these13 devices have yet13 to be finalised but13 will include a means of identifying wasteful use ofenergy including TV sets that13 are left13 on and unattended fridges and freezers that13 are set13 attoo low temperatures and dryers that13 are used for too long or when the weather is suitablefor using a washing line They could be an enabling factor that13 supports changes inbehaviour driven by a need to use less power but13 it13 is unlikely that13 they will offer a bigreduction in costs that13 are already a problem for many vulnerable families
24
More generally the need for power conservation will include devices that13 are moreefficient and a significant13 emphasis on heat13 retention in buildings through betterinsulation
The energy crisis may force many people to spend more time in community settingsincluding shops and public buildings where they can benefit13 from the warmth Increasingreliance on mobile communication devices will lead to increasing demand for batterycharging facilities
Greater use may be made of portable devices for generating power based on solar cellswind or hand motion
222 Smart cities and homes
The Digital City initiatives have been based on information and how it13 can be used most13 effectively to make people aware of what13 is going on around them This means bettercoordination of resources more rapid access to advice and a battery of sensors measuringevery conceivable parameter from sound and light13 levels through to air quality andtemperature fluctuations There are several Digital or Smart13 City initiatives currently beingimplemented both in the UK and across the world They may significantly impact13 the livesof the millions of people living in them but13 the timeframe for outcome benefits to influenceplanning and design elsewhere is likely to be at least13 20 years and therefore outside thetimeframe of the current13 project
Housing plays a big role in the lives of most13 people both through their aspirations to moveup in the world (usually to a bigger property with a garden) and as the heart13 of the familylife which is associated with good quality of life UK properties have a life span approaching100 years which is about13 double that13 of their European counterparts (and certainly longerthan the wooden-shy‐frame buildings built13 in North America13 for example) A shortage ofhouses has plagued improvements in social welfare for the past13 30 years There is anargument13 that13 there are enough houses but13 the wrong size and in the wrong places andthis has some basis in fact13 as demography changes lead to more people (and more olderpeople) living alone However if there are two million homes in Scotland each with alifespan of 100 years then the renewal rate needs only to be 20000 per annum to maintainthe status quo However it13 must13 be clear that13 the impact13 of smart13 house development13 willbe small The focus should therefore be on adapting existing properties to render themmore appropriate for vulnerable people
Housing adaptations are a branch of assistive technologies The technologies for providingdifferent13 forms of accessible bath and level access shower are well-shy‐established with littleresearch considering anything other than alternative building materials and methods formaintaining the temperature of the bathwater Different13 technologies for bathing will beconsidered separately
25
Thus housing technologies are not likely to impact on social work13 within the next 20years13 though13 the use of information13 technology13 to ensure that people are aware of what13 is available is likely to be commonplace well before then
26
3 BEHAVIOUR AND ATTITUDE CHANGES DUE TO TECHNOLOGICALADVANCES
Technology is only one factor that13 will affect13 the way society changes in the next13 10 or 15years This chapter will consider the context13 in which the technological developmentsoutlined in the previous chapter will be supported (or held back) by societal factors
When the impact13 of such factors has been considered we can then apply theseassumptions to a number of case studies listed in Appendix13 A13
The headings selected for this chapter are not13 arbitrary as they reflect13 the context13 in whichtechnological changes must13 be considered They must13 include consideration of factors suchas demography and long-shy‐term conditions already addressed in the introduction to thesepapers together with the aspects of workforce and citizenship considered in the parallelpapers The additional elements here focus on trends that13 are already occurring and whichmay leave people struggling with the changes that13 occur
Finally there is a need to consider the attitudes of people to technology generally andespecially to the issues of privacy and social responsibility that13 could be radically changedby technology In some cases public opinion will prevent13 some forms of technology beingdeveloped if not13 commercialised In other cases some technologies will be fast-shy‐trackedeither at the request13 of government13 or because of a clear public demand for theopportunities that13 it13 can bring
Predictions13 about the13 future13 must inevitably be13 subject to considerable13 uncertainty butthat is no reason to stop thinking what might happen
31 The Welfare State
The UK can be rightly proud of the way that13 its welfare state has developed during the past13 100 years to provide a safety net13 of financial support13 to people and to their families whenthey are unemployed destitute homeless or challenged by crises and emergencies Therange of benefits received is considerable some are complex and many people struggle tounderstand their entitlements Some are universal some are discretionary some apply onlyto parents others to anyone
The total cost13 of providing these benefits continues to rise and when the economy isstagnating there is inevitably both political pressure often supported by popular publicopinion to introduce welfare reform so that13 people who do not13 work cannot13 be better offthan they would be if they were in full-shy‐time employment This strategy requires a universalbenefit13 to be introduced so that13 it13 is easier for claimants to access support13 but13 also easierfor agencies to identify the total benefits received The idea13 of a benefits cap then becomes
27
more practical to introduce especially if all the processes involved in making a claim arehandled electronically Indeed this encourages government13 to insist13 on applications forbenefits to be made on-shy‐line Unfortunately this will marginalise those people who haveneither a computer nor access to the internet thus emphasising the digital divide in amanner which works against13 some of the most13 disadvantaged people in society
There are currently few tangible links between digital technology and welfare provisionThe most13 obvious are universal benefits such as a free television licence (worth pound14550)13 for13 everyone aged 75 or older with blind and visually impaired people entitled to a 50discount13 irrespective of their age The significance of this position is that13 6 of revenuesgenerated through licence fees are to fund BBC on-shy‐line services13 such13 as websites and i-shy‐player In Scotland the BBCrsquos Alba Gaelic language television service is predominantlyfunded13 by MG Alba an organisation funded by the Scottish Government It is thereforeconceivable that13 in the future licence fees may be used to directly subsidise access toinformation and advice through the Internet13 for vulnerable people whether it13 is throughbroadband access or through a set-shy‐top box which removes the need for a computer in thehome to access particular websites or to use e-shy‐mail services
A second age-shy‐related benefit13 available in the UK is the winter fuel subsidy People whoreceive certain benefits receive the payments automatically while others must13 make aclaim Those who are not13 eligible for benefit13 due to a lack of an address for example missout13 on these payments and also on Cold Weather payments of pound25 for each seven dayperiod of very cold weather between 1 November and 31 March
The development13 of new warm home initiatives plus the complex of subsidies that13 theelectricity supply industry and government13 offer to people with solar cells further changesthe economic arguments Global warming may lead to greater variations in weatherextremes but13 might13 also increase the amount13 of electricity that13 can be generated byalternative (green) sources such as wind and solar cells It is estimated that13 energyconsumption in the UK increased by 17 between Christmas and Easter 2013 compared toprevious years as a result13 of cold weather but13 the above subsidy scheme did not13 benefit13 older people because two of the seven day cold periods were after 31st March It must13 beassumed that13 there will be more people living in fuel poverty in the future and this will leadto more cases of cold related illness including influenza13 and stroke
32 Management of long term conditions
The management13 of long term conditions will be improved for patients who are compliant13 with their medication regime so it13 is possible that13 there may be compulsion to adhere tothe prescription Such compulsion may be monitored using technology Indeed the remotemonitoring of vital signs using telehealthcare will become commonplace as the old boxesand sensors are replaced by devices that13 can be worn continuously or which can beembedded into the fabric of homes (including furniture and bedding) or can be worn asvests or patches They will wirelessly transmit13 data13 to smartphones or tablets and mobile
28
transmission and cloud technology will enable real-shy‐time data13 collection analysis andfeedback
One of the diseases which is projected to increase most13 significantly over the comingdecade is Type 2 diabetes Whilst13 there is a hereditary susceptibility to this condition formany people including those from the Middle East13 and the Asian sub-shy‐continent it13 is also adisease which tends to affect13 those people who are overweight13 andor have a sedentarylifestyle If untreated diabetes can lead to dizziness and collapse at any time but13 can alsohave more devastating long term consequences which include kidney failure strokeblindness and in extreme cases lower limb amputations Management13 therefore includesdaily monitoring of blood glucose levels and major dietary changes such as a significant13 reduction in the consumption of carbohydrates as well as a rigid exercise regime
Many newly diagnosed diabetics follow this advice closely and can lead normal lives for 40years or more but13 some struggle to accept13 the change in lifestyle required as well asremembering which foods are allowed and how much exercise they need to takeIndividual support13 plans are now forthcoming and over the next13 ten years best13 practicewill emerge in the form of smartphone apps that13 are personalised and which can becomean individualrsquos health coach This level of support13 will be fine for some people but13 otherswill need incentives so it13 is likely that13 gaming technologies will be introduced perhapsoffering rewards for good compliance There will be a temptation for some people tocheat perhaps allowing others to perform exercise for them or changing theirconsumption details
Many of these opportunities for cheating will be removed through the use of a uniquebiometric identifier a technology that13 will be mature enough to use in place of passwordson smartphones However the biggest13 challenge may be in encouraging older people to usethe technology Many older people have multiple morbidities Indeed a survey of Scottishpatients implied that13 42 of people aged over 80 will suffer from three long termconditions It will be essential for those people to comply with treatment13 regimes if they arenot13 to have the functional deficits that13 follow
33 Finding people who13 donrsquot fit
People who have low social capital are likely to have few relatives and friends with whomthey regularly communicate and are also unlikely to be part13 of community or faithorganisations such as clubs societies and church groups They also die several yearsyounger than most13 of the population often because they donrsquot13 engage with public healthinitiatives such as vaccinations against13 flu regular checks on their blood pressure bloodsugar levels or in the case of women smear tests or mammography The most13 likelyreason for disappearing beneath the radar of such initiatives is their mobility which leadsalmost13 inevitably to them having no fixed abode and no fixed telephone line It thenbecomes very difficult13 for them to be contacted because their mobile telephones are likelyto have Pay-shy‐As-shy‐You-shy‐Go contracts that13 donrsquot13 require validated names addresses and bankaccounts
29
It follows that13 some of the most13 vulnerable people in society including those who live onthe streets are effectively unknown to both the NHS and to social work departments untilthey are referred in a crisis This could be an emergency presentation to a hospital Accident13 and Emergency Department13 where they will come into contact13 with a social worker becausedischarge may be unsafe This often highlights the importance of the prevention agenda13 and the potential for avoiding admissions to hospital by intervening at an earlier stage
The advantages of being able to locate people who are vulnerable to specific diseases willincrease as genetic testing becomes more routine It is already possible to determine whomight13 be most13 at risk of breast13 cancer and prostate cancer as a result13 of family history Addto this the evidence that13 particular diet13 and exposure to environmental factors can furtherincrease risk then it13 is evident13 that13 individuals can be identified and offered treatmentsthat13 could save their lives many years before they become ill In the case of cancersperhaps only the individual is involved but13 for infectious diseases it13 is the whole of societythat13 is at risk if someone contracts one of the new strains of influenza or if someonechooses not13 to be vaccinated against13 rubella In Chinese airports all visitors are screenedfor fever and refused entry if they tested positive in cities the public are monitored in thesame way Similar approaches may be necessary in the UK if potential carriers cannot13 otherwise be identified
34 Volunteering
It is estimated that13 72 per cent13 of people volunteered to perform a charitable act13 at least13 once during 2012 a rise from 65 per cent13 the previous year About13 four out13 of every 10volunteers offer their services formally to one or more organisations The remaindervolunteer informally by helping out13 a friend or a neighbour Around 50 per cent13 volunteered at least13 once a month in the past13 year up from 41 per cent13 on the previous13 year Most13 have retired many of them before the statutory retirement13 age Those whodonrsquot13 feel able to offer time have offered their financial support13 at a time when the fundingavailable from sources such as the National Lottery has been decreasing Despite economicausterity donations to charities have been increasing 74 per cent13 said they had given tocharity at least13 once in the previous month up from 72 per cent13 the previous year
Strikingly 78 per cent13 of people strongly believe that13 they are part13 of their localneighbourhood an increase from 70 per cent13 10 years previously Community cohesion isstronger than ever 87 per cent13 of people believe their local area13 is a place where peoplefrom different13 backgrounds get13 on well together compared to 80 per cent13 in 2003
The role of volunteers in supporting vulnerable people is therefore likely to increase overthe next13 decade perhaps exploiting the success of the army of volunteers that13 was highlysuccessful in London during the Olympic and Paralympic games The greatest13 role for suchvolunteers may be in providing informal care for older people Already the UK has someseven million informal carers whose value in monetary terms has been calculated to be
30
more than the combined budgets of the NHS and social care Maintaining or extending thisprovision will help to support13 services in the future and may be supported by technology
Whilst13 there is ample evidence to suggest13 that13 telecare services support13 informal carers asmuch as (if not13 more than) the people that13 they are caring for it13 is the potential for utilisingthe internet13 and apps to make their role easier to coordinate and hence more effectivethat13 is likely to be most13 successful moving forward
Many of these focus on particular tasks that13 informal carers can help offer to older peoplesuch as organising their medication A pillbox program is just13 one feature of an app calledBalance It also includes sections for caregiving tips notes for the doctor and the patientsappointments plus a lsquolearning sectionrsquo with articles on aspects of Alzheimers and an RSSfeed for news about13 the disease Tyze is another multi-shy‐functional app it13 allows carers to
bull Organise appointmentsbull Plan outingsbull Share storiesbull Send updates to other family members
Another application is Rally Round which helps carers to organise someone to perform littlejobs often on a temporary basis when someone has dementia physical frailty or isrecovering from accident13 or illness Similar applications are MeMaxi and Finerday
35 The High13 Street
The shape and appearance of UK shopping centres have been changing for half a centuryPeople complain that13 centres are losing their identity with one town looking like everyother both in terms of the stores and in terms of the layout But13 there are three trendswhich are having a profound impact13 on many of the most13 vulnerable people in society
bull Centres lock their doors at 6pm or in some cases 10pm -shy‐ thus denying people whosuffer from claustrophobia13 from window shopping at times when other shoppershave left
bull Out13 of town shopping malls -shy‐ these US style centres are ideal for people in carsbecause they offer free parking which is essential for people who want13 to buy largeritems but13 difficult13 for people who have no transport13 and who must13 rely on publictransport13 that13 is often deficient
bull The rise of online shopping -shy‐ which means that13 many potential shoppers only visit13 High Street13 stores to check the prices before returning home to make a purchaseonline
It is the third of these effects that13 has the greatest13 potential for changing the High Street13 forever and it13 is making life for traditional retailers increasingly difficult13 at a time when highrents are crippling stores large and small It is difficult13 to see how this trend is likely tochange because consolidation in banking and estate agencies is already forcing the closure
31
of other High Street13 players while additional pressures on pubs has led to the closure ofthousands of pubs every year
Those figures however demonstrate that13 consumers still value what13 the high street13 canoffer -shy‐ the chance to inspect13 what13 theyrsquore thinking of buying -shy‐ as well as the new opennessof the internet Customer service makes a difference to people especially if there is aproblem and goods need to be returned One of the most13 common reasons for furniture tobe returned for example is that13 when a sofa13 or a wardrobe was delivered it13 couldnrsquot13 fit13 through the front13 door or up the stairs In the future people will be able to benefit from13 visualisation technology they will upload the floor plans of their homes enabling theretailer to inform them of the problem before they try to delivery Augmented reality viewwill similarly allow customers to see what13 a new item of furniture will look like in itsintended place so that13 they can be more informed about13 the effect13 of size and colour
In terms of improving the viability of the High Street stores will have to focus on theimportance of brand which could mean that13 individual independent13 retailers will have topartner with national suppliers to support13 a local tailored offering based on products that13 are designed for a more global market This is a lsquoconnected High Streetrsquo approach whichcould be enabled by the developments in internet13 availability and smart13 phone accessdescribed in the previous section
The overall effect13 of all these changes could mean that13 town centres become smaller but13 more vibrant13 areas They could thrive if people are attracted there in large numbers whichmeans that13 retail must13 be developed alongside restaurants pubs galleries and other leisureopportunities This is possible in new shopping centres which are already being integratedwith transport13 hubs including railway and bus stations but13 may be more of a design13 challenge for older towns and cities with large Victorian buildings To ensure that13 morepeople are welcomed into the new centres they should include attention to green spacesand areas where people can relax without13 feeling that13 they are second class citizensbecause they donrsquot13 have the same buying power
3513 Privacy
To some people privacy is their right13 to live their lives without13 interference they may seethe State as a potential lsquoBig Brotherrsquo spying on their every move and judging their actions13 and activities Other people have fewer concerns about13 the role of the State but13 great13 fearof individuals interfering with and invading their privacy Some embrace the concept13 of lsquomyspacersquo an area13 of a square metre or so into which nobody can enter without13 permissionThis allows them to avoid physical contact13 and to feel safe from any form of threateningbehaviour
Yet13 this idea13 of private space and its potential violation is merely the tip of the iceberg asfar as privacy is concerned more significant13 is the idea13 of personal (and private)information being shared with anyone and everyone This could be related to identityopinion or image for an individual who wants to remain anonymous or even secretive thisis going to become an increasing problem as technology provides the means of taking
32
photographs recording conversations and capturing environment13 with something as smalland ubiquitous as a mobile phone The fact13 that13 this information can then be shared withthe rest13 of the world using e-shy‐mail Twitter and Facebook makes the problem all the moredifficult So the threat13 is no longer solely from the long lenses of the Paparazzi but13 fromanyone (and that13 means everyone) who has even the most13 basic of mobile phones
This relates to the changing views of society on what13 information should remain privateand what13 should be shared with others The success of social media13 has been based on anattitude of lsquosharing everythingrsquo with either your friends or the world This has introduced anaiumlve idea13 in the minds of some younger people (especially those known as Millennials ieaged 18-shy‐30) that13 everyone can be their friends whilst13 perhaps failing to reinforce the bondsof genuine friendship with any form of test13 or restriction Technology could play a role indefining these friendships and allowing individuals to understand what13 makes a goodfriend but13 this approach has yet13 to be developed and may be slow to overcome the needfor some people to measure their own popularity simply as the number of people that13 theycan list13 as friends on their Facebook page
It follows that13 there may be a need for a new definition of privacy that13 is in keeping withthe web and its ability to display images and opinion in an unregulated manner This needsto embrace past13 concerns about13 the ability of an individual to live without13 the threat13 ofothers being able to watch them whilst13 offering some protection from random postingsabout13 them online Perhaps this could include a right13 to be able to edit13 or remove anythingrelating to themselves on the Web including images that13 are not13 news-shy‐worthy Theownership of image rights may be an associated issue that13 needs to be addressedespecially as modern technology can remove an individual from a group (or a background)13 view provide digital touch-shy‐up or air-shy‐brushing and then republish it13 in a different13 contextHowever there is general agreement13 that13 personal information (such as contact13 details andbank codes) should not13 have a place on the web Surprisingly few people take proactivemeasures to prevent13 tracking functions being activated
It follows that13 too much privacy could lead to younger people fearing that13 they maybecome lost13 in a digital world It is not13 surprising then that13 they are prepared to make lots13 of personal information available often with no fear of how it13 might13 be used by othersWhen Google glasses and similar technologies become available during the next13 few yearsthey will have the potential to identify a stranger walking down the street and to find manyof their secrets to present13 to the wearer in a fraction of a second They could know moreabout13 them than their genuine friends know -shy‐ so who will be their friends in the future
36 Data sharing and13 protection
By lsquodata13 sharingrsquo we mean the disclosure of data13 held by one organisation on an individualto a third party organisation(s) or the sharing of data13 between different13 parts of anorganisation Some data13 sharing doesnrsquot13 involve personal data13 because it13 has beenanonymised in such a way that13 the statistics can be used for the collective good without13 theidentification of the individual The Data13 Protection Act13 (DPA) is in place to provide a legal
33
framework that13 ensures that13 organisations that13 hold personal data13 must13 act13 responsibly atall times These principles adequately describe the position of public and government13 bodies especially social services departments who are responsible for the informationconcerning the health and well-shy‐being of individuals -shy‐ and hence by implication thesensitive data13 relating to their vulnerability
The legal framework that13 applies to private and third sector organisations differs from that13 which applies to public sector organisations which may only act13 within the defined limits oftheir statutory powers However all bodies must13 comply fully with the data13 protectionprinciples and this situation is unlikely to change within the next13 10 to 15 years In someprivate sector contexts there are legal constraints on the disclosure of personal dataHowever most13 private and third sector organisations have a general ability to shareinformation provided this does not13 breach the DPA or any other law It is advisable for acompany to check its constitutional documents such as its memorandum and articles13 ofassociation to make sure there are no restrictions that13 would prevent13 it13 from sharingpersonal data13 in a particular context The type of data13 held is therefore a subject13 ofconcern as it13 may be difficult13 for legislation to keep up with the additional layers of data13 created on-shy‐line and through the Internet13 of Things
Private and third sector organisations should have regard to any industry-shy‐specific regulationor guidance about13 handling individualsrsquo information as this may affect13 the organisationrsquosability to share information They should also be aware of the legal issues that13 can arisewhen sharing personal data13 with public sector bodies This becomes more of an issue asprivate and third sector bodies are carrying out13 a wider range of traditionally public sectorfunctions Opportunities for inappropriate sharing of sensitive data13 will therefore inevitablyincrease
Public authorities must13 comply with the Human Rights Act13 (HRA) legislation in theperformance of their functions The HRA also applies to organisations in the private sectorinsofar as they carry out13 functions of a public nature which could include delivering a socialcare activity Where the HRA applies organisations must13 not13 act13 in a way that13 would beincompatible with rights under the European Convention on Human Rights Article 8 of theConvention giving everyone the right13 to respect13 for their private and family life their homeand their correspondence is especially relevant13 to sharing personal data If personal data13 isdisclosed or shared in ways that13 comply with the DPA the sharing or disclosure of that13 information is also likely to comply with the HRA The problem may still be in policing theActs and the rights of an individual if they believe that13 their personal data13 has been sharedor accessed by an inappropriate organisation or individual
A legal industry may be born to deal with such matters but13 this is unlikely to benefit13 peoplewho cannot13 afford the fees involved They would require either legal aid or to employ13 more13 lsquono win no feersquo companies Public attitudes to such costs might13 become negative unlessthey prove successful in preventing breaches of data13 security There may need to belegislation to provide a stronger basis for forcing compliance with privacy laws
34
37 Connecting with13 people
We are social creatures most13 of us rely on our friendships and interactions with friendsand families to share our happiest13 moments and experiences Research suggests that13 thishappiness is infectious at all levels and leads to a 15 increase in the happiness of a closecontact 10 for a second degree contact13 such as the friendrsquos spouse and a 6 increase fora friend of a friend It is hardly surprising that13 the success of social media13 such as Facebookis intimately related to the ability of people to quickly share their happiest13 moments with asmany of their friends and connections as possible
All this has happened during the rise of the Internet13 and the corresponding increase inopportunities for connecting online ie this is a 21st Century phenomenon which has beenfacilitated by Information and Communications Technology But13 the Internet13 remains in itsinfancy and we are only beginning to understand and exploit13 its potential In terms ofaccessing the Internet there are now perhaps two billion people who have access with99 of them having gained this during the past13 decade This number will have doubled bythe period 2020 to 2025 It is likely that13 everyone who wants to be connected in the UK willby then be connected Turning this on its head only those who donrsquot13 want13 to be online willnot13 be on the Internet13 within a decade Connecting with the unconnected will therefore bea case of identifying those people who donrsquot13 want13 to be found unfortunately these mayinclude many people who need the support13 of social care organisations It means that13 theywill be looking for support13 only when they are in crisis unless other ways of finding andormonitoring them are found
While the number of people connected via the Internet13 has exploded this might13 bedwarfed by the number of connected lsquothingsrsquo During 2009 the number of thingsconnected to the Internet13 surpassed the number of connected people at which point13 webegan to experience what13 this report13 has described as the lsquoInternet13 of Thingsrsquo Yet 99 ofall physical objects that13 could join this network are not13 yet13 connected but13 the number couldgrow by 25 every year for the next13 decade so that13 there could be 100 billion connectedobjects by 2025 some of which will be owned or used by everyone in the UK includingthose people who donrsquot13 want13 to be connected themselves We will then have an Internet13 of Everything which will be the smart13 connection of people data events and actions
With each new person object or data13 that13 comes online the connection possibilitiesbetween all these elements grows exponentially The rise of big data mobile networkingcloud storage and data13 mining technologies will all play a critical role in the Internet13 ofEverything The result13 will be new capabilities richer experiences and unprecedentedvalue for individuals businesses communities and countries everywhere The lsquonetworkeffectrsquo of the Internet13 of Everything will be a very powerful thing the true impact13 of whichwe wonrsquot13 fully understand for several years As it13 develops however those who are not13 connected will feel even more digitally and socially excluded There will be a need to reachout13 to vulnerable people unless the process of claiming requires proof of online identityand the payments to be received can only be redeemed using a chipped card or adownloaded app onto a smartphone This is of course the way that13 welfare arrangementsare already developing thus it13 might13 prove impossible to make a successful claim without13
35
already being connected to lsquothe systemrsquo either through an online presence or through theInternet13 of Things
38 Downloading everything
Sixty years ago information was discovered by reading books often in a library wherenotes had to be made because the books or journals couldnrsquot13 be removed Then in theearly 1960s the first13 office photocopying machines were introduced into the UK theyimmediately meant13 that13 pages or articles from books could be copied and taken away to beread and summarised later Within a few years photocopying became a replacement13 forreading as researchers became less adept13 at selecting a few sentences and every deskbecame a depository for reams of printed paper Paper became the means of recordingeverything from bank statements through to music
We now appreciate that13 printing everything is a waste of both the ink (or toner) used tocreate the black print13 and of paper which requires trees to be chopped down and pulpedbefore it13 can be pressed into thin sheets Saving paper is therefore seen as green and goodfor the planet Fortunately we no longer need to print13 everything because computermemory is unlimited thanks to the cloud and we can then view pages and articles onportable or fixed screens
The internet13 has everything and it13 is all available instantly for downloading providing thereis a device available to accept13 it and there is sufficient13 communication bandwidth toperform the transfer of data13 sufficiently quickly Thus we can record all text13 articles that13 are relevant13 to us including digital records of birth certificates qualifications and passportsand the need for original printed versions will decline But13 we can also do this forphotographs Most13 handheld computing devices include at least13 one camera so they cangenerate enormous number of pictures which can be kept13 for posterity without13 having toconsume inks and special papers to print13 them
But13 the materials that13 can be downloaded donrsquot13 stop at pictures software is available that13 can grab TV shows after they air and movies as soon as theyre released In the same wayit13 is possible to schedule music comic books video games and practically anything else asa download with minimal effort People will need enormous hard drives if they want13 theirown digital copies of these files so will more than likely make use of cloud storage that13 willbe available from many organisations The location of the servers may become sensitivedue to border restrictions as will the security of the data13 and the way that13 it13 is backed up sothat13 it13 is resilient13 to failures
It may be evident13 that13 application forms for all types of welfare payment13 will be availableonly for downloading so that once digitised they can be processed by computer andrecords sent13 to various servers for subsequent13 storage and processing Some people maywant13 to keep their data13 on them once it13 has been downloaded Pen drives can already holdseveral GB of data so it13 is likely that13 people will be able to carry their downloaded data13 withthem at all times irrespective of the size and complexities of the information
36
39 Health13 and13 well-shy‐being
The general health of the population is unlikely to deteriorate noticeably within 10 to 20years Indeed expectations of the population are that13 things must13 improve as surgicaltechniques mature and as pharmaceutical interventions become more personalised andpowerful However the rising demand for health services due to an ageing population andthe increasing cost13 of providing sophisticated therapies will make delivering a free anduniversal health service difficult13 without13 substantial increases in taxation This is unlikely tohappen in the UK even though spending on health services will be protected against13 thecuts facing other services
There will have to be changes in how the NHS works For twenty years hospitals have beenclosed and replaced by fewer new facilities so that13 the bed count13 is reduced This has led toa significant13 shift13 in resources to primary care and community care supporting shorter staysin hospital and speedier transfer back home for people after surgery or illness This hasbeen13 successful but13 there remain problems with demand for GP services especially out-shy‐of-shy‐hours and at weekends Indeed despite the introduction of NHS24 and similar help-shy‐linesthe demand for GP appointments continues to increase Delays are inevitable and this willincrease system failures with more unnecessary deaths and a failure for people to access adiagnosis that13 might13 lead to early interventions and ultimately lower delivery costs Over250 more patients are added to waiting lists every day
This will lead to a new model of primary care consistent13 with existing changes which haveseen surgeries move from High Street13 locations to medical centres close to bus routes andwith more parking for patients The process of making an appointment13 is changing from atelephone-shy‐based interview process dominated by a medically-shy‐unqualified receptionist13 to achoose and book approach using an online process linked to electronic patient13 records Thiswill give patients more convenience but13 will allow priority for those who have Internet13 access at the expensive of those who are digitally excluded Making the process of bookingan appointment13 quick and easy may also increase demand from people who do not13 need tobe seen as it13 will fail to identify those in greatest13 need
A greater use of telehealth and telecare technologies will be inevitable beginning with thefirst13 contact13 as an encounter using the telephone e-shy‐mail or video conferencing -shy‐ a visit13 tothe GP surgery should be a last13 resort and should involve a nurse consultation in the first13 instance This would be consistent13 with three quarters of appointments currently involvinga chronic disease or long term condition which relates to improved self-shy‐care The support13 ofthese patients at home should be prioritised through tele-shy‐ and web-shy‐based technologies andshould involve training and coaching through a network of nurse practitioners Home visitsshould generally be unnecessary through the use of these technologies but13 could besupplemented by satellite surgeries manned by nursing in community premises or inpharmacies nurseries and Internet13 cafes
The homes13 of people who13 need13 closer monitoring can then become part13 of virtual wardswith real or electronic visits by health professionals University Hospital Southampton NHSFoundation Trust13 already looks after patients who have undergone surgery such as a hip orknee13 replacements in virtual wards with high levels of satisfaction The Royal Free London
37
NHS Foundation Trust13 offers a similar service but13 plans to add the possibility of videoconsultations between patient13 and consultant
310 Attitudes to public health issues ndash obesity smoking alcohol abuse drugs
As self-shy‐care becomes the focus of the NHS the public will increasingly understand that13 thecosts and availability of services are being harmed by the poor health behaviour ofrelatively small numbers of people The link between public health initiatives today andhealthcare needs and costs in the future will become increasingly evident13 as a result13 of theway that13 information is presented Thus the overweight13 smoker who currently attractsconcern and pity when they are diagnosed with diabetes and COPD is increasingly beingseen as the victim of their own stupidity or lack of self-shy‐discipline If they continue to neglect13 medical advice and continue with an unhealthy lifestyle then the way that13 they receivetreatment13 and consume resources will become a matter for the entire population
Obesity is seen as due to a combination of poor diet13 and a sedentary lifestyle No longer isthe idea13 that13 people are lsquobig bonedrsquo acceptable Governments will respond initially byrequiring manufacturers and food processors to provide nutritional information onpackaging and on menus in restaurants But13 people can choose not13 to read the data13 and toneglect13 both the importance of food quality content13 and quantity This will increasepressure to introduce fat13 or sugar taxes and these are likely to be in force within a decade
Although the high taxes on tobacco products has forced some smokers to reduce theirconsumption or to give up altogether the impact13 has been reduced by the smuggling ofproducts from overseas and by the availability of duty-shy‐free cigarettes for people returningfrom foreign holidays and business meetings Further measures are planned to changepackaging and to include even more graphic images and warnings on cigarette packages tomake smokers aware of the effects of smoking on their health and well-shy‐being There is asyet little evidence of how successful this might13 be More effective has been the banning ofsmoking in public places including trains and aircraft Expensive medical interventions suchas heart13 transplants will be denied to individuals until they change their lifestyle behaviourSmokers might13 therefore be increasingly ostracised leading to a loss of esteem This mayhave a particular impact13 on people who already suffer from mental health problems whoare more likely to smoke
The overuse of alcohol is being recognised as a major factor in hospital admissions withNHS figures showing an increase of over 40 in such admissions over the past13 decadeLinked to this has been a 75 increase in prescriptions to treat13 alcohol dependency Fewpeople have sympathy for those who waste their limited income on booze If they havechildren or other dependents they will be the ones who suffer and who may need thesupport13 of social care
Drug users are already significant13 users of social services as their habit13 is likely to makethem unemployable They receive little sympathy from the general public because they areseen as criminals and people who waste public resources Levels of drug abuse have been
38
slowly increasing over the years but13 this trend is slowly being reversed Indeed the numberof people using drugs during the past13 year has fallen to its lowest13 level for nearly 20 years(below 9) with cannabis being most13 likely often following excessive drinking Aselectronic noses and other technologies can detect13 traces of drugs it13 seems likely that13 success in overcoming addiction can be measured objectively This may become a two-shy‐edged sword rewarding those who can turn around their lives but13 further marginalisingthose who canrsquot13 or wont13 accept13 the lsquocold turkeyrsquo
311 Attitudes to surveillance
Issues associated with privacy confidentiality and data13 security have been discussedpreviously in the context13 of information technology the World Wide Web and the ease ofcollecting recording recalling analysing and displaying data The monitoring of individualsand their methods of using this information can be regarded as surveillance As thequantities of data13 increase along with the number of devices that13 can be used to access itthe surveillance tools will also increase in their sophistication Indeed the Big Data13 approaches described in the previous section will enable the combination of structureddata13 (such as the information held in databases) to be married with unstructured data13 fromimages in such a way that13 it13 can be mined
Whilst13 the lsquodigital surveillancersquo methods described above may cause most13 concern topeople because of its impact13 on anonymity it13 is the collection and analysis of images that13 are the major concern to people as they contemplate the ways that13 lsquoBig Brotherrsquo maydevelop to restrict13 freedom Every major UK city and town centre has an array of CCTVcameras that13 continually record activities from every angle If it13 used to be true that13 nobody in London was more than 10 yards from a rat it13 is certainly the case today that13 nobody can be more than this distance from being in view of a surveillance camera Yetthey receive so much positive publicity from TV programmes where their footage is used todetect13 vehicles close to a crime scene or to monitor the movements of suspects that13 theyare now accepted by the public as a deterrent13 in the same way as lsquobobbies on the beatrsquowere seen 25 years ago There is therefore little public reaction to the expansion in the useof video surveillance except13 for the practical observation of how so many views can beinspected and recorded
Looking to the future the tumbling cost13 of video technology will surely lead to anotherincrease in the number of devices The aerial views taken from towers will besupplemented by more local views taken by devices that13 are embedded in the fabric ofbuildings or carried by individuals either on their person (for example on clothing orspectacles) or in the bags that13 they carry The time and date-shy‐stamped images as Big Datawill be recorded to lsquothe Cloudrsquo where it13 can be added to other data It can then be usedwhen an incident13 has occurred or to provide further detail of night-shy‐time activities
It follows that13 there will be no hiding place for people who simply want13 to disappear Theymay respond by wearing clothing (such as hoodies) that13 hide their faces or which make it13 difficult13 to distinguish gait13 or mannerisms from which they might13 be identified New forms
39
of clothing may be designed to make shapes more difficult13 to analyse and these might13 become the uniforms of a class of person who wants to live in a way that13 they donrsquot13 interact13 with officials from any ministry or local government13 department If they also obstruct13 services then they will be considered to be anarchists of some form sparking protests fromother sectors of society
31213 Attitudes to driving
Motor cars have been a feature of UK roads for over a century but13 it13 is only during the past13 50 years that13 they have become a resource that13 most13 families have had access to enablingthem to travel without13 the restrictions imposed by a limited railway network and non-shy‐integrated bus transport People who have had a car throughout13 their lives often see theircars as an important13 factor in enabling them to remain independent13 and to exercise choicesrelating to where they shop and where they spend their leisure time This extends to theirspouse and to friends and neighbours that13 they might13 take with them on their variousexpeditions
Unfortunately there are incidents involving older drivers who perhaps go down amotorway in the wrong direction who are taken ill at the wheel or who are involved in anaccident13 involving no other vehicles These are small in number but13 often lead to a reactionthat13 they shouldnrsquot13 be allowed to drive lsquoat13 their agersquo Age itself is not13 an indicator ofdriving quality but13 because old age also brings more chance of having limited long termconditions and other illnesses it13 is easy to make a link between driving ability and age Thelicensing system does require continued driving to be linked with medical advice andforbids people with poor eyesight epilepsy and other conditions to hold a licence in oldage
Yet13 statistically older drivers cause far fewer accidents than younger drivers The reasonsfor this may be complex and are likely to include the fact13 that13 they drive less often covershorter distances and donrsquot13 go out13 in the dark or in poor weather However it13 does not13 wholly explain why the UKrsquos drivers aged over 70 and who represent13 some 8 of all driversare involved in only 4 of accidents that13 cause injury This compares favourably with the15 of13 drivers aged between 17 and 29 who are involved in over a third of crashes that13 result13 in injury
By 2020 the number of drivers aged over 70 on UK roads is likely to increase to over 7million This will require a new national strategy perhaps involving support13 for olderdrivers further training raising awareness of issues and making more use of adaptivetechnologies to support13 the driver in avoiding collision or forgetting to check on the statusof their vehicle Poor eyesight13 could be enhanced by camera technologies rather thanforcing people off the road if they are unable to read a licence plate
The International Longevity Centre has found that13 one in four Britons thought13 driversshould be made to switch off the ignition for good somewhere between the ages of 70 and75 The numbers may decrease as the population ages and as cars become safer Forcing
40
older people off the road may be a natural consequence of providing free bus passes andsubsidised rail fares but13 the growth in the pavement13 scooter industry demonstrates that13 older people value their independence and will do almost13 anything to get13 out13 and aboutPerhaps legislation will result13 in more regulation of electric vehicles and where they cantravel
There can be no doubt13 that13 getting out13 will be associated with better quality of life andwell-shy‐being and this is likely to be supported in the future as evidence of improvedoutcomes emerges It is to be hoped that13 positive stories will be publicised so that13 publicattitudes arenrsquot13 hardened This may be supported by more in-shy‐car monitoring of drivers andthe linking of performance with on-shy‐line driving records and licences These could throughremotely monitored ignition systems prevent13 the use of motor vehicles by people without13 a licence or without13 insurance
313 Climate change
There is a general view that13 the emissions of carbon gases are contributing to globalwarming in a manner that13 will change the UK climate in such a way that13 the climate maybecome more Mediterranean However some scientists believe that13 manrsquos impact13 on theenvironment13 may be small compared with natural variations caused for example bycyclical changes in the sunrsquos energy output13 or by the effects of volcanoes and earthquakesRecent13 evidence has suggested that13 we are going through a phase of changing extremesand that13 this is more likely to cause storms periods of excessive rainfall and unusualseasonal trends with snow and frost13 in the spring and warmer winters Considerableuncertainty remains and it13 might13 be necessary to plan for a number of different13 scenariosand for the impact13 on vulnerable people
I Colder winters UK properties are poorly insulated resulting in excess mortalitiesduring cold spells due to an increased number of people suffering from stroke aswell as bronchitis and other pulmonary diseases The cost13 of heating continues toincrease putting more households into a state of fuel poverty Any further coolingduring the winter months will result13 in more people living in unhealthy coldconditions Winter fuel payments are likely to be restricted to the poorest13 peoplebut13 this might13 exclude people who live in larger properties that13 are more difficult13 toheat
II More storms excessive winds and rain can cause flooding at any time of the yearMany UK communities are built13 close to rivers and these can surge during heavyrainfall causing houses to be filled with water and furniture and carpets lostInsurance can be problematic for properties built13 on flood plains which can blight13 properties and prevent13 owners from being able to sell and move on High winds canrip off roofs causing injury and also causing families to be left13 homeless anddependent13 on social services
III Hot13 summers Europe suffered high temperatures during the summers of 2003 and2004 leading to heat13 stroke and hypothermia The UK has not13 previously sufferedfrom such problems but13 might13 be expected to experience days of extreme
41
temperature and humidity at times Older people may not13 be prepared for suchweather Street13 dwellers may be unable to find shade and supplies of drinkingwater
Irrespective of what13 combination of weather scenarios arise it13 must13 be concluded that13 any extremes will have a major negative impact13 on vulnerable people especially if theyare not13 prepared because they havenrsquot13 received the weather warnings and advice that13 can be broadcast13 using the TV radio and online services Once again the digitallyexcluded will suffer and will pay a high cost Society will continue to pick up the bill interms of demands on social care services unless preventive actions are taken in theform of connecting these people to each other and to formal services
42
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
s13 13
13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
n13 13
13 s13
r13 n13
e13 at13
e13 y13 e13 ld13
ly13
13 e13 t13 e13
s13 er13 e13
f13
rt13 13
13 13
13
r13 13
s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
e13 g13 13
e13
13 13 ial13
13
d13
13 d13 h13 r13
d13 13
s13 y13
e13
13
rd13 r13 e13
13
13
13
e13
e13
d13 13
13
13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
Accessibility acceptability and fashion
People adopt13 new technologies at different13 rates and some reject13 them completely Themobile phone might13 seem ubiquitous but13 some people refuse to have anything to do withthem
Some new devices are emerging such as an lsquoi-shy‐watchrsquo -shy‐ a kind of i-shy‐phone worn on the wristwhile a number of companies have suggested that they will use flexible electronic circuit13 boards to produce conformable devices that13 might13 be integrated into clothing or producedas a band that13 could be worn on the forearm
Google has been experimenting with heads-shy‐up displays which would allow someone to viewa display without13 having to carry a screen This approach would enable an individual toreceive real-shy‐time information as they walked around It might13 promote virtual visits todistant13 locations and virtual reality scenarios for games will increasingly interact13 with thereal world
It is likely that13 there will be an increasing choice allowing users to select13 devices most13 appropriate to their own lifestyle Ease of use may become a more important13 factor infuture designs thus enabling all citizens to enjoy ownership and applications of thetechnology
It is possible that13 not13 owning such a device or not13 being able to fully utilise it will become acharacteristic of the disadvantaged few -shy‐ and perhaps the people who will most13 need helpfrom13 social workers
22 Information generation and storage
As recently as ten years ago the amount13 of digital data13 or information we could store wasstrictly limited by the capacity and cost13 of storage media tapes floppy discs and harddrives The cost13 has fallen so much that13 today there is effectively ample space to store allthe data13 that13 we can create
The challenge is to store it securely and in such a way that it can then be retrieved quicklywhen needed and from13 any location13
We can now easily access bus and train timetables online the Kindle has created a hugemarket13 in e-shy‐books and even the Argos catalogue is expected to be available only as a digitaldownload
Cloud storage is the term used to describe a world in which we no longer keep our data13 (documents books photos video) on our own devices Instead we store them on cloudservices such as Flickr Youtube Google Drive We can even keep personal data13 such asreceipts using services such as httpwwwimmobilisecom which offers an online
5
portfolio for your personal belongings And Final Fling is an example that13 enables us to planfor our death
If entire identities are effectively digitised and stored in this way people who have not13 allowed their data13 to be created and warehoused in this way will be seriouslydisadvantaged They could be forced to join an underworld of digital refuseniks who areunable to apply for jobs for a passport for a driving licence and for welfare payments
23 Stratification13 and analytical techniques
The amount13 of data13 collected about13 each individual in society is increasing rapidly The data13 gathered by government13 and health systems tends to be highly structured which allowseasy comparisons to be made between any individualrsquos result13 and an average value forsimilar people This leads to important13 knowledge of distributions and how they might13 change over time
But13 commercial organisations such as supermarkets and online retailers also routinelygather data13 about13 our purchases our movements and our preferences This is known as BigData and analytical techniques known as Data Mining are evolving which look for trendsthat13 might13 offer some level of prediction
From an individual perspective Big Data13 can tell people how much they are like everybodyelse Indeed a personal analysis might13 tell them that13 there are another several hundredpeople just13 like them in Glasgow in Scotland in the UK in Europe or in the world How thisinformation is used is the important13 issue If it13 is used to make people feel lsquonormalrsquo then it13 can be positive but13 equally if it13 is used to stop people feeling that13 they are lsquospecialrsquo thenthis could lead to a loss of self-shy‐esteem
24 Communication13 technologies
The origins13 of social alarms lie in sheltered housing The assumption during the 1950s and1960s was that13 the people who needed to live in this type of accommodation were bothvulnerable and relatively poor As telephone lines were at that13 time a luxury whichcouldnrsquot13 be afforded by many hard-shy‐wired warden-shy‐call systems similar to the hospitalbedside call were devised Subsequently they evolved into two-shy‐way intercom systemsbetween the resident13 and a call monitoring centre rather than a local warden
These hard-shy‐wired arrangements were bespoke to each manufacturer and were thereforelimited in performance and in linking in with other peripheral devices and telecare Duringthe 1970s the telephone became less of a luxury and the number of households of allincome levels who had their own telephone lines rose rapidly
6
The 1990s saw the emergence of home computing the BBC Micro and gaming machinessuch as the Commodore 64 and the Attari Electronic mail (e-shy‐mail) until then the preserveof academic and research institutions moved into the mainstream at first13 connecting via13 (relatively slow) modems and ordinary telephone lines One drawback was that13 thetelephone could not13 be used at the same time as the computer was connected to theinternet a frequent13 cause of family friction In the late 1990s and early 2000s this problemwas solved when broadband became more widely available and cheaper allowing fasterspeeds an always-shy‐on facility and the ability to use the telephone at the same time
As broadband speed and capacity continued to increase so did the ability to use theinternet13 to access video music and all kinds of electronic commerce (for example shoppingtravel)
Perhaps even more dramatic have been the improvements made in mobilecommunications Third Generation (3G) phones allow us to use the Internet13 lsquoon the moversquovia13 smart13 phones and tablet13 devices Fourth Generation (4G) began rolling out13 in 2012offering faster access
By 2025 one can13 confidently13 predict13 that wireless13 communications13 will13 be available across13 the UK and with a bandwidth which13 can13 support13 both audio and video13 services
Effectively anyone who wants to speak to people will be able to do so and the only peoplewho will not13 be able to do this will be those who wish to hide or to avoid contact
25 The internet of things and the Quantified13 Self
The internet13 works by connecting computers around the world Each computer connectedto the internet13 has a unique address (known as an IP -shy‐ Internet13 Protocol -shy‐ number) Manydevices13 now contain some kind of microchip which makes such a device in effect acomputer
This means that13 electrical appliances from washing machines to refrigerators cancommunicate with other machines also connected to the Internet Indeed manufacturershave provided this facility for a number of years in order to monitor performance and tocheck remotely on their operational status The same principle can be applied inagriculture a cow on a farm could be identified by an IP address allowing the farmer and adairy to its monitor its milk output13 or its health
As more and more devices acquire an internet13 address we talk about13 the lsquointernet13 ofthingsrsquo lsquoequipping all objects in the world with minuscule identifying devicesrsquo(httpenwikipediaorgwikiInternet_of_Things) These things might13 include buildingsthe home healthcare and transport healthcare providers cars and emergency serviceslocations such as industrial parks hospitals car parks and police stations and devices suchas tablet13 computers and cash machines
7
The development13 of small and relatively low-shy‐cost13 medical devices for measuring relevant13 vital signs or medical parameters such as pulse rate and blood sugar level means that13 individuals can take their own measurements and then take responsibility forunderstanding their meaning (with appropriate support13 where necessary) and modifyingtheir behaviour accordingly
The availability of smart13 phones capable of running apps (specialised lsquoapplications) has ledto the development13 of new measures of well-shy‐being that13 are based on the individualinputting information on location the way that13 they feel and their interactions with othersThe smartphone can provide additional context13 automatically including location thenumber of conversations the distance travelled and external parameters such as theweather and the temperature This supports the idea13 of a life that13 can be measured in asensitive manner many times a day and without13 being seen as intrusive This leads to theconcept13 of the Quantified Self
Knowing how one feels and how one lives in a way that13 can be measured and easilycompared with other people can have both benefits and disadvantages The benefits tosociety mainly stem from an ability to identify people who are unhealthy both with respect13 to acute needs and from a predictive point13 of view those who are likely to be unwell atsome time in the future In the mental health space people who have bipolar disorder canbe monitored and supported more efficiently perhaps leading to a reduction in self-shy‐harmand suicide
There are likely to be some people who rebel against13 the need for measuring their owncondition daily and for ever They could view the measurement13 regime as being arestriction on their own lives preventing them from doing what13 they want13 to do because ofthe need to compete with their own measurements This could lead them to walk awayfrom treatment13 regimes resulting in a sudden decline in their well-shy‐being
26 Social networks
Social capital1 refers to the collective or economic benefits derived from cooperationbetween individuals and groups and highlights the importance of social networks that13 linkfamily friends neighbours and communities Wellbeing can be affected by connectivitypeople who have low social capital are likely to be lonely but13 also are more likely to reject13 public health initiatives such as flu jabs which could be beneficial to their health and well-shy‐being
The number of older people who live alone has been increasing for many decades By 2025two out13 of every five older people are likely to live alone Their quality of life may dependon them being able to build strong social networks Traditionally these networks were built13
1 lsquoJust as a screwdriver (physical capital) or a university education (cultural capital or human capital) can increase productivity (both individual and collective) so do social contacts affect theproductivity of individuals and groupsrsquo httpenwikipediaorgwikiSocial_capital
8
on neighbourhoods clubs and pubs and religious groups Meetings became social eventsand absence either signified a rejection of the group or a trigger for other members tobegin to visit But13 what13 happens when a network starts to disintegrate because of death orgeographic dispersal or because the individual loses physical capacity Can web-shy‐basedsocial networks compensate by nullifying geographic separation or by building newnetworks
Skype arguably demonstrates that13 lsquogeography is historyrsquo by making possible free real timevideo communication with family and friends thousands miles and continents apart Thebarrier of course is being able to afford a computer and a broadband connection whichmay limit13 use by lower socio-shy‐economic groups However its potential as a support13 mechanism should not13 be underestimated the technology is simple and it13 works we needonly the social economic and political will to make it13 happen In Scotland older peopleenjoy free bus travel why not13 free broadband
Social networks such as Friends Reunited and more significantly Facebook have emergedas vehicles that13 can not13 only link friends together but13 can also become a means of appealingfor associations and linkages that13 can be supported by the sharing of personal information
The inclusion of a camera13 on smartphones makes it13 easy to share photographs which canenrich communication For example proud parents may announce the arrival of a newbaby with a picture that13 everyone might13 wish to see On the other hand employers might13 also see evidence of why someone who has phoned in sick is unavailable for work on aparticular day Being aware of and able to set13 privacy levels is therefore important13 in orderto control who can see your personal information and news young people and vulnerableadults in particular may admit13 more people as lsquofriendsrsquo (or connections) than might13 beadvisable
The lifetime of major social networks is likely to be limited to a few years as new businessmodels13 emerge and new promotional strategies offer benefits to subscribers This mayoffer an opportunity for new networks to be created to deal specifically with those peoplewho are excluded in any way including those who will be referred to social services forassessment13 and support
27 Entertainment
Many people still remember the coronation of Queen Elizabeth in 1953 being shown live ontelevision This was an important13 milestone in establishing this new medium as acompetitor to radio and the cinema13 as a source of entertainment The arrival of colour TVin the late 1960s contributed to the declining popularity of cinemas and theatres many ofwhich closed
Today many homes have a TV in every room and technology has advanced to deliver highdefinition and 3D pictures on very large screens or lsquohome cinemasrsquo with surround sound
9
Paradoxically perhaps radio is more popular than ever and cinema13 has bounced back fromdecline to once again become an important13 element13 in the social lives of many people
Video images still or moving can be displayed also on laptops tablet13 devices andsmartphones which means that13 people can be entertained or informed on the move Sometrain operators have followed airlines in providing an lsquoat13 seatrsquo entertainment13 experience13 which can be offered with certain choices though many passengers prefer to use their owndevices and content In the future it13 seems likely that13 access to both audio and videoentertainment13 will be possible at any location and in a way that13 doesnrsquot13 interfere with theenvironment13 of other passengers
For those who want13 neither video nor audio (eg music) entertainment reading mayremain the entertainment13 of choice Many older people have struggled to find suitablereading materials as a result13 of the closure of local public and mobile libraries Some peoplecannot13 support13 the weight13 of a book while others lack the dexterity to turn the pagesOthers have sight13 problems which prevent13 them from reading small print All theseproblems can be overcome using either text13 to speech technologies (which are replacingtalking books) or by using e-shy‐reader devices which allow font13 sizes to be increased easily andwhich offer simple interfacing for moving pages backwards or forwards
In the future it13 must13 be assumed that13 all entertainment13 media13 will be held in the lsquocloud2rsquoand will be downloadable to an appropriate device on payment13 of a fee provided that13 acommunications contract13 is in place
The pre-shy‐requisites will bebull A device (eg PC laptop tablet Kindle)bull A contract13 with a telecoms provider (eg BT Virgin Sky) for broadbandbull A contract13 or contracts with media13 provider(s) (eg Netflix iTunes)
Those who lack any of these components may be entertainment13 excluded
28 Cash13 and13 money
Cash has been king since the abolition of the gold standard It is an expensive method oftransferring money between people and organisations and is a considerable overhead forindustry and for individuals travelling between different13 countries The highest13 denominations are lightweight13 and easily lost stolen or destroyed while the smallest13 denominations are heavy dirty and difficult13 to handle It is surprising that13 physical cashcontinues to be used It can only be a matter of time before it13 is digitised and replaced byvirtual cash
2 This means the material (book film or whatever) is stored in a remote computer (thecloud) and downloaded (or lsquostreamedrsquo) to your device on demand and possibly onlytemporarily
10
Large payments were previously made by cheque They are expensive to process by thebanks because people can write them by hand which makes them difficult13 to readelectronically and automatically Consequently they require human intervention and this isnot13 what13 modern banks wish to do so they want13 to promote greater use of debit13 and credit13 cards The latter were used initially as a cheque guarantee but13 are now being used almost13 exclusively as a means of withdrawing cash from ATMs and for making paymentselectronically UK banks wanted to do away with cheques by mid-shy‐2012 but13 they had toperform a u-shy‐turn under pressure from charities representing older people It is apparent13 that13 digital cheques and other cheque-shy‐replacement13 strategies will be introduced soon that13 satisfy the most13 pressing concerns of older people
It was difficult13 to see how cash could be replaced for payments for lower cost13 items such asnewspapers and sweets until the era13 of contactless payments Near field communicationsystems are likely to replace bar-shy‐codes to carry product13 identification information Theycan be read by electronic receivers The same technology can be two-shy‐directional allowinginformation to be passed from a smart13 phone to a reader and back again The smart13 phoneeffectively becomes a wallet13 which can be digitally filled by the owner and then emptiedwhen making purchases For small sums of money this approach is ideal and is likely to berolled out If cash disappears then begging will become difficult13 and welfare paymentsmade on a card Such cards are already used by social services as a means of providingclaimants with a means of receiving self directed care and support By restricting use of thecard to outlets that13 can provide care and support13 services opportunities for spending thecash inappropriately are restricted
It follows that13 many users of social services will need to have a smart13 phone as well as acard that13 can be used to buy services In the future smart13 phones may be provided as aloan item to claimants for social care This could include a digital wallet13 facility as well asthe communications and information ecosystem that13 would allow these people to receive awhole range of other services that13 would prevent13 their social exclusion and which could beused directly to provide them with information and access to entertainment
29 Biometrics and fraud13 prevention
Identity theft13 is used by criminals to pretend to be someone else in order to accessresources or obtain credit13 and other benefits in that13 persons name Although the concept13 has been around for centuries it13 is a growing concern in the digital world as we acquiremultiple online identities for bank accounts social networks and using public services such13 as paying tax electoral registration etc
Passwords are fraught13 with difficulty typically they are hard for humans to remember andeasy for machines to crack Efforts are therefore focused on other forms of provingidentity for example
11
bull Fingerprints have been accepted for over two thousand years to confirm identitymostly in criminal justice The technique has been applied to door-shy‐lock opening insome supported housing schemes There are practical problems associated withregistering lsquoallowedrsquo fingerprints and the useful lifetime of such products is also onlyabout13 three or four years
bull Retinal imaging and DNA analysis have been relatively slow to follow but13 only dueto the sophistication required for measurements and the time taken for testing Acombination of retinal imaging with facial gestures and blinking is possible in the labbut13 currently takes half a minute to achieve a match -shy‐ and this is achieved only withthe use of considerable computer processing power This sort13 of time makesapplications in mass people transfer impossible
Current13 research in this area13 is focusing on the uniqueness of other body parts such as earsand knees as biometric indicators The ears have great13 potential because they are usuallyexposed though hidden sometimes behind hair and other times by hats and other clothingOn the other hand the knees are rarely visible and however unique they may be there willbe cultural and religious obstacles to overcome before scanning could become a regularpart13 of identity confirmation The cameras which are central to such systems used to beexpensive but as the cost13 of high quality cameras continues to fall (there is one in nearlyevery mobile phone) it13 becomes feasible to devise identification devices that13 use multiplecameras to simultaneously recognise the eye and the ear
Movement analysis can be used to identify people by their walk gait13 and other biorhythmsprovide unique signatures It is possible to learn someone elsersquos gait13 though and injury orillness13 can have a temporary effect13 on gait
Over the next13 ten years with more sophisticated databases and image processing facilitiesthe cost13 of implementing advanced biometrics will fall enabling their application acrossmore diverse areas and in more social opportunities Potentially cameras will use cloud-shy‐technologies to provide individuals with instant13 recognition of anyone approaching them inthe street This could prompt13 a name or the occasion when they were last13 seen or spokento as a secondary method of control in much the same way as Internet13 banking seeks toavoid fraud This13 has13 the13 potential to remove13 the13 need for13 passwords13 and might13 then be13 the basis of machine-shy‐based13 communication13 either in front13 of a laptop or tablet13 device orwhen using13 a smart13 phone
There will need to be special measures introduced to support13 people with any form ofdisability as they might13 well have one or more sensory deficits Similarly people maystruggle to communicate following a stroke or a serious accident Nevertheless it13 may bereasonable to conclude that13 such systems will be both available and acceptable within thenext13 10 to 12 years
12
210 Health13 information
Health records in the form of written documents x-shy‐ray images and clinical observations arean important13 means of making all interventions efficient13 and safe Increasingly people havemany different13 conditions (comorbidities) and may be treated by several specialists Asthese physical records are moved inevitably some get13 lost estimates suggest13 that13 one inthree records is lsquolostrsquo at any one time
The best13 resource for information about13 a patient13 is his or her primary care record which isheld by the GP The UK was an early adopter of electronic primary care records and can beproud of the way that13 these have enabled population-shy‐based information to be collectedand analysed Scotland (and to a lesser extent13 Wales) has led the way in ensuring that13 allthese records are accessible through anonymised approaches that13 allow researchers toexamine trends and improve analysis of performance Fundamental to this has been theallocation of a unique identifier At13 the same time individuals can access these recordsboth to check for accuracy and to see what13 their doctor has said about13 them
This13 has13 the potential to make people more responsible for their own conditions andmight lead to better13 self-shy‐care13 and changes in behaviour13 that might reduce13 the13 incidence13 or severity13 of chronic conditions13 that are related13 to lifestyle
In the future we can expect13 the primary electronic health record to be linked with hospitaladministration systems picture archiving systems and other records held by hospitals sothat13 appropriate medical staff can have access to all relevant13 data
When the social care record is added to the mix then this will mean fewer but13 shorter andbetter assessments for social workers and for healthcare staff They will knowcircumstances and factors that13 could influence the choice of approaches This supports theidea13 of there being only one record consisting of several components all of which areaccessible by an appropriate professional at any time and in any place
The13 ambitions13 described above13 are not13 limited by technology most13 of the interoperabilityissues between rival commercial record systems have been resolved and databaseproviders are being compelled to support13 joint13 working The English NHS Mandate requiresTrusts to effectively replicate arrangements already in place in Scotland and in Wales andthis will go a long way towards achieving a genuinely paperless NHS well before 2020 Withnew biometric identification technologies individual records will be available to out-shy‐of-shy‐hours physicians and to those working in an AampE department13 irrespective of theconsciousness state of a patient
New telecare and telehealth technologies will produce significant13 more volumes of data13 which are currently held in different13 places and owned by different13 organisations rarely thepatient These data13 will also need to be shared but13 only in a manner that13 is acceptable toeveryone Patients may not13 want13 all their mental health information published in a formthat13 can be viewed by social workers GPs may not13 want13 to have access to all the data13 that13 might13 suggest13 that13 there is a domestic crisis to which they had neither the wish nor capacity
13
to respond Monitoring systems that13 support13 the lsquoquantified13 selfrsquo may also offer data13 that13 may or may not be added to the full recordThe future of health information might13 therefore be about13 providing individuals with themeans of producing relevant13 information storing it13 somewhere secure and then viewing it13 at a later time but13 in a format13 (or with advice) that13 is acceptable
See also httpmydexorg lsquoMydex gives individuals back control over their personal datarsquo
(see also Digital Scotland 2020 Achieving World-shy‐Class digital infrastructure a final report13 tothe Scottish Government13 httpwwwscotlandgovukPublications2013029054lsquoconnectivity by any device anywhere and anytimersquo)
211 The Future of Healthcare
The strains on our healthcare delivery system are becoming greater as they are in otherdeveloped countries as a result13 of an aging population rising expectations and unhealthylifestyles The necessary changes will require a significant13 shift13 in resources13 fromsecondary13 care13 where unit costs13 are high to community13 carewhere people can generallybe treated at home
The future must13 therefore necessarily involve efficiencies in hospitals and in the way that13 people can be treated in less expensive locations ultimately in their own homes Hospitalswill use more sophisticated diagnostic tools including scanners of all types to non-shy‐invasivelyprobe inside peoplersquos bodies This will result13 in more day cases and hospital stays (alreadyaveraging under a week) to even shorter periods with on-shy‐going support13 provided inintermediate care settings that13 might13 include hotels care homes or the personrsquos own homeif it13 is clean safe secure and has all the necessary amenities (include access to theInternet)
Advances in medical technology will allow more treatments to be delivered in the homeThis will mean fewer visits by clinical staff and fewer opportunities to attend primary carecentres Pharmacists will become suppliers of information as well as drugs so the balanceof care will shift13 significantly away from doctors who will work in different13 ways relying13 increasingly on telemedicine to bring the specialist13 to the patient13 for an online consultation13 For example if a patient13 complains of nausea13 and severe headaches a virtual consultationcan be offered almost13 immediately and without13 having to send a patient13 with a potentiallyserious and acute condition on a potentially long journey to a hospital
In the above example a neurologist13 may ask further questions as well as conduct13 acomplete neurological examination using videoconferencing technology Airedale GeneralHospital consultants have new contracts that13 require them all to be available for virtualconsultations The first13 benefit13 has been in reducing the need for prisoners at local jails tobe brought13 into AampE (which may need to be locked down depending on the circumstancesand the potential for violence of the individuals involved) potentially saving hundreds of
14
pounds in security costs It also avoids the need for healthcare staff to have to go into aprison environment
The principles described above are already saving lives through telestroke services whichlead to more people being thrombolysed appropriately and avoiding long term support13 that13 often follows a stroke incident Teledermatology has been practised for a number of yearsand results in rapid diagnosis and resolution of problems that13 previously required significant13 time for remedy
212 Gadgets and13 DIY13 healthcare
There are at least13 three elements to healthcare
bull Gathering information on symptoms and physiological parametersbull Interpreting the information andbull Responding to the diagnosis with treatment
Many people choose to exercise self-shy‐care because this gives them control whilst13 avoidingthe need to share their concerns and personal details with others A lsquodo It yourselfrsquoapproach might13 even be encouraged by the NHS as a viable way of using scare resources
Medical devices that monitor vital signs are mature and have been miniaturised so that13 they can be used in the home by individuals with little or no medical training Indeed bloodsugar monitors are being produced specifically for use outside the hospital and in such away that13 they can be used reliably by people with advice and training being provided onlinevia13 YouTube
Many medical monitoring devices do no more than produce a single measure which theuser may record or respond to Others link wirelessly to smart13 phones allowing data13 to bestored and entered into a personal health record where trending opportunities existingIndeed individuals can easily enter their data13 into an app running on their laptop tablet13 orsmart13 phone This trending information may be useful13 for self-shy‐care and could be passed onto a physician though the volume of data13 produced in this way and doubts about13 thequality of the data are likely to persuade GPs to discount13 data13 produced in this way
This gap in knowledge can be filled with advice information and diagnosis that13 can beobtained online using a lsquoDoctor Googlersquo approach The quality of such diagnosis may varysignificantly although there are many sources of information that13 are both supported andapproved by the NHS (and by similar sources in other countries) However with a data-shy‐richapproach and a choice of diagnosis people may be empowered to take a greater role inhealthcare
15
The final component13 for the DIY enthusiast13 is the treatment13 option Many people fear longterm use of medication produced by the big pharmaceutical industry and prefer morenatural remedies which are available over the counter More medical treatment13 devicesare available that13 stimulate blood flow and counter pain through the use of electrical andphysical stimulation
The evidence may be weak at present13 but13 might13 grow as more people use them and as theircost13 drops The13 impact13 of13 such technologies13 on vulnerable13 people13 is13 difficult13 to gauge
213 Telecare
Support13 provided at a distance to people in their own homes is known as telecare Thename implies remote monitoring and interaction and includes the monitoring of the homeenvironment13 and of the individual as well as the interaction of the individual with thisenvironment Definitions have become difficult13 due to some US medical devicemanufacturers introducing the term telehealth to describe medical telecare such as remotemeasurement13 and collection of vital signs data
In the UK telecare alarm services have matured quickly using the robust13 platform andinfrastructure of social alarm systems which were originally used by tenants in shelteredhousing schemes to seek help when they didnrsquot13 own a telephone The majority of telecareservice users today live in their own homes and use dispersed alarm units to link with amonitoring centre through the telephone network Improved assessments of needs andrisks to independence have resulted in combinations of sensors being used to support13 theoption of staying put13 rather than moving into residential care or having increasing levels ofdomiciliary support They support13 the policy of bringing care closer to home and ofencouraging people to become partners in their long term support13 arrangements
Telecare services developments over the past13 decade include standalone items such asautomatic lights which have achieved significant13 efficiencies especially for people who arefrail and prone to falling and to those suffering from mild cognitive impairment epilepsyand anxiety People who have long term conditions including chronic conditions such asdiabetes and hypertension can also be managed more effectively through telecare supportThe benefits of telecare services include a relief of stress for family caregivers enablingthem to continue to provide unpaid support13 while holding down a job and maintaining theirquality of life
New developments enable continuous monitoring of behaviour and smart13 devices that13 canfor example remotely control the cooker the water supply and door entry Such13 monitoring may detect13 incidents early and prevent13 emergencies arising Devices arebecoming smaller and easier to embed quickly within the home environment making themmore acceptable and less noticeable Longer battery life means less frequent13 maintenancevisits
16
The13 monitoring13 centre13 becomes13 an information hub13 offering13 both advice13 and a vehicle13 for checking that someone is coping especially following a trigger event such as a stay inhospital or the illness13 of an informal13 carer
New systems utilise web technology that13 allows family members to be more proactive inthe monitoring of their relatives This can lead to greater interaction with them especiallywhen the relatives live a considerable distance away (perhaps in another country) Thesenext13 generation systems might13 include video conferencing and the use of tablets smart13 phones or smart13 TVs but13 when an emergency response is required (perhaps to lift13 someoneup after a non-shy‐injurious fall) there remains a need for human intervention
The13 future13 of13 telecare13 might therefore13 include13 an increasing13 dependence13 on volunteersfrom13 the13 community to provide13 the13 required support Social networking may need to beused13 to support13 telecare technologies
214 Mobile healthcare
While telecare can support13 people effectively in their own homes it13 is now recognised that13 being able to go out13 to enjoy open spaces and to overcome the fear that13 the home is aprison is an important13 part13 of improving well being and supporting a higher quality of lifeExtending telecare technologies to operate outside the home is known as mobile healthcare(or mCare) and is based on mobile telephone networks rather than landlines
The simplest13 form of mCare requires only a basic mobile phone to deliver telephone callsvoice13 messages and SMS (text13 messages) The technology is mature and there are countlessapplications in use both in the UK and in developing countries such as Africa13 and India13 where mobile telephones have already achieved a saturation level and where fixedtelephone infrastructures are not13 likely to be established at any time Such telephones areuniversally available in the UK and are used by the vast13 majority of people including manyolder people especially if they have been introduced to the low cost13 (pound30) devices that13 have large buttons large displays and a separate large button for calling an emergencynumber
Smart13 phones are rapidly replacing basic phones and allow the use of a large range of lsquoappsrsquothat13 are being developed to provide information and for enhanced experiences In thehealthcare space Skype FaceTime Vidyo and GoToMeeting with HD Faces are all current13 examples of video conferencing software available on tablets and smartphones
The specific software will depend on the nature of the communication desired
bull Skype will13 manage a simple video phone callbull Where an AampE physician needs to share a CT scan of head with a Neurologist13 on call
from home GoToMeeting would be more appropriate
17
bull If the physician would rather have a dedicated online meeting room that13 patientsand colleagues can simply drop in for a virtual meeting a Vidyo virtual room may bemore appropriate
This technology can suit13 any form of lifestyle including many people with complex needswhose lifestyle is not13 consistent13 with a fixed address
Social care apps are available already to deal with problems of sensory deficit
bull Guiding a blind person through GPS navigation and reading signs through appslinked to the devicersquos camera13
bull The microphone can be used as a hearing aidbull Speech recognition software can be used either to replay speech at a slower speed
or for translation into a language of choicebull Speech can also be selected for people who have a stammer or who have a problem
with their larynxbull Apps are becoming contextually aware recognising situations and locations and are
thus becoming a personal assistant13 for people with disabilities
By 2020 it is therefore possible that a smartphone may13 be prescribed13 for people who13 need13 social13 care13 together with13 a range of apps that have been13 selected13 to meet13 theirassessed13 needs
Whilst13 smart13 phones tablet13 devices and apps may become an important13 part13 of anindividualrsquos personal support13 armoury the potential of mCare will be limited only by anindividualrsquos ability to make use of all its functions Each device could become a part13 of anindividualrsquos personality supporting them to improve behaviour take exercise avoidtemptation and manage their own health and well-shy‐being Potentially mCare could becomethe most13 important13 element13 of social care and support13 within 10 years
215 Artificial Sensing and Enhancement Devices
bull It is estimated that13 one in seven people has imperfect13 hearingbull The numbers who are born deaf are quite small and many of these people may
have some form of hearing restored through surgery or through technologybull Similarly while there may be nearly a million people registered as blind or having a
severe visual impairment the vast13 majority lose their sight13 during their lives as aresult13 of disease
bull New treatments will deliver sight13 recovery or restoration over the course of the next13 10 to 20 years
Fortunately technology can provide excellent13 sensing capabilities that13 are already providingpeople with external portable devices for enhancing their lives The simple hearing aid is anexcellent13 example of a device which has been improved through both miniaturisation
18
personalisation and enhanced performance Today digital hearing aids use sub-shy‐miniaturemicrophones that13 can be unidirectional or omnidirectional and which can be adjusted insensitivity over an extended range Tomorrowrsquos devices can be switched between modesby the user so that13 they can benefit13 from hearing perfectly in any environment Indeedthey can be used with adaptive filtering technologies (as used by helicopter pilot13 headsets)to eliminate some sounds so that13 the rich speech (or music) components alone remainFuture developments will be on optimising control so that13 the user can switch seamlesslybetween different13 amplification applications without13 appearing to be distracted A smart13 phone or mp3 music player may be used as either a processing unit13 or as a ubiquitousoutput13 device that13 looks cool and natural
These same technologies will also be developed for use within the home environment13 fortimes when a deaf user isnrsquot13 present13 or is asleep Acoustic signatures associated withadverse events and incidents such as the hiss of a gas leak the crackle of a fire the sound ofa smoke detector the drip or a water leak or the sound of breaking glass can be directlyassociated with programmed actions Speech will be recognised interpreted translatedsimplified or displayed so that13 an individual knows what13 is said and can be provided withclear instructions on how to respond
Video cameras have become smaller and cheaper and capable of producing high definitionimages The problem of storing and editing these large image files is being solved by thearrival of cloud computing
Electronic noses are already capable of detecting the quality of wine and fresh fruit Similartechnology will be based in smart13 phones and will be able to analyse the air to warn of13 foodthat is no longer fresh and of other indicators of danger including gases that13 have13 little13 natural13 smell These13 devices13 could support13 people with13 cognitive impairment13 -shy‐ whose13 sense of smell13 tends13 to deteriorate -shy‐ to live independently
Many older and vulnerable people are at risk of hypothermia during the winter Sensordevices can provide warnings of low temperature In the same way heat13 stress can be adanger during the summer months so sensors can alert13 people of the need to openwindows or to operate a fanFinally people who have damaged13 their fingers13 or hands will be able to wear sensorsembedded in artificial skin or in gloves that13 will enable them to identify textures and shapesand be able to dress and undress without13 the assistance of carers
216 Robotics
We may recoil at the idea13 of personal care being delivered by robotic devices but13 it13 is likelythat13 within a decade personal assistants will exist13 to assist13 with household tasks These areunlikely to be humanoid and are more likely to be machines dedicated to helping frailpeople to support13 their own weight13 and to carry trays of food around the home
19
There are four broad classes of robot13 under development13 that13 are likely to mature within 10to 12 years
1 Miniature industrial robots that13 have been programmed to perform specific taskswith precision They are likely to be relatively heavy enabling them to bear weight13 but13 still have the necessary flexibility to carry an individual over short13 distancesplacing them in a chair or on a bed They will have sensors and cameras to provideimmediate feedback and to adjust13 rapidly in response to verbal commands or cues13 from the user Some designs may build on existing assistive devices such as abathroom hoist13 or a bathing aid to become intelligent13 extensions of productsalready on the market A stair lift13 with intelligence is already being designed by a UKcompany and is aimed at providing the user with more control of the journeybetween floors of a house
2 The second group of devices might13 be described as intelligent13 furniture Beds andchairs are already available that13 adjust13 to make the user more comfortable and also13 to help them get13 into or out13 of bed The control units are fairly cumbersome andare suited to operation by a carer Voice activated controls and built-shy‐in intelligencewill give the user more control and independence Other items of furniture to whichintelligence might13 be added would be tables whose height13 can adjust13 and whichhold items of food and medicine securely The table would recognise these objectsand could provide prompts or reminders
3 Mobile robots form the third group These could be goffers that13 can either fetchand carry items such as newspapers drinks or trays or which can accompany theuser when they move between rooms providing them with support13 or prompts Thistype of robot13 could be an intelligent13 walking frame with wheels which13 could13 doubleup as a smart13 wheelchair when necessary
4 Finally there are companion robots These might13 be in the form of an electronicpet typically a cat13 or a dog though the Japanese Paro robot13 is a seal Pets canrespond to stroking and being patted they can also remind their owners that13 theyneed to take exercise and to eat drink and take their medication Various designsare already available which provide feedback but13 future models would includecameras and a screen to provide a mobile means of information and interactionwith other people over the Internet Intelligence within the device could allow themto have a personality of their own and gain knowledge by scraping data13 fromwebsites so that13 they can generate speech and have conversations about13 the newsthe weather or sports results
217 Transport and transfer technologies
Walking is good exercise and is a no-shy‐cost13 form of transport13 that13 is encouraged because of itsimpact13 on well-shy‐being For an individual with a chronic disability or suffering from theeffects of an accident13 or an injury this becomes impractical without13 an assistive technology(AT) A walking stick is the simplest13 example of AT
20
Within the home the stair lift13 has enabled people who live in conventional properties that13 are on two or more floors to continue to use facilities on different13 floors when climbing thestairs has become too difficult This is often the case for people who have arthritis a lowerlimb amputation a long term condition such as Chronic Obstructive Pulmonary Disease orpeople approaching the end of life and who have chosen to die in their own homes
Designs have improved so that13 a curved staircase is no longer an issue and the reliabilityhas reached a level where breakdown is a rare occurrence13 Through-shy‐floor lifts have been analternative proposition but13 they remain too large for most13 properties Alternativeapproaches may emerge using air pressure or water pressure as the driving force ABrazilian design already utilises a plastic tube in which a pod is moved effortlessly up anddown
Electronic wheelchairs are now available that13 allow the individual to become moreindependent13 as they allow the user to control both propulsion and steering Some modelshave the capability of mounting a pavement13 or a step or even a flight13 of stairs Personalmuscle amplification devices have been developed originally with the intention of helpingpeople who are confined to a wheelchair due to a neurological disorder to perform sometasks from a standing position Indeed the Rex walkerrsquos manufacturers claim that13 anyonewho can propel themselves in a wheelchair could walk by using Rex
Other approaches have focused on the rehabilitation of people after major accidents that13 have caused partial paralysis They quickly extend into exoskeleton designs that13 enableanyone to gain a mechanical advantage and thus to tackle physical tasks that13 would not13 otherwise be possible These suits are the focus of major research projects across theworld Some13 products such as the system developed by Honda are being tested inAssisted Living facilities and are likely to become more and more enabling over the next13 decade
Similar benefits are also occurring outside the home with a number of novel carryingsystems appearing over the past13 few years They are generally termed lsquoscootersrsquo but13 thiscovers a wide range of systems and devices ranging from the Segway a device that13 is amobile platform on which the user stands and navigates through to conventional electricvehicles that13 have been developed from golf buggies There remain a number of issuesconcerning their use on roads or on pavements but13 similar problems will need to beresolved for bicycles to play their full part13 in enabling people to get13 more exercise13 Thepotential for hybrid scooters remains
218 Smart domestic appliances and personal hygiene
The bathroom is a dangerous place and one where many older and disabled people slip andsuffer a fall Many older people recall taking a bath in a tin tub in front13 of an open fireToday the options tend to be a level access shower (ie a type of wet13 room) for anyoneunable to get13 into a bath There are various aids to help people get13 into and out13 of thebath most13 involving a seat13 that13 can be raised or lower with some bath-shy‐tubs having a door
21
There has been some research into alternative methods of keeping the body clean Sanyointroduced a machine in 1970 modelled on a clothes or dish washing machines the personsits on a seat13 inside the machine where13 they are cleaned by a set13 of water jets These havenot13 proved popular and furthermore require the individual to be transported to themachine Thus the technology may find application in nursing homes but13 are unlikely to beattractive to people living independently in the community
The washing needs of people change over time Over the past13 20 years body piercingshave appeared which have demanded additional attention to avoid the problemsassociated with poor hygiene and metals Similarly hair may be permed and dyed usingchemicals which are much stronger and which might13 damage the hair Add to this thepainting of finger and toe nails and the washing needs are rather different13 to what13 theymight13 have been even ten years ago Finally tattoos were once popular only with sailorsToday they are likely to be found on the arms backs and legs of both men and womenNew ways of cleaning these tattoos will be needed especially if they become infected orare sites at which pressure sores develop
Even if a personrsquos body is clean if their clothes are dirty they may become socially isolatedBut13 the washing of clothes can be strenuous even if a launderette is used The need toconserve water has driven research into ultrasound techniques to beat13 the dirt13 out13 ofclothing while some companies are experimenting with polymer chips These13 ldquogreenrdquo13 technologies are quickly maturing and are likely to be standard in the next 10 years
Other smart13 household appliances are already appearing on the market13 and may soonbecome common13 in UK homes13
bull Robovac devices have sensors to enable them to detect13 dirt13 on carpets and to adjust13 their operation accordingly
bull Refrigerators can read bar codes or RFID tags to identify their contents and theirldquouse byrdquo13 dates enabling them to inform the owner that13 they should use theproducts before they are out13 of date They can be linked to the Internet13 to reorderitems as they are consumed or to suggest13 menu options for the individual based ontheir preferences or according to the diet13 required to manage a condition
bull Ovens will automatically switch off if they are left13 without13 attention for too longand drying machines will set13 times automatically
Devices may be linked so that13 they are more efficient and report13 maintenance issues sothat13 they can be repaired (perhaps remotely) before they suffer a catastrophic breakdown
219 Personal and home13 security
It might13 appear perverse but13 people with very little personal wealth and property are morelikely to be the victims of crime than those who have expensive items This may be due towhere poorer people tend to live or because people who have valuable assets take greater
22
steps to protect13 them There can be no doubt13 that13 crime has a very negative effect13 onindividuals and on their families creating a fear factor that13 may be difficult13 to remove Theimpact13 on quality of life is therefore very considerable especially if it13 forces people to stayat home behind locked doors effectively isolating themselves from society
Modern policing places increasing reliance on the use of closed circuit13 television (CCTV)Town centres are covered by cameras used increasingly in the fight13 against13 crime by bothdetecting anti-shy‐social incidents and identifying the people involved They are also used tomonitor the movement13 of cars that13 may be involved in incidents of burglary and violenceand are fast13 becoming the primary mechanism of law enforcement13 agencies to solve crime
CCTV has moved into the home to record movement but13 monitoring the footage is timeconsuming and often not13 practical Cameras are now available which provide an instant13 video feed to a smart13 phone when movement13 is detected These may have intercomcapability allowing someone to remotely speak to an intruder sometimes before they havegained access to a building This may serve as a deterrent13 and when fitted alongside simpledevices that13 switch lights on randomly around the home may force burglars to goelsewhere
As the price of cameras continues to fall the option of carrying a camera13 on the body that13 continuously monitors personal space is becoming more useful Using wireless networksthe data13 collected can be sent13 continuously to the cloud for safe storage It cansubsequently be retrieved to provide evidence (video and audio) of confrontations enablingsuccessful prosecutions to be made The smart13 phone itself is becoming a valuable itemthat13 is attractive to criminals These can be tethered to personal attack buttons usingwireless technology allowing the device to be activated by the pressing of a button if theowner is being attacked The phones can then be tracked and located by the police whilebeing rendered useless to the assailant
Bogus callers are a perennial problem for vulnerable people Video door bells can beconfigured to display images and record the words of visitors before they are admittedallowing remote monitoring centres to oversee the situations and use image recognitionsoftware to confirm the bona13 fide of visitors Such13 arrangements may become13 commonplace13 over13 the13 next five13 or13 six years13 significantly13 improving the safety of peopleliving independently
220 Personal safety
The biggest13 risks to personal safety stem from fires and falls Most13 fires are the result13 ofpoor cooking practices resulting in burns or scalds Floods and gas emissions are caused bya failure to remember to close taps
The current13 approach involves detection of an emergency situation as soon as possible but13 always after a problem has already occurred This responsive approach can minimise therisks provided that13 there is a protocol in place for intervening This could increasingly be an
23
automated response such as the switching off of the gas of water or the switching on of asprinkler system or a water mist13 system
In the future monitoring systems will be more sophisticated and will have sensors and localintelligence to identify activities In this way reminders can be issued before an emergencyoccurs13 This lsquosmart kitchenrsquo approach may become13 an integral part of13 homes of13 vulnerable13 people
A prototype system has been developed at the Culture Lab in Newcastle Sensors havebeen embedded into cooking utensils enabling the kitchen to identify what13 the person istrying to cook or prepare It can provide interventions as messages on an instructionscreen
Accidents also occur out13 of doors People with dementia13 might13 become lost13 and may havepoor road safety awareness Location devices based on GPS have advanced from large andheavy receivers that13 were used on ships and boats to small battery-shy‐operated devices that13 can be carried in the hand or in a handbag The current13 generation of locators has limitedbattery life and are rather too large to be secreted about13 a personrsquos clothing while devicesthat13 are integrated into a wrist-shy‐watch are rather clunky and unattractive
Within 10 years the13 technologies13 will have13 matured and will be13 much smaller13 so that theycan be embedded in shoes in walking sticks hats or any other item of clothing Powerrequirements will have reduced so that13 energy harvesting from the movements of theindividual will be sufficient13 to keep these products working for several weeks without13 theneed for recharging The devices will not13 simply indicate to others where the individualhappens to be but13 will provide subtle guidance cues to direct13 them home
Cameras might13 also form part13 of the personal security systems that13 will protect13 people fromaccidents Data13 may be sent13 to the cloud and analysed in real time if the person is in adangerous location and can provide prompts either to the individual or broadcast13 advice toothers to clear the danger These systems may be embedded in items of clothing (such as ahat) or they may be attached to spectacles
221 Energy and13 portable power supplies
The demands of developing economies for more power will inevitably lead to higherdomestic fuel charges in the UK especially as oil and gas reserves dwindle
By 2018 UK homes should be fitted with new smart13 meters The specifications for these13 devices have yet13 to be finalised but13 will include a means of identifying wasteful use ofenergy including TV sets that13 are left13 on and unattended fridges and freezers that13 are set13 attoo low temperatures and dryers that13 are used for too long or when the weather is suitablefor using a washing line They could be an enabling factor that13 supports changes inbehaviour driven by a need to use less power but13 it13 is unlikely that13 they will offer a bigreduction in costs that13 are already a problem for many vulnerable families
24
More generally the need for power conservation will include devices that13 are moreefficient and a significant13 emphasis on heat13 retention in buildings through betterinsulation
The energy crisis may force many people to spend more time in community settingsincluding shops and public buildings where they can benefit13 from the warmth Increasingreliance on mobile communication devices will lead to increasing demand for batterycharging facilities
Greater use may be made of portable devices for generating power based on solar cellswind or hand motion
222 Smart cities and homes
The Digital City initiatives have been based on information and how it13 can be used most13 effectively to make people aware of what13 is going on around them This means bettercoordination of resources more rapid access to advice and a battery of sensors measuringevery conceivable parameter from sound and light13 levels through to air quality andtemperature fluctuations There are several Digital or Smart13 City initiatives currently beingimplemented both in the UK and across the world They may significantly impact13 the livesof the millions of people living in them but13 the timeframe for outcome benefits to influenceplanning and design elsewhere is likely to be at least13 20 years and therefore outside thetimeframe of the current13 project
Housing plays a big role in the lives of most13 people both through their aspirations to moveup in the world (usually to a bigger property with a garden) and as the heart13 of the familylife which is associated with good quality of life UK properties have a life span approaching100 years which is about13 double that13 of their European counterparts (and certainly longerthan the wooden-shy‐frame buildings built13 in North America13 for example) A shortage ofhouses has plagued improvements in social welfare for the past13 30 years There is anargument13 that13 there are enough houses but13 the wrong size and in the wrong places andthis has some basis in fact13 as demography changes lead to more people (and more olderpeople) living alone However if there are two million homes in Scotland each with alifespan of 100 years then the renewal rate needs only to be 20000 per annum to maintainthe status quo However it13 must13 be clear that13 the impact13 of smart13 house development13 willbe small The focus should therefore be on adapting existing properties to render themmore appropriate for vulnerable people
Housing adaptations are a branch of assistive technologies The technologies for providingdifferent13 forms of accessible bath and level access shower are well-shy‐established with littleresearch considering anything other than alternative building materials and methods formaintaining the temperature of the bathwater Different13 technologies for bathing will beconsidered separately
25
Thus housing technologies are not likely to impact on social work13 within the next 20years13 though13 the use of information13 technology13 to ensure that people are aware of what13 is available is likely to be commonplace well before then
26
3 BEHAVIOUR AND ATTITUDE CHANGES DUE TO TECHNOLOGICALADVANCES
Technology is only one factor that13 will affect13 the way society changes in the next13 10 or 15years This chapter will consider the context13 in which the technological developmentsoutlined in the previous chapter will be supported (or held back) by societal factors
When the impact13 of such factors has been considered we can then apply theseassumptions to a number of case studies listed in Appendix13 A13
The headings selected for this chapter are not13 arbitrary as they reflect13 the context13 in whichtechnological changes must13 be considered They must13 include consideration of factors suchas demography and long-shy‐term conditions already addressed in the introduction to thesepapers together with the aspects of workforce and citizenship considered in the parallelpapers The additional elements here focus on trends that13 are already occurring and whichmay leave people struggling with the changes that13 occur
Finally there is a need to consider the attitudes of people to technology generally andespecially to the issues of privacy and social responsibility that13 could be radically changedby technology In some cases public opinion will prevent13 some forms of technology beingdeveloped if not13 commercialised In other cases some technologies will be fast-shy‐trackedeither at the request13 of government13 or because of a clear public demand for theopportunities that13 it13 can bring
Predictions13 about the13 future13 must inevitably be13 subject to considerable13 uncertainty butthat is no reason to stop thinking what might happen
31 The Welfare State
The UK can be rightly proud of the way that13 its welfare state has developed during the past13 100 years to provide a safety net13 of financial support13 to people and to their families whenthey are unemployed destitute homeless or challenged by crises and emergencies Therange of benefits received is considerable some are complex and many people struggle tounderstand their entitlements Some are universal some are discretionary some apply onlyto parents others to anyone
The total cost13 of providing these benefits continues to rise and when the economy isstagnating there is inevitably both political pressure often supported by popular publicopinion to introduce welfare reform so that13 people who do not13 work cannot13 be better offthan they would be if they were in full-shy‐time employment This strategy requires a universalbenefit13 to be introduced so that13 it13 is easier for claimants to access support13 but13 also easierfor agencies to identify the total benefits received The idea13 of a benefits cap then becomes
27
more practical to introduce especially if all the processes involved in making a claim arehandled electronically Indeed this encourages government13 to insist13 on applications forbenefits to be made on-shy‐line Unfortunately this will marginalise those people who haveneither a computer nor access to the internet thus emphasising the digital divide in amanner which works against13 some of the most13 disadvantaged people in society
There are currently few tangible links between digital technology and welfare provisionThe most13 obvious are universal benefits such as a free television licence (worth pound14550)13 for13 everyone aged 75 or older with blind and visually impaired people entitled to a 50discount13 irrespective of their age The significance of this position is that13 6 of revenuesgenerated through licence fees are to fund BBC on-shy‐line services13 such13 as websites and i-shy‐player In Scotland the BBCrsquos Alba Gaelic language television service is predominantlyfunded13 by MG Alba an organisation funded by the Scottish Government It is thereforeconceivable that13 in the future licence fees may be used to directly subsidise access toinformation and advice through the Internet13 for vulnerable people whether it13 is throughbroadband access or through a set-shy‐top box which removes the need for a computer in thehome to access particular websites or to use e-shy‐mail services
A second age-shy‐related benefit13 available in the UK is the winter fuel subsidy People whoreceive certain benefits receive the payments automatically while others must13 make aclaim Those who are not13 eligible for benefit13 due to a lack of an address for example missout13 on these payments and also on Cold Weather payments of pound25 for each seven dayperiod of very cold weather between 1 November and 31 March
The development13 of new warm home initiatives plus the complex of subsidies that13 theelectricity supply industry and government13 offer to people with solar cells further changesthe economic arguments Global warming may lead to greater variations in weatherextremes but13 might13 also increase the amount13 of electricity that13 can be generated byalternative (green) sources such as wind and solar cells It is estimated that13 energyconsumption in the UK increased by 17 between Christmas and Easter 2013 compared toprevious years as a result13 of cold weather but13 the above subsidy scheme did not13 benefit13 older people because two of the seven day cold periods were after 31st March It must13 beassumed that13 there will be more people living in fuel poverty in the future and this will leadto more cases of cold related illness including influenza13 and stroke
32 Management of long term conditions
The management13 of long term conditions will be improved for patients who are compliant13 with their medication regime so it13 is possible that13 there may be compulsion to adhere tothe prescription Such compulsion may be monitored using technology Indeed the remotemonitoring of vital signs using telehealthcare will become commonplace as the old boxesand sensors are replaced by devices that13 can be worn continuously or which can beembedded into the fabric of homes (including furniture and bedding) or can be worn asvests or patches They will wirelessly transmit13 data13 to smartphones or tablets and mobile
28
transmission and cloud technology will enable real-shy‐time data13 collection analysis andfeedback
One of the diseases which is projected to increase most13 significantly over the comingdecade is Type 2 diabetes Whilst13 there is a hereditary susceptibility to this condition formany people including those from the Middle East13 and the Asian sub-shy‐continent it13 is also adisease which tends to affect13 those people who are overweight13 andor have a sedentarylifestyle If untreated diabetes can lead to dizziness and collapse at any time but13 can alsohave more devastating long term consequences which include kidney failure strokeblindness and in extreme cases lower limb amputations Management13 therefore includesdaily monitoring of blood glucose levels and major dietary changes such as a significant13 reduction in the consumption of carbohydrates as well as a rigid exercise regime
Many newly diagnosed diabetics follow this advice closely and can lead normal lives for 40years or more but13 some struggle to accept13 the change in lifestyle required as well asremembering which foods are allowed and how much exercise they need to takeIndividual support13 plans are now forthcoming and over the next13 ten years best13 practicewill emerge in the form of smartphone apps that13 are personalised and which can becomean individualrsquos health coach This level of support13 will be fine for some people but13 otherswill need incentives so it13 is likely that13 gaming technologies will be introduced perhapsoffering rewards for good compliance There will be a temptation for some people tocheat perhaps allowing others to perform exercise for them or changing theirconsumption details
Many of these opportunities for cheating will be removed through the use of a uniquebiometric identifier a technology that13 will be mature enough to use in place of passwordson smartphones However the biggest13 challenge may be in encouraging older people to usethe technology Many older people have multiple morbidities Indeed a survey of Scottishpatients implied that13 42 of people aged over 80 will suffer from three long termconditions It will be essential for those people to comply with treatment13 regimes if they arenot13 to have the functional deficits that13 follow
33 Finding people who13 donrsquot fit
People who have low social capital are likely to have few relatives and friends with whomthey regularly communicate and are also unlikely to be part13 of community or faithorganisations such as clubs societies and church groups They also die several yearsyounger than most13 of the population often because they donrsquot13 engage with public healthinitiatives such as vaccinations against13 flu regular checks on their blood pressure bloodsugar levels or in the case of women smear tests or mammography The most13 likelyreason for disappearing beneath the radar of such initiatives is their mobility which leadsalmost13 inevitably to them having no fixed abode and no fixed telephone line It thenbecomes very difficult13 for them to be contacted because their mobile telephones are likelyto have Pay-shy‐As-shy‐You-shy‐Go contracts that13 donrsquot13 require validated names addresses and bankaccounts
29
It follows that13 some of the most13 vulnerable people in society including those who live onthe streets are effectively unknown to both the NHS and to social work departments untilthey are referred in a crisis This could be an emergency presentation to a hospital Accident13 and Emergency Department13 where they will come into contact13 with a social worker becausedischarge may be unsafe This often highlights the importance of the prevention agenda13 and the potential for avoiding admissions to hospital by intervening at an earlier stage
The advantages of being able to locate people who are vulnerable to specific diseases willincrease as genetic testing becomes more routine It is already possible to determine whomight13 be most13 at risk of breast13 cancer and prostate cancer as a result13 of family history Addto this the evidence that13 particular diet13 and exposure to environmental factors can furtherincrease risk then it13 is evident13 that13 individuals can be identified and offered treatmentsthat13 could save their lives many years before they become ill In the case of cancersperhaps only the individual is involved but13 for infectious diseases it13 is the whole of societythat13 is at risk if someone contracts one of the new strains of influenza or if someonechooses not13 to be vaccinated against13 rubella In Chinese airports all visitors are screenedfor fever and refused entry if they tested positive in cities the public are monitored in thesame way Similar approaches may be necessary in the UK if potential carriers cannot13 otherwise be identified
34 Volunteering
It is estimated that13 72 per cent13 of people volunteered to perform a charitable act13 at least13 once during 2012 a rise from 65 per cent13 the previous year About13 four out13 of every 10volunteers offer their services formally to one or more organisations The remaindervolunteer informally by helping out13 a friend or a neighbour Around 50 per cent13 volunteered at least13 once a month in the past13 year up from 41 per cent13 on the previous13 year Most13 have retired many of them before the statutory retirement13 age Those whodonrsquot13 feel able to offer time have offered their financial support13 at a time when the fundingavailable from sources such as the National Lottery has been decreasing Despite economicausterity donations to charities have been increasing 74 per cent13 said they had given tocharity at least13 once in the previous month up from 72 per cent13 the previous year
Strikingly 78 per cent13 of people strongly believe that13 they are part13 of their localneighbourhood an increase from 70 per cent13 10 years previously Community cohesion isstronger than ever 87 per cent13 of people believe their local area13 is a place where peoplefrom different13 backgrounds get13 on well together compared to 80 per cent13 in 2003
The role of volunteers in supporting vulnerable people is therefore likely to increase overthe next13 decade perhaps exploiting the success of the army of volunteers that13 was highlysuccessful in London during the Olympic and Paralympic games The greatest13 role for suchvolunteers may be in providing informal care for older people Already the UK has someseven million informal carers whose value in monetary terms has been calculated to be
30
more than the combined budgets of the NHS and social care Maintaining or extending thisprovision will help to support13 services in the future and may be supported by technology
Whilst13 there is ample evidence to suggest13 that13 telecare services support13 informal carers asmuch as (if not13 more than) the people that13 they are caring for it13 is the potential for utilisingthe internet13 and apps to make their role easier to coordinate and hence more effectivethat13 is likely to be most13 successful moving forward
Many of these focus on particular tasks that13 informal carers can help offer to older peoplesuch as organising their medication A pillbox program is just13 one feature of an app calledBalance It also includes sections for caregiving tips notes for the doctor and the patientsappointments plus a lsquolearning sectionrsquo with articles on aspects of Alzheimers and an RSSfeed for news about13 the disease Tyze is another multi-shy‐functional app it13 allows carers to
bull Organise appointmentsbull Plan outingsbull Share storiesbull Send updates to other family members
Another application is Rally Round which helps carers to organise someone to perform littlejobs often on a temporary basis when someone has dementia physical frailty or isrecovering from accident13 or illness Similar applications are MeMaxi and Finerday
35 The High13 Street
The shape and appearance of UK shopping centres have been changing for half a centuryPeople complain that13 centres are losing their identity with one town looking like everyother both in terms of the stores and in terms of the layout But13 there are three trendswhich are having a profound impact13 on many of the most13 vulnerable people in society
bull Centres lock their doors at 6pm or in some cases 10pm -shy‐ thus denying people whosuffer from claustrophobia13 from window shopping at times when other shoppershave left
bull Out13 of town shopping malls -shy‐ these US style centres are ideal for people in carsbecause they offer free parking which is essential for people who want13 to buy largeritems but13 difficult13 for people who have no transport13 and who must13 rely on publictransport13 that13 is often deficient
bull The rise of online shopping -shy‐ which means that13 many potential shoppers only visit13 High Street13 stores to check the prices before returning home to make a purchaseonline
It is the third of these effects that13 has the greatest13 potential for changing the High Street13 forever and it13 is making life for traditional retailers increasingly difficult13 at a time when highrents are crippling stores large and small It is difficult13 to see how this trend is likely tochange because consolidation in banking and estate agencies is already forcing the closure
31
of other High Street13 players while additional pressures on pubs has led to the closure ofthousands of pubs every year
Those figures however demonstrate that13 consumers still value what13 the high street13 canoffer -shy‐ the chance to inspect13 what13 theyrsquore thinking of buying -shy‐ as well as the new opennessof the internet Customer service makes a difference to people especially if there is aproblem and goods need to be returned One of the most13 common reasons for furniture tobe returned for example is that13 when a sofa13 or a wardrobe was delivered it13 couldnrsquot13 fit13 through the front13 door or up the stairs In the future people will be able to benefit from13 visualisation technology they will upload the floor plans of their homes enabling theretailer to inform them of the problem before they try to delivery Augmented reality viewwill similarly allow customers to see what13 a new item of furniture will look like in itsintended place so that13 they can be more informed about13 the effect13 of size and colour
In terms of improving the viability of the High Street stores will have to focus on theimportance of brand which could mean that13 individual independent13 retailers will have topartner with national suppliers to support13 a local tailored offering based on products that13 are designed for a more global market This is a lsquoconnected High Streetrsquo approach whichcould be enabled by the developments in internet13 availability and smart13 phone accessdescribed in the previous section
The overall effect13 of all these changes could mean that13 town centres become smaller but13 more vibrant13 areas They could thrive if people are attracted there in large numbers whichmeans that13 retail must13 be developed alongside restaurants pubs galleries and other leisureopportunities This is possible in new shopping centres which are already being integratedwith transport13 hubs including railway and bus stations but13 may be more of a design13 challenge for older towns and cities with large Victorian buildings To ensure that13 morepeople are welcomed into the new centres they should include attention to green spacesand areas where people can relax without13 feeling that13 they are second class citizensbecause they donrsquot13 have the same buying power
3513 Privacy
To some people privacy is their right13 to live their lives without13 interference they may seethe State as a potential lsquoBig Brotherrsquo spying on their every move and judging their actions13 and activities Other people have fewer concerns about13 the role of the State but13 great13 fearof individuals interfering with and invading their privacy Some embrace the concept13 of lsquomyspacersquo an area13 of a square metre or so into which nobody can enter without13 permissionThis allows them to avoid physical contact13 and to feel safe from any form of threateningbehaviour
Yet13 this idea13 of private space and its potential violation is merely the tip of the iceberg asfar as privacy is concerned more significant13 is the idea13 of personal (and private)information being shared with anyone and everyone This could be related to identityopinion or image for an individual who wants to remain anonymous or even secretive thisis going to become an increasing problem as technology provides the means of taking
32
photographs recording conversations and capturing environment13 with something as smalland ubiquitous as a mobile phone The fact13 that13 this information can then be shared withthe rest13 of the world using e-shy‐mail Twitter and Facebook makes the problem all the moredifficult So the threat13 is no longer solely from the long lenses of the Paparazzi but13 fromanyone (and that13 means everyone) who has even the most13 basic of mobile phones
This relates to the changing views of society on what13 information should remain privateand what13 should be shared with others The success of social media13 has been based on anattitude of lsquosharing everythingrsquo with either your friends or the world This has introduced anaiumlve idea13 in the minds of some younger people (especially those known as Millennials ieaged 18-shy‐30) that13 everyone can be their friends whilst13 perhaps failing to reinforce the bondsof genuine friendship with any form of test13 or restriction Technology could play a role indefining these friendships and allowing individuals to understand what13 makes a goodfriend but13 this approach has yet13 to be developed and may be slow to overcome the needfor some people to measure their own popularity simply as the number of people that13 theycan list13 as friends on their Facebook page
It follows that13 there may be a need for a new definition of privacy that13 is in keeping withthe web and its ability to display images and opinion in an unregulated manner This needsto embrace past13 concerns about13 the ability of an individual to live without13 the threat13 ofothers being able to watch them whilst13 offering some protection from random postingsabout13 them online Perhaps this could include a right13 to be able to edit13 or remove anythingrelating to themselves on the Web including images that13 are not13 news-shy‐worthy Theownership of image rights may be an associated issue that13 needs to be addressedespecially as modern technology can remove an individual from a group (or a background)13 view provide digital touch-shy‐up or air-shy‐brushing and then republish it13 in a different13 contextHowever there is general agreement13 that13 personal information (such as contact13 details andbank codes) should not13 have a place on the web Surprisingly few people take proactivemeasures to prevent13 tracking functions being activated
It follows that13 too much privacy could lead to younger people fearing that13 they maybecome lost13 in a digital world It is not13 surprising then that13 they are prepared to make lots13 of personal information available often with no fear of how it13 might13 be used by othersWhen Google glasses and similar technologies become available during the next13 few yearsthey will have the potential to identify a stranger walking down the street and to find manyof their secrets to present13 to the wearer in a fraction of a second They could know moreabout13 them than their genuine friends know -shy‐ so who will be their friends in the future
36 Data sharing and13 protection
By lsquodata13 sharingrsquo we mean the disclosure of data13 held by one organisation on an individualto a third party organisation(s) or the sharing of data13 between different13 parts of anorganisation Some data13 sharing doesnrsquot13 involve personal data13 because it13 has beenanonymised in such a way that13 the statistics can be used for the collective good without13 theidentification of the individual The Data13 Protection Act13 (DPA) is in place to provide a legal
33
framework that13 ensures that13 organisations that13 hold personal data13 must13 act13 responsibly atall times These principles adequately describe the position of public and government13 bodies especially social services departments who are responsible for the informationconcerning the health and well-shy‐being of individuals -shy‐ and hence by implication thesensitive data13 relating to their vulnerability
The legal framework that13 applies to private and third sector organisations differs from that13 which applies to public sector organisations which may only act13 within the defined limits oftheir statutory powers However all bodies must13 comply fully with the data13 protectionprinciples and this situation is unlikely to change within the next13 10 to 15 years In someprivate sector contexts there are legal constraints on the disclosure of personal dataHowever most13 private and third sector organisations have a general ability to shareinformation provided this does not13 breach the DPA or any other law It is advisable for acompany to check its constitutional documents such as its memorandum and articles13 ofassociation to make sure there are no restrictions that13 would prevent13 it13 from sharingpersonal data13 in a particular context The type of data13 held is therefore a subject13 ofconcern as it13 may be difficult13 for legislation to keep up with the additional layers of data13 created on-shy‐line and through the Internet13 of Things
Private and third sector organisations should have regard to any industry-shy‐specific regulationor guidance about13 handling individualsrsquo information as this may affect13 the organisationrsquosability to share information They should also be aware of the legal issues that13 can arisewhen sharing personal data13 with public sector bodies This becomes more of an issue asprivate and third sector bodies are carrying out13 a wider range of traditionally public sectorfunctions Opportunities for inappropriate sharing of sensitive data13 will therefore inevitablyincrease
Public authorities must13 comply with the Human Rights Act13 (HRA) legislation in theperformance of their functions The HRA also applies to organisations in the private sectorinsofar as they carry out13 functions of a public nature which could include delivering a socialcare activity Where the HRA applies organisations must13 not13 act13 in a way that13 would beincompatible with rights under the European Convention on Human Rights Article 8 of theConvention giving everyone the right13 to respect13 for their private and family life their homeand their correspondence is especially relevant13 to sharing personal data If personal data13 isdisclosed or shared in ways that13 comply with the DPA the sharing or disclosure of that13 information is also likely to comply with the HRA The problem may still be in policing theActs and the rights of an individual if they believe that13 their personal data13 has been sharedor accessed by an inappropriate organisation or individual
A legal industry may be born to deal with such matters but13 this is unlikely to benefit13 peoplewho cannot13 afford the fees involved They would require either legal aid or to employ13 more13 lsquono win no feersquo companies Public attitudes to such costs might13 become negative unlessthey prove successful in preventing breaches of data13 security There may need to belegislation to provide a stronger basis for forcing compliance with privacy laws
34
37 Connecting with13 people
We are social creatures most13 of us rely on our friendships and interactions with friendsand families to share our happiest13 moments and experiences Research suggests that13 thishappiness is infectious at all levels and leads to a 15 increase in the happiness of a closecontact 10 for a second degree contact13 such as the friendrsquos spouse and a 6 increase fora friend of a friend It is hardly surprising that13 the success of social media13 such as Facebookis intimately related to the ability of people to quickly share their happiest13 moments with asmany of their friends and connections as possible
All this has happened during the rise of the Internet13 and the corresponding increase inopportunities for connecting online ie this is a 21st Century phenomenon which has beenfacilitated by Information and Communications Technology But13 the Internet13 remains in itsinfancy and we are only beginning to understand and exploit13 its potential In terms ofaccessing the Internet there are now perhaps two billion people who have access with99 of them having gained this during the past13 decade This number will have doubled bythe period 2020 to 2025 It is likely that13 everyone who wants to be connected in the UK willby then be connected Turning this on its head only those who donrsquot13 want13 to be online willnot13 be on the Internet13 within a decade Connecting with the unconnected will therefore bea case of identifying those people who donrsquot13 want13 to be found unfortunately these mayinclude many people who need the support13 of social care organisations It means that13 theywill be looking for support13 only when they are in crisis unless other ways of finding andormonitoring them are found
While the number of people connected via the Internet13 has exploded this might13 bedwarfed by the number of connected lsquothingsrsquo During 2009 the number of thingsconnected to the Internet13 surpassed the number of connected people at which point13 webegan to experience what13 this report13 has described as the lsquoInternet13 of Thingsrsquo Yet 99 ofall physical objects that13 could join this network are not13 yet13 connected but13 the number couldgrow by 25 every year for the next13 decade so that13 there could be 100 billion connectedobjects by 2025 some of which will be owned or used by everyone in the UK includingthose people who donrsquot13 want13 to be connected themselves We will then have an Internet13 of Everything which will be the smart13 connection of people data events and actions
With each new person object or data13 that13 comes online the connection possibilitiesbetween all these elements grows exponentially The rise of big data mobile networkingcloud storage and data13 mining technologies will all play a critical role in the Internet13 ofEverything The result13 will be new capabilities richer experiences and unprecedentedvalue for individuals businesses communities and countries everywhere The lsquonetworkeffectrsquo of the Internet13 of Everything will be a very powerful thing the true impact13 of whichwe wonrsquot13 fully understand for several years As it13 develops however those who are not13 connected will feel even more digitally and socially excluded There will be a need to reachout13 to vulnerable people unless the process of claiming requires proof of online identityand the payments to be received can only be redeemed using a chipped card or adownloaded app onto a smartphone This is of course the way that13 welfare arrangementsare already developing thus it13 might13 prove impossible to make a successful claim without13
35
already being connected to lsquothe systemrsquo either through an online presence or through theInternet13 of Things
38 Downloading everything
Sixty years ago information was discovered by reading books often in a library wherenotes had to be made because the books or journals couldnrsquot13 be removed Then in theearly 1960s the first13 office photocopying machines were introduced into the UK theyimmediately meant13 that13 pages or articles from books could be copied and taken away to beread and summarised later Within a few years photocopying became a replacement13 forreading as researchers became less adept13 at selecting a few sentences and every deskbecame a depository for reams of printed paper Paper became the means of recordingeverything from bank statements through to music
We now appreciate that13 printing everything is a waste of both the ink (or toner) used tocreate the black print13 and of paper which requires trees to be chopped down and pulpedbefore it13 can be pressed into thin sheets Saving paper is therefore seen as green and goodfor the planet Fortunately we no longer need to print13 everything because computermemory is unlimited thanks to the cloud and we can then view pages and articles onportable or fixed screens
The internet13 has everything and it13 is all available instantly for downloading providing thereis a device available to accept13 it and there is sufficient13 communication bandwidth toperform the transfer of data13 sufficiently quickly Thus we can record all text13 articles that13 are relevant13 to us including digital records of birth certificates qualifications and passportsand the need for original printed versions will decline But13 we can also do this forphotographs Most13 handheld computing devices include at least13 one camera so they cangenerate enormous number of pictures which can be kept13 for posterity without13 having toconsume inks and special papers to print13 them
But13 the materials that13 can be downloaded donrsquot13 stop at pictures software is available that13 can grab TV shows after they air and movies as soon as theyre released In the same wayit13 is possible to schedule music comic books video games and practically anything else asa download with minimal effort People will need enormous hard drives if they want13 theirown digital copies of these files so will more than likely make use of cloud storage that13 willbe available from many organisations The location of the servers may become sensitivedue to border restrictions as will the security of the data13 and the way that13 it13 is backed up sothat13 it13 is resilient13 to failures
It may be evident13 that13 application forms for all types of welfare payment13 will be availableonly for downloading so that once digitised they can be processed by computer andrecords sent13 to various servers for subsequent13 storage and processing Some people maywant13 to keep their data13 on them once it13 has been downloaded Pen drives can already holdseveral GB of data so it13 is likely that13 people will be able to carry their downloaded data13 withthem at all times irrespective of the size and complexities of the information
36
39 Health13 and13 well-shy‐being
The general health of the population is unlikely to deteriorate noticeably within 10 to 20years Indeed expectations of the population are that13 things must13 improve as surgicaltechniques mature and as pharmaceutical interventions become more personalised andpowerful However the rising demand for health services due to an ageing population andthe increasing cost13 of providing sophisticated therapies will make delivering a free anduniversal health service difficult13 without13 substantial increases in taxation This is unlikely tohappen in the UK even though spending on health services will be protected against13 thecuts facing other services
There will have to be changes in how the NHS works For twenty years hospitals have beenclosed and replaced by fewer new facilities so that13 the bed count13 is reduced This has led toa significant13 shift13 in resources to primary care and community care supporting shorter staysin hospital and speedier transfer back home for people after surgery or illness This hasbeen13 successful but13 there remain problems with demand for GP services especially out-shy‐of-shy‐hours and at weekends Indeed despite the introduction of NHS24 and similar help-shy‐linesthe demand for GP appointments continues to increase Delays are inevitable and this willincrease system failures with more unnecessary deaths and a failure for people to access adiagnosis that13 might13 lead to early interventions and ultimately lower delivery costs Over250 more patients are added to waiting lists every day
This will lead to a new model of primary care consistent13 with existing changes which haveseen surgeries move from High Street13 locations to medical centres close to bus routes andwith more parking for patients The process of making an appointment13 is changing from atelephone-shy‐based interview process dominated by a medically-shy‐unqualified receptionist13 to achoose and book approach using an online process linked to electronic patient13 records Thiswill give patients more convenience but13 will allow priority for those who have Internet13 access at the expensive of those who are digitally excluded Making the process of bookingan appointment13 quick and easy may also increase demand from people who do not13 need tobe seen as it13 will fail to identify those in greatest13 need
A greater use of telehealth and telecare technologies will be inevitable beginning with thefirst13 contact13 as an encounter using the telephone e-shy‐mail or video conferencing -shy‐ a visit13 tothe GP surgery should be a last13 resort and should involve a nurse consultation in the first13 instance This would be consistent13 with three quarters of appointments currently involvinga chronic disease or long term condition which relates to improved self-shy‐care The support13 ofthese patients at home should be prioritised through tele-shy‐ and web-shy‐based technologies andshould involve training and coaching through a network of nurse practitioners Home visitsshould generally be unnecessary through the use of these technologies but13 could besupplemented by satellite surgeries manned by nursing in community premises or inpharmacies nurseries and Internet13 cafes
The homes13 of people who13 need13 closer monitoring can then become part13 of virtual wardswith real or electronic visits by health professionals University Hospital Southampton NHSFoundation Trust13 already looks after patients who have undergone surgery such as a hip orknee13 replacements in virtual wards with high levels of satisfaction The Royal Free London
37
NHS Foundation Trust13 offers a similar service but13 plans to add the possibility of videoconsultations between patient13 and consultant
310 Attitudes to public health issues ndash obesity smoking alcohol abuse drugs
As self-shy‐care becomes the focus of the NHS the public will increasingly understand that13 thecosts and availability of services are being harmed by the poor health behaviour ofrelatively small numbers of people The link between public health initiatives today andhealthcare needs and costs in the future will become increasingly evident13 as a result13 of theway that13 information is presented Thus the overweight13 smoker who currently attractsconcern and pity when they are diagnosed with diabetes and COPD is increasingly beingseen as the victim of their own stupidity or lack of self-shy‐discipline If they continue to neglect13 medical advice and continue with an unhealthy lifestyle then the way that13 they receivetreatment13 and consume resources will become a matter for the entire population
Obesity is seen as due to a combination of poor diet13 and a sedentary lifestyle No longer isthe idea13 that13 people are lsquobig bonedrsquo acceptable Governments will respond initially byrequiring manufacturers and food processors to provide nutritional information onpackaging and on menus in restaurants But13 people can choose not13 to read the data13 and toneglect13 both the importance of food quality content13 and quantity This will increasepressure to introduce fat13 or sugar taxes and these are likely to be in force within a decade
Although the high taxes on tobacco products has forced some smokers to reduce theirconsumption or to give up altogether the impact13 has been reduced by the smuggling ofproducts from overseas and by the availability of duty-shy‐free cigarettes for people returningfrom foreign holidays and business meetings Further measures are planned to changepackaging and to include even more graphic images and warnings on cigarette packages tomake smokers aware of the effects of smoking on their health and well-shy‐being There is asyet little evidence of how successful this might13 be More effective has been the banning ofsmoking in public places including trains and aircraft Expensive medical interventions suchas heart13 transplants will be denied to individuals until they change their lifestyle behaviourSmokers might13 therefore be increasingly ostracised leading to a loss of esteem This mayhave a particular impact13 on people who already suffer from mental health problems whoare more likely to smoke
The overuse of alcohol is being recognised as a major factor in hospital admissions withNHS figures showing an increase of over 40 in such admissions over the past13 decadeLinked to this has been a 75 increase in prescriptions to treat13 alcohol dependency Fewpeople have sympathy for those who waste their limited income on booze If they havechildren or other dependents they will be the ones who suffer and who may need thesupport13 of social care
Drug users are already significant13 users of social services as their habit13 is likely to makethem unemployable They receive little sympathy from the general public because they areseen as criminals and people who waste public resources Levels of drug abuse have been
38
slowly increasing over the years but13 this trend is slowly being reversed Indeed the numberof people using drugs during the past13 year has fallen to its lowest13 level for nearly 20 years(below 9) with cannabis being most13 likely often following excessive drinking Aselectronic noses and other technologies can detect13 traces of drugs it13 seems likely that13 success in overcoming addiction can be measured objectively This may become a two-shy‐edged sword rewarding those who can turn around their lives but13 further marginalisingthose who canrsquot13 or wont13 accept13 the lsquocold turkeyrsquo
311 Attitudes to surveillance
Issues associated with privacy confidentiality and data13 security have been discussedpreviously in the context13 of information technology the World Wide Web and the ease ofcollecting recording recalling analysing and displaying data The monitoring of individualsand their methods of using this information can be regarded as surveillance As thequantities of data13 increase along with the number of devices that13 can be used to access itthe surveillance tools will also increase in their sophistication Indeed the Big Data13 approaches described in the previous section will enable the combination of structureddata13 (such as the information held in databases) to be married with unstructured data13 fromimages in such a way that13 it13 can be mined
Whilst13 the lsquodigital surveillancersquo methods described above may cause most13 concern topeople because of its impact13 on anonymity it13 is the collection and analysis of images that13 are the major concern to people as they contemplate the ways that13 lsquoBig Brotherrsquo maydevelop to restrict13 freedom Every major UK city and town centre has an array of CCTVcameras that13 continually record activities from every angle If it13 used to be true that13 nobody in London was more than 10 yards from a rat it13 is certainly the case today that13 nobody can be more than this distance from being in view of a surveillance camera Yetthey receive so much positive publicity from TV programmes where their footage is used todetect13 vehicles close to a crime scene or to monitor the movements of suspects that13 theyare now accepted by the public as a deterrent13 in the same way as lsquobobbies on the beatrsquowere seen 25 years ago There is therefore little public reaction to the expansion in the useof video surveillance except13 for the practical observation of how so many views can beinspected and recorded
Looking to the future the tumbling cost13 of video technology will surely lead to anotherincrease in the number of devices The aerial views taken from towers will besupplemented by more local views taken by devices that13 are embedded in the fabric ofbuildings or carried by individuals either on their person (for example on clothing orspectacles) or in the bags that13 they carry The time and date-shy‐stamped images as Big Datawill be recorded to lsquothe Cloudrsquo where it13 can be added to other data It can then be usedwhen an incident13 has occurred or to provide further detail of night-shy‐time activities
It follows that13 there will be no hiding place for people who simply want13 to disappear Theymay respond by wearing clothing (such as hoodies) that13 hide their faces or which make it13 difficult13 to distinguish gait13 or mannerisms from which they might13 be identified New forms
39
of clothing may be designed to make shapes more difficult13 to analyse and these might13 become the uniforms of a class of person who wants to live in a way that13 they donrsquot13 interact13 with officials from any ministry or local government13 department If they also obstruct13 services then they will be considered to be anarchists of some form sparking protests fromother sectors of society
31213 Attitudes to driving
Motor cars have been a feature of UK roads for over a century but13 it13 is only during the past13 50 years that13 they have become a resource that13 most13 families have had access to enablingthem to travel without13 the restrictions imposed by a limited railway network and non-shy‐integrated bus transport People who have had a car throughout13 their lives often see theircars as an important13 factor in enabling them to remain independent13 and to exercise choicesrelating to where they shop and where they spend their leisure time This extends to theirspouse and to friends and neighbours that13 they might13 take with them on their variousexpeditions
Unfortunately there are incidents involving older drivers who perhaps go down amotorway in the wrong direction who are taken ill at the wheel or who are involved in anaccident13 involving no other vehicles These are small in number but13 often lead to a reactionthat13 they shouldnrsquot13 be allowed to drive lsquoat13 their agersquo Age itself is not13 an indicator ofdriving quality but13 because old age also brings more chance of having limited long termconditions and other illnesses it13 is easy to make a link between driving ability and age Thelicensing system does require continued driving to be linked with medical advice andforbids people with poor eyesight epilepsy and other conditions to hold a licence in oldage
Yet13 statistically older drivers cause far fewer accidents than younger drivers The reasonsfor this may be complex and are likely to include the fact13 that13 they drive less often covershorter distances and donrsquot13 go out13 in the dark or in poor weather However it13 does not13 wholly explain why the UKrsquos drivers aged over 70 and who represent13 some 8 of all driversare involved in only 4 of accidents that13 cause injury This compares favourably with the15 of13 drivers aged between 17 and 29 who are involved in over a third of crashes that13 result13 in injury
By 2020 the number of drivers aged over 70 on UK roads is likely to increase to over 7million This will require a new national strategy perhaps involving support13 for olderdrivers further training raising awareness of issues and making more use of adaptivetechnologies to support13 the driver in avoiding collision or forgetting to check on the statusof their vehicle Poor eyesight13 could be enhanced by camera technologies rather thanforcing people off the road if they are unable to read a licence plate
The International Longevity Centre has found that13 one in four Britons thought13 driversshould be made to switch off the ignition for good somewhere between the ages of 70 and75 The numbers may decrease as the population ages and as cars become safer Forcing
40
older people off the road may be a natural consequence of providing free bus passes andsubsidised rail fares but13 the growth in the pavement13 scooter industry demonstrates that13 older people value their independence and will do almost13 anything to get13 out13 and aboutPerhaps legislation will result13 in more regulation of electric vehicles and where they cantravel
There can be no doubt13 that13 getting out13 will be associated with better quality of life andwell-shy‐being and this is likely to be supported in the future as evidence of improvedoutcomes emerges It is to be hoped that13 positive stories will be publicised so that13 publicattitudes arenrsquot13 hardened This may be supported by more in-shy‐car monitoring of drivers andthe linking of performance with on-shy‐line driving records and licences These could throughremotely monitored ignition systems prevent13 the use of motor vehicles by people without13 a licence or without13 insurance
313 Climate change
There is a general view that13 the emissions of carbon gases are contributing to globalwarming in a manner that13 will change the UK climate in such a way that13 the climate maybecome more Mediterranean However some scientists believe that13 manrsquos impact13 on theenvironment13 may be small compared with natural variations caused for example bycyclical changes in the sunrsquos energy output13 or by the effects of volcanoes and earthquakesRecent13 evidence has suggested that13 we are going through a phase of changing extremesand that13 this is more likely to cause storms periods of excessive rainfall and unusualseasonal trends with snow and frost13 in the spring and warmer winters Considerableuncertainty remains and it13 might13 be necessary to plan for a number of different13 scenariosand for the impact13 on vulnerable people
I Colder winters UK properties are poorly insulated resulting in excess mortalitiesduring cold spells due to an increased number of people suffering from stroke aswell as bronchitis and other pulmonary diseases The cost13 of heating continues toincrease putting more households into a state of fuel poverty Any further coolingduring the winter months will result13 in more people living in unhealthy coldconditions Winter fuel payments are likely to be restricted to the poorest13 peoplebut13 this might13 exclude people who live in larger properties that13 are more difficult13 toheat
II More storms excessive winds and rain can cause flooding at any time of the yearMany UK communities are built13 close to rivers and these can surge during heavyrainfall causing houses to be filled with water and furniture and carpets lostInsurance can be problematic for properties built13 on flood plains which can blight13 properties and prevent13 owners from being able to sell and move on High winds canrip off roofs causing injury and also causing families to be left13 homeless anddependent13 on social services
III Hot13 summers Europe suffered high temperatures during the summers of 2003 and2004 leading to heat13 stroke and hypothermia The UK has not13 previously sufferedfrom such problems but13 might13 be expected to experience days of extreme
41
temperature and humidity at times Older people may not13 be prepared for suchweather Street13 dwellers may be unable to find shade and supplies of drinkingwater
Irrespective of what13 combination of weather scenarios arise it13 must13 be concluded that13 any extremes will have a major negative impact13 on vulnerable people especially if theyare not13 prepared because they havenrsquot13 received the weather warnings and advice that13 can be broadcast13 using the TV radio and online services Once again the digitallyexcluded will suffer and will pay a high cost Society will continue to pick up the bill interms of demands on social care services unless preventive actions are taken in theform of connecting these people to each other and to formal services
42
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
s13 13
13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
n13 13
13 s13
r13 n13
e13 at13
e13 y13 e13 ld13
ly13
13 e13 t13 e13
s13 er13 e13
f13
rt13 13
13 13
13
r13 13
s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
e13 g13 13
e13
13 13 ial13
13
d13
13 d13 h13 r13
d13 13
s13 y13
e13
13
rd13 r13 e13
13
13
13
e13
e13
d13 13
13
13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
portfolio for your personal belongings And Final Fling is an example that13 enables us to planfor our death
If entire identities are effectively digitised and stored in this way people who have not13 allowed their data13 to be created and warehoused in this way will be seriouslydisadvantaged They could be forced to join an underworld of digital refuseniks who areunable to apply for jobs for a passport for a driving licence and for welfare payments
23 Stratification13 and analytical techniques
The amount13 of data13 collected about13 each individual in society is increasing rapidly The data13 gathered by government13 and health systems tends to be highly structured which allowseasy comparisons to be made between any individualrsquos result13 and an average value forsimilar people This leads to important13 knowledge of distributions and how they might13 change over time
But13 commercial organisations such as supermarkets and online retailers also routinelygather data13 about13 our purchases our movements and our preferences This is known as BigData and analytical techniques known as Data Mining are evolving which look for trendsthat13 might13 offer some level of prediction
From an individual perspective Big Data13 can tell people how much they are like everybodyelse Indeed a personal analysis might13 tell them that13 there are another several hundredpeople just13 like them in Glasgow in Scotland in the UK in Europe or in the world How thisinformation is used is the important13 issue If it13 is used to make people feel lsquonormalrsquo then it13 can be positive but13 equally if it13 is used to stop people feeling that13 they are lsquospecialrsquo thenthis could lead to a loss of self-shy‐esteem
24 Communication13 technologies
The origins13 of social alarms lie in sheltered housing The assumption during the 1950s and1960s was that13 the people who needed to live in this type of accommodation were bothvulnerable and relatively poor As telephone lines were at that13 time a luxury whichcouldnrsquot13 be afforded by many hard-shy‐wired warden-shy‐call systems similar to the hospitalbedside call were devised Subsequently they evolved into two-shy‐way intercom systemsbetween the resident13 and a call monitoring centre rather than a local warden
These hard-shy‐wired arrangements were bespoke to each manufacturer and were thereforelimited in performance and in linking in with other peripheral devices and telecare Duringthe 1970s the telephone became less of a luxury and the number of households of allincome levels who had their own telephone lines rose rapidly
6
The 1990s saw the emergence of home computing the BBC Micro and gaming machinessuch as the Commodore 64 and the Attari Electronic mail (e-shy‐mail) until then the preserveof academic and research institutions moved into the mainstream at first13 connecting via13 (relatively slow) modems and ordinary telephone lines One drawback was that13 thetelephone could not13 be used at the same time as the computer was connected to theinternet a frequent13 cause of family friction In the late 1990s and early 2000s this problemwas solved when broadband became more widely available and cheaper allowing fasterspeeds an always-shy‐on facility and the ability to use the telephone at the same time
As broadband speed and capacity continued to increase so did the ability to use theinternet13 to access video music and all kinds of electronic commerce (for example shoppingtravel)
Perhaps even more dramatic have been the improvements made in mobilecommunications Third Generation (3G) phones allow us to use the Internet13 lsquoon the moversquovia13 smart13 phones and tablet13 devices Fourth Generation (4G) began rolling out13 in 2012offering faster access
By 2025 one can13 confidently13 predict13 that wireless13 communications13 will13 be available across13 the UK and with a bandwidth which13 can13 support13 both audio and video13 services
Effectively anyone who wants to speak to people will be able to do so and the only peoplewho will not13 be able to do this will be those who wish to hide or to avoid contact
25 The internet of things and the Quantified13 Self
The internet13 works by connecting computers around the world Each computer connectedto the internet13 has a unique address (known as an IP -shy‐ Internet13 Protocol -shy‐ number) Manydevices13 now contain some kind of microchip which makes such a device in effect acomputer
This means that13 electrical appliances from washing machines to refrigerators cancommunicate with other machines also connected to the Internet Indeed manufacturershave provided this facility for a number of years in order to monitor performance and tocheck remotely on their operational status The same principle can be applied inagriculture a cow on a farm could be identified by an IP address allowing the farmer and adairy to its monitor its milk output13 or its health
As more and more devices acquire an internet13 address we talk about13 the lsquointernet13 ofthingsrsquo lsquoequipping all objects in the world with minuscule identifying devicesrsquo(httpenwikipediaorgwikiInternet_of_Things) These things might13 include buildingsthe home healthcare and transport healthcare providers cars and emergency serviceslocations such as industrial parks hospitals car parks and police stations and devices suchas tablet13 computers and cash machines
7
The development13 of small and relatively low-shy‐cost13 medical devices for measuring relevant13 vital signs or medical parameters such as pulse rate and blood sugar level means that13 individuals can take their own measurements and then take responsibility forunderstanding their meaning (with appropriate support13 where necessary) and modifyingtheir behaviour accordingly
The availability of smart13 phones capable of running apps (specialised lsquoapplications) has ledto the development13 of new measures of well-shy‐being that13 are based on the individualinputting information on location the way that13 they feel and their interactions with othersThe smartphone can provide additional context13 automatically including location thenumber of conversations the distance travelled and external parameters such as theweather and the temperature This supports the idea13 of a life that13 can be measured in asensitive manner many times a day and without13 being seen as intrusive This leads to theconcept13 of the Quantified Self
Knowing how one feels and how one lives in a way that13 can be measured and easilycompared with other people can have both benefits and disadvantages The benefits tosociety mainly stem from an ability to identify people who are unhealthy both with respect13 to acute needs and from a predictive point13 of view those who are likely to be unwell atsome time in the future In the mental health space people who have bipolar disorder canbe monitored and supported more efficiently perhaps leading to a reduction in self-shy‐harmand suicide
There are likely to be some people who rebel against13 the need for measuring their owncondition daily and for ever They could view the measurement13 regime as being arestriction on their own lives preventing them from doing what13 they want13 to do because ofthe need to compete with their own measurements This could lead them to walk awayfrom treatment13 regimes resulting in a sudden decline in their well-shy‐being
26 Social networks
Social capital1 refers to the collective or economic benefits derived from cooperationbetween individuals and groups and highlights the importance of social networks that13 linkfamily friends neighbours and communities Wellbeing can be affected by connectivitypeople who have low social capital are likely to be lonely but13 also are more likely to reject13 public health initiatives such as flu jabs which could be beneficial to their health and well-shy‐being
The number of older people who live alone has been increasing for many decades By 2025two out13 of every five older people are likely to live alone Their quality of life may dependon them being able to build strong social networks Traditionally these networks were built13
1 lsquoJust as a screwdriver (physical capital) or a university education (cultural capital or human capital) can increase productivity (both individual and collective) so do social contacts affect theproductivity of individuals and groupsrsquo httpenwikipediaorgwikiSocial_capital
8
on neighbourhoods clubs and pubs and religious groups Meetings became social eventsand absence either signified a rejection of the group or a trigger for other members tobegin to visit But13 what13 happens when a network starts to disintegrate because of death orgeographic dispersal or because the individual loses physical capacity Can web-shy‐basedsocial networks compensate by nullifying geographic separation or by building newnetworks
Skype arguably demonstrates that13 lsquogeography is historyrsquo by making possible free real timevideo communication with family and friends thousands miles and continents apart Thebarrier of course is being able to afford a computer and a broadband connection whichmay limit13 use by lower socio-shy‐economic groups However its potential as a support13 mechanism should not13 be underestimated the technology is simple and it13 works we needonly the social economic and political will to make it13 happen In Scotland older peopleenjoy free bus travel why not13 free broadband
Social networks such as Friends Reunited and more significantly Facebook have emergedas vehicles that13 can not13 only link friends together but13 can also become a means of appealingfor associations and linkages that13 can be supported by the sharing of personal information
The inclusion of a camera13 on smartphones makes it13 easy to share photographs which canenrich communication For example proud parents may announce the arrival of a newbaby with a picture that13 everyone might13 wish to see On the other hand employers might13 also see evidence of why someone who has phoned in sick is unavailable for work on aparticular day Being aware of and able to set13 privacy levels is therefore important13 in orderto control who can see your personal information and news young people and vulnerableadults in particular may admit13 more people as lsquofriendsrsquo (or connections) than might13 beadvisable
The lifetime of major social networks is likely to be limited to a few years as new businessmodels13 emerge and new promotional strategies offer benefits to subscribers This mayoffer an opportunity for new networks to be created to deal specifically with those peoplewho are excluded in any way including those who will be referred to social services forassessment13 and support
27 Entertainment
Many people still remember the coronation of Queen Elizabeth in 1953 being shown live ontelevision This was an important13 milestone in establishing this new medium as acompetitor to radio and the cinema13 as a source of entertainment The arrival of colour TVin the late 1960s contributed to the declining popularity of cinemas and theatres many ofwhich closed
Today many homes have a TV in every room and technology has advanced to deliver highdefinition and 3D pictures on very large screens or lsquohome cinemasrsquo with surround sound
9
Paradoxically perhaps radio is more popular than ever and cinema13 has bounced back fromdecline to once again become an important13 element13 in the social lives of many people
Video images still or moving can be displayed also on laptops tablet13 devices andsmartphones which means that13 people can be entertained or informed on the move Sometrain operators have followed airlines in providing an lsquoat13 seatrsquo entertainment13 experience13 which can be offered with certain choices though many passengers prefer to use their owndevices and content In the future it13 seems likely that13 access to both audio and videoentertainment13 will be possible at any location and in a way that13 doesnrsquot13 interfere with theenvironment13 of other passengers
For those who want13 neither video nor audio (eg music) entertainment reading mayremain the entertainment13 of choice Many older people have struggled to find suitablereading materials as a result13 of the closure of local public and mobile libraries Some peoplecannot13 support13 the weight13 of a book while others lack the dexterity to turn the pagesOthers have sight13 problems which prevent13 them from reading small print All theseproblems can be overcome using either text13 to speech technologies (which are replacingtalking books) or by using e-shy‐reader devices which allow font13 sizes to be increased easily andwhich offer simple interfacing for moving pages backwards or forwards
In the future it13 must13 be assumed that13 all entertainment13 media13 will be held in the lsquocloud2rsquoand will be downloadable to an appropriate device on payment13 of a fee provided that13 acommunications contract13 is in place
The pre-shy‐requisites will bebull A device (eg PC laptop tablet Kindle)bull A contract13 with a telecoms provider (eg BT Virgin Sky) for broadbandbull A contract13 or contracts with media13 provider(s) (eg Netflix iTunes)
Those who lack any of these components may be entertainment13 excluded
28 Cash13 and13 money
Cash has been king since the abolition of the gold standard It is an expensive method oftransferring money between people and organisations and is a considerable overhead forindustry and for individuals travelling between different13 countries The highest13 denominations are lightweight13 and easily lost stolen or destroyed while the smallest13 denominations are heavy dirty and difficult13 to handle It is surprising that13 physical cashcontinues to be used It can only be a matter of time before it13 is digitised and replaced byvirtual cash
2 This means the material (book film or whatever) is stored in a remote computer (thecloud) and downloaded (or lsquostreamedrsquo) to your device on demand and possibly onlytemporarily
10
Large payments were previously made by cheque They are expensive to process by thebanks because people can write them by hand which makes them difficult13 to readelectronically and automatically Consequently they require human intervention and this isnot13 what13 modern banks wish to do so they want13 to promote greater use of debit13 and credit13 cards The latter were used initially as a cheque guarantee but13 are now being used almost13 exclusively as a means of withdrawing cash from ATMs and for making paymentselectronically UK banks wanted to do away with cheques by mid-shy‐2012 but13 they had toperform a u-shy‐turn under pressure from charities representing older people It is apparent13 that13 digital cheques and other cheque-shy‐replacement13 strategies will be introduced soon that13 satisfy the most13 pressing concerns of older people
It was difficult13 to see how cash could be replaced for payments for lower cost13 items such asnewspapers and sweets until the era13 of contactless payments Near field communicationsystems are likely to replace bar-shy‐codes to carry product13 identification information Theycan be read by electronic receivers The same technology can be two-shy‐directional allowinginformation to be passed from a smart13 phone to a reader and back again The smart13 phoneeffectively becomes a wallet13 which can be digitally filled by the owner and then emptiedwhen making purchases For small sums of money this approach is ideal and is likely to berolled out If cash disappears then begging will become difficult13 and welfare paymentsmade on a card Such cards are already used by social services as a means of providingclaimants with a means of receiving self directed care and support By restricting use of thecard to outlets that13 can provide care and support13 services opportunities for spending thecash inappropriately are restricted
It follows that13 many users of social services will need to have a smart13 phone as well as acard that13 can be used to buy services In the future smart13 phones may be provided as aloan item to claimants for social care This could include a digital wallet13 facility as well asthe communications and information ecosystem that13 would allow these people to receive awhole range of other services that13 would prevent13 their social exclusion and which could beused directly to provide them with information and access to entertainment
29 Biometrics and fraud13 prevention
Identity theft13 is used by criminals to pretend to be someone else in order to accessresources or obtain credit13 and other benefits in that13 persons name Although the concept13 has been around for centuries it13 is a growing concern in the digital world as we acquiremultiple online identities for bank accounts social networks and using public services such13 as paying tax electoral registration etc
Passwords are fraught13 with difficulty typically they are hard for humans to remember andeasy for machines to crack Efforts are therefore focused on other forms of provingidentity for example
11
bull Fingerprints have been accepted for over two thousand years to confirm identitymostly in criminal justice The technique has been applied to door-shy‐lock opening insome supported housing schemes There are practical problems associated withregistering lsquoallowedrsquo fingerprints and the useful lifetime of such products is also onlyabout13 three or four years
bull Retinal imaging and DNA analysis have been relatively slow to follow but13 only dueto the sophistication required for measurements and the time taken for testing Acombination of retinal imaging with facial gestures and blinking is possible in the labbut13 currently takes half a minute to achieve a match -shy‐ and this is achieved only withthe use of considerable computer processing power This sort13 of time makesapplications in mass people transfer impossible
Current13 research in this area13 is focusing on the uniqueness of other body parts such as earsand knees as biometric indicators The ears have great13 potential because they are usuallyexposed though hidden sometimes behind hair and other times by hats and other clothingOn the other hand the knees are rarely visible and however unique they may be there willbe cultural and religious obstacles to overcome before scanning could become a regularpart13 of identity confirmation The cameras which are central to such systems used to beexpensive but as the cost13 of high quality cameras continues to fall (there is one in nearlyevery mobile phone) it13 becomes feasible to devise identification devices that13 use multiplecameras to simultaneously recognise the eye and the ear
Movement analysis can be used to identify people by their walk gait13 and other biorhythmsprovide unique signatures It is possible to learn someone elsersquos gait13 though and injury orillness13 can have a temporary effect13 on gait
Over the next13 ten years with more sophisticated databases and image processing facilitiesthe cost13 of implementing advanced biometrics will fall enabling their application acrossmore diverse areas and in more social opportunities Potentially cameras will use cloud-shy‐technologies to provide individuals with instant13 recognition of anyone approaching them inthe street This could prompt13 a name or the occasion when they were last13 seen or spokento as a secondary method of control in much the same way as Internet13 banking seeks toavoid fraud This13 has13 the13 potential to remove13 the13 need for13 passwords13 and might13 then be13 the basis of machine-shy‐based13 communication13 either in front13 of a laptop or tablet13 device orwhen using13 a smart13 phone
There will need to be special measures introduced to support13 people with any form ofdisability as they might13 well have one or more sensory deficits Similarly people maystruggle to communicate following a stroke or a serious accident Nevertheless it13 may bereasonable to conclude that13 such systems will be both available and acceptable within thenext13 10 to 12 years
12
210 Health13 information
Health records in the form of written documents x-shy‐ray images and clinical observations arean important13 means of making all interventions efficient13 and safe Increasingly people havemany different13 conditions (comorbidities) and may be treated by several specialists Asthese physical records are moved inevitably some get13 lost estimates suggest13 that13 one inthree records is lsquolostrsquo at any one time
The best13 resource for information about13 a patient13 is his or her primary care record which isheld by the GP The UK was an early adopter of electronic primary care records and can beproud of the way that13 these have enabled population-shy‐based information to be collectedand analysed Scotland (and to a lesser extent13 Wales) has led the way in ensuring that13 allthese records are accessible through anonymised approaches that13 allow researchers toexamine trends and improve analysis of performance Fundamental to this has been theallocation of a unique identifier At13 the same time individuals can access these recordsboth to check for accuracy and to see what13 their doctor has said about13 them
This13 has13 the potential to make people more responsible for their own conditions andmight lead to better13 self-shy‐care13 and changes in behaviour13 that might reduce13 the13 incidence13 or severity13 of chronic conditions13 that are related13 to lifestyle
In the future we can expect13 the primary electronic health record to be linked with hospitaladministration systems picture archiving systems and other records held by hospitals sothat13 appropriate medical staff can have access to all relevant13 data
When the social care record is added to the mix then this will mean fewer but13 shorter andbetter assessments for social workers and for healthcare staff They will knowcircumstances and factors that13 could influence the choice of approaches This supports theidea13 of there being only one record consisting of several components all of which areaccessible by an appropriate professional at any time and in any place
The13 ambitions13 described above13 are not13 limited by technology most13 of the interoperabilityissues between rival commercial record systems have been resolved and databaseproviders are being compelled to support13 joint13 working The English NHS Mandate requiresTrusts to effectively replicate arrangements already in place in Scotland and in Wales andthis will go a long way towards achieving a genuinely paperless NHS well before 2020 Withnew biometric identification technologies individual records will be available to out-shy‐of-shy‐hours physicians and to those working in an AampE department13 irrespective of theconsciousness state of a patient
New telecare and telehealth technologies will produce significant13 more volumes of data13 which are currently held in different13 places and owned by different13 organisations rarely thepatient These data13 will also need to be shared but13 only in a manner that13 is acceptable toeveryone Patients may not13 want13 all their mental health information published in a formthat13 can be viewed by social workers GPs may not13 want13 to have access to all the data13 that13 might13 suggest13 that13 there is a domestic crisis to which they had neither the wish nor capacity
13
to respond Monitoring systems that13 support13 the lsquoquantified13 selfrsquo may also offer data13 that13 may or may not be added to the full recordThe future of health information might13 therefore be about13 providing individuals with themeans of producing relevant13 information storing it13 somewhere secure and then viewing it13 at a later time but13 in a format13 (or with advice) that13 is acceptable
See also httpmydexorg lsquoMydex gives individuals back control over their personal datarsquo
(see also Digital Scotland 2020 Achieving World-shy‐Class digital infrastructure a final report13 tothe Scottish Government13 httpwwwscotlandgovukPublications2013029054lsquoconnectivity by any device anywhere and anytimersquo)
211 The Future of Healthcare
The strains on our healthcare delivery system are becoming greater as they are in otherdeveloped countries as a result13 of an aging population rising expectations and unhealthylifestyles The necessary changes will require a significant13 shift13 in resources13 fromsecondary13 care13 where unit costs13 are high to community13 carewhere people can generallybe treated at home
The future must13 therefore necessarily involve efficiencies in hospitals and in the way that13 people can be treated in less expensive locations ultimately in their own homes Hospitalswill use more sophisticated diagnostic tools including scanners of all types to non-shy‐invasivelyprobe inside peoplersquos bodies This will result13 in more day cases and hospital stays (alreadyaveraging under a week) to even shorter periods with on-shy‐going support13 provided inintermediate care settings that13 might13 include hotels care homes or the personrsquos own homeif it13 is clean safe secure and has all the necessary amenities (include access to theInternet)
Advances in medical technology will allow more treatments to be delivered in the homeThis will mean fewer visits by clinical staff and fewer opportunities to attend primary carecentres Pharmacists will become suppliers of information as well as drugs so the balanceof care will shift13 significantly away from doctors who will work in different13 ways relying13 increasingly on telemedicine to bring the specialist13 to the patient13 for an online consultation13 For example if a patient13 complains of nausea13 and severe headaches a virtual consultationcan be offered almost13 immediately and without13 having to send a patient13 with a potentiallyserious and acute condition on a potentially long journey to a hospital
In the above example a neurologist13 may ask further questions as well as conduct13 acomplete neurological examination using videoconferencing technology Airedale GeneralHospital consultants have new contracts that13 require them all to be available for virtualconsultations The first13 benefit13 has been in reducing the need for prisoners at local jails tobe brought13 into AampE (which may need to be locked down depending on the circumstancesand the potential for violence of the individuals involved) potentially saving hundreds of
14
pounds in security costs It also avoids the need for healthcare staff to have to go into aprison environment
The principles described above are already saving lives through telestroke services whichlead to more people being thrombolysed appropriately and avoiding long term support13 that13 often follows a stroke incident Teledermatology has been practised for a number of yearsand results in rapid diagnosis and resolution of problems that13 previously required significant13 time for remedy
212 Gadgets and13 DIY13 healthcare
There are at least13 three elements to healthcare
bull Gathering information on symptoms and physiological parametersbull Interpreting the information andbull Responding to the diagnosis with treatment
Many people choose to exercise self-shy‐care because this gives them control whilst13 avoidingthe need to share their concerns and personal details with others A lsquodo It yourselfrsquoapproach might13 even be encouraged by the NHS as a viable way of using scare resources
Medical devices that monitor vital signs are mature and have been miniaturised so that13 they can be used in the home by individuals with little or no medical training Indeed bloodsugar monitors are being produced specifically for use outside the hospital and in such away that13 they can be used reliably by people with advice and training being provided onlinevia13 YouTube
Many medical monitoring devices do no more than produce a single measure which theuser may record or respond to Others link wirelessly to smart13 phones allowing data13 to bestored and entered into a personal health record where trending opportunities existingIndeed individuals can easily enter their data13 into an app running on their laptop tablet13 orsmart13 phone This trending information may be useful13 for self-shy‐care and could be passed onto a physician though the volume of data13 produced in this way and doubts about13 thequality of the data are likely to persuade GPs to discount13 data13 produced in this way
This gap in knowledge can be filled with advice information and diagnosis that13 can beobtained online using a lsquoDoctor Googlersquo approach The quality of such diagnosis may varysignificantly although there are many sources of information that13 are both supported andapproved by the NHS (and by similar sources in other countries) However with a data-shy‐richapproach and a choice of diagnosis people may be empowered to take a greater role inhealthcare
15
The final component13 for the DIY enthusiast13 is the treatment13 option Many people fear longterm use of medication produced by the big pharmaceutical industry and prefer morenatural remedies which are available over the counter More medical treatment13 devicesare available that13 stimulate blood flow and counter pain through the use of electrical andphysical stimulation
The evidence may be weak at present13 but13 might13 grow as more people use them and as theircost13 drops The13 impact13 of13 such technologies13 on vulnerable13 people13 is13 difficult13 to gauge
213 Telecare
Support13 provided at a distance to people in their own homes is known as telecare Thename implies remote monitoring and interaction and includes the monitoring of the homeenvironment13 and of the individual as well as the interaction of the individual with thisenvironment Definitions have become difficult13 due to some US medical devicemanufacturers introducing the term telehealth to describe medical telecare such as remotemeasurement13 and collection of vital signs data
In the UK telecare alarm services have matured quickly using the robust13 platform andinfrastructure of social alarm systems which were originally used by tenants in shelteredhousing schemes to seek help when they didnrsquot13 own a telephone The majority of telecareservice users today live in their own homes and use dispersed alarm units to link with amonitoring centre through the telephone network Improved assessments of needs andrisks to independence have resulted in combinations of sensors being used to support13 theoption of staying put13 rather than moving into residential care or having increasing levels ofdomiciliary support They support13 the policy of bringing care closer to home and ofencouraging people to become partners in their long term support13 arrangements
Telecare services developments over the past13 decade include standalone items such asautomatic lights which have achieved significant13 efficiencies especially for people who arefrail and prone to falling and to those suffering from mild cognitive impairment epilepsyand anxiety People who have long term conditions including chronic conditions such asdiabetes and hypertension can also be managed more effectively through telecare supportThe benefits of telecare services include a relief of stress for family caregivers enablingthem to continue to provide unpaid support13 while holding down a job and maintaining theirquality of life
New developments enable continuous monitoring of behaviour and smart13 devices that13 canfor example remotely control the cooker the water supply and door entry Such13 monitoring may detect13 incidents early and prevent13 emergencies arising Devices arebecoming smaller and easier to embed quickly within the home environment making themmore acceptable and less noticeable Longer battery life means less frequent13 maintenancevisits
16
The13 monitoring13 centre13 becomes13 an information hub13 offering13 both advice13 and a vehicle13 for checking that someone is coping especially following a trigger event such as a stay inhospital or the illness13 of an informal13 carer
New systems utilise web technology that13 allows family members to be more proactive inthe monitoring of their relatives This can lead to greater interaction with them especiallywhen the relatives live a considerable distance away (perhaps in another country) Thesenext13 generation systems might13 include video conferencing and the use of tablets smart13 phones or smart13 TVs but13 when an emergency response is required (perhaps to lift13 someoneup after a non-shy‐injurious fall) there remains a need for human intervention
The13 future13 of13 telecare13 might therefore13 include13 an increasing13 dependence13 on volunteersfrom13 the13 community to provide13 the13 required support Social networking may need to beused13 to support13 telecare technologies
214 Mobile healthcare
While telecare can support13 people effectively in their own homes it13 is now recognised that13 being able to go out13 to enjoy open spaces and to overcome the fear that13 the home is aprison is an important13 part13 of improving well being and supporting a higher quality of lifeExtending telecare technologies to operate outside the home is known as mobile healthcare(or mCare) and is based on mobile telephone networks rather than landlines
The simplest13 form of mCare requires only a basic mobile phone to deliver telephone callsvoice13 messages and SMS (text13 messages) The technology is mature and there are countlessapplications in use both in the UK and in developing countries such as Africa13 and India13 where mobile telephones have already achieved a saturation level and where fixedtelephone infrastructures are not13 likely to be established at any time Such telephones areuniversally available in the UK and are used by the vast13 majority of people including manyolder people especially if they have been introduced to the low cost13 (pound30) devices that13 have large buttons large displays and a separate large button for calling an emergencynumber
Smart13 phones are rapidly replacing basic phones and allow the use of a large range of lsquoappsrsquothat13 are being developed to provide information and for enhanced experiences In thehealthcare space Skype FaceTime Vidyo and GoToMeeting with HD Faces are all current13 examples of video conferencing software available on tablets and smartphones
The specific software will depend on the nature of the communication desired
bull Skype will13 manage a simple video phone callbull Where an AampE physician needs to share a CT scan of head with a Neurologist13 on call
from home GoToMeeting would be more appropriate
17
bull If the physician would rather have a dedicated online meeting room that13 patientsand colleagues can simply drop in for a virtual meeting a Vidyo virtual room may bemore appropriate
This technology can suit13 any form of lifestyle including many people with complex needswhose lifestyle is not13 consistent13 with a fixed address
Social care apps are available already to deal with problems of sensory deficit
bull Guiding a blind person through GPS navigation and reading signs through appslinked to the devicersquos camera13
bull The microphone can be used as a hearing aidbull Speech recognition software can be used either to replay speech at a slower speed
or for translation into a language of choicebull Speech can also be selected for people who have a stammer or who have a problem
with their larynxbull Apps are becoming contextually aware recognising situations and locations and are
thus becoming a personal assistant13 for people with disabilities
By 2020 it is therefore possible that a smartphone may13 be prescribed13 for people who13 need13 social13 care13 together with13 a range of apps that have been13 selected13 to meet13 theirassessed13 needs
Whilst13 smart13 phones tablet13 devices and apps may become an important13 part13 of anindividualrsquos personal support13 armoury the potential of mCare will be limited only by anindividualrsquos ability to make use of all its functions Each device could become a part13 of anindividualrsquos personality supporting them to improve behaviour take exercise avoidtemptation and manage their own health and well-shy‐being Potentially mCare could becomethe most13 important13 element13 of social care and support13 within 10 years
215 Artificial Sensing and Enhancement Devices
bull It is estimated that13 one in seven people has imperfect13 hearingbull The numbers who are born deaf are quite small and many of these people may
have some form of hearing restored through surgery or through technologybull Similarly while there may be nearly a million people registered as blind or having a
severe visual impairment the vast13 majority lose their sight13 during their lives as aresult13 of disease
bull New treatments will deliver sight13 recovery or restoration over the course of the next13 10 to 20 years
Fortunately technology can provide excellent13 sensing capabilities that13 are already providingpeople with external portable devices for enhancing their lives The simple hearing aid is anexcellent13 example of a device which has been improved through both miniaturisation
18
personalisation and enhanced performance Today digital hearing aids use sub-shy‐miniaturemicrophones that13 can be unidirectional or omnidirectional and which can be adjusted insensitivity over an extended range Tomorrowrsquos devices can be switched between modesby the user so that13 they can benefit13 from hearing perfectly in any environment Indeedthey can be used with adaptive filtering technologies (as used by helicopter pilot13 headsets)to eliminate some sounds so that13 the rich speech (or music) components alone remainFuture developments will be on optimising control so that13 the user can switch seamlesslybetween different13 amplification applications without13 appearing to be distracted A smart13 phone or mp3 music player may be used as either a processing unit13 or as a ubiquitousoutput13 device that13 looks cool and natural
These same technologies will also be developed for use within the home environment13 fortimes when a deaf user isnrsquot13 present13 or is asleep Acoustic signatures associated withadverse events and incidents such as the hiss of a gas leak the crackle of a fire the sound ofa smoke detector the drip or a water leak or the sound of breaking glass can be directlyassociated with programmed actions Speech will be recognised interpreted translatedsimplified or displayed so that13 an individual knows what13 is said and can be provided withclear instructions on how to respond
Video cameras have become smaller and cheaper and capable of producing high definitionimages The problem of storing and editing these large image files is being solved by thearrival of cloud computing
Electronic noses are already capable of detecting the quality of wine and fresh fruit Similartechnology will be based in smart13 phones and will be able to analyse the air to warn of13 foodthat is no longer fresh and of other indicators of danger including gases that13 have13 little13 natural13 smell These13 devices13 could support13 people with13 cognitive impairment13 -shy‐ whose13 sense of smell13 tends13 to deteriorate -shy‐ to live independently
Many older and vulnerable people are at risk of hypothermia during the winter Sensordevices can provide warnings of low temperature In the same way heat13 stress can be adanger during the summer months so sensors can alert13 people of the need to openwindows or to operate a fanFinally people who have damaged13 their fingers13 or hands will be able to wear sensorsembedded in artificial skin or in gloves that13 will enable them to identify textures and shapesand be able to dress and undress without13 the assistance of carers
216 Robotics
We may recoil at the idea13 of personal care being delivered by robotic devices but13 it13 is likelythat13 within a decade personal assistants will exist13 to assist13 with household tasks These areunlikely to be humanoid and are more likely to be machines dedicated to helping frailpeople to support13 their own weight13 and to carry trays of food around the home
19
There are four broad classes of robot13 under development13 that13 are likely to mature within 10to 12 years
1 Miniature industrial robots that13 have been programmed to perform specific taskswith precision They are likely to be relatively heavy enabling them to bear weight13 but13 still have the necessary flexibility to carry an individual over short13 distancesplacing them in a chair or on a bed They will have sensors and cameras to provideimmediate feedback and to adjust13 rapidly in response to verbal commands or cues13 from the user Some designs may build on existing assistive devices such as abathroom hoist13 or a bathing aid to become intelligent13 extensions of productsalready on the market A stair lift13 with intelligence is already being designed by a UKcompany and is aimed at providing the user with more control of the journeybetween floors of a house
2 The second group of devices might13 be described as intelligent13 furniture Beds andchairs are already available that13 adjust13 to make the user more comfortable and also13 to help them get13 into or out13 of bed The control units are fairly cumbersome andare suited to operation by a carer Voice activated controls and built-shy‐in intelligencewill give the user more control and independence Other items of furniture to whichintelligence might13 be added would be tables whose height13 can adjust13 and whichhold items of food and medicine securely The table would recognise these objectsand could provide prompts or reminders
3 Mobile robots form the third group These could be goffers that13 can either fetchand carry items such as newspapers drinks or trays or which can accompany theuser when they move between rooms providing them with support13 or prompts Thistype of robot13 could be an intelligent13 walking frame with wheels which13 could13 doubleup as a smart13 wheelchair when necessary
4 Finally there are companion robots These might13 be in the form of an electronicpet typically a cat13 or a dog though the Japanese Paro robot13 is a seal Pets canrespond to stroking and being patted they can also remind their owners that13 theyneed to take exercise and to eat drink and take their medication Various designsare already available which provide feedback but13 future models would includecameras and a screen to provide a mobile means of information and interactionwith other people over the Internet Intelligence within the device could allow themto have a personality of their own and gain knowledge by scraping data13 fromwebsites so that13 they can generate speech and have conversations about13 the newsthe weather or sports results
217 Transport and transfer technologies
Walking is good exercise and is a no-shy‐cost13 form of transport13 that13 is encouraged because of itsimpact13 on well-shy‐being For an individual with a chronic disability or suffering from theeffects of an accident13 or an injury this becomes impractical without13 an assistive technology(AT) A walking stick is the simplest13 example of AT
20
Within the home the stair lift13 has enabled people who live in conventional properties that13 are on two or more floors to continue to use facilities on different13 floors when climbing thestairs has become too difficult This is often the case for people who have arthritis a lowerlimb amputation a long term condition such as Chronic Obstructive Pulmonary Disease orpeople approaching the end of life and who have chosen to die in their own homes
Designs have improved so that13 a curved staircase is no longer an issue and the reliabilityhas reached a level where breakdown is a rare occurrence13 Through-shy‐floor lifts have been analternative proposition but13 they remain too large for most13 properties Alternativeapproaches may emerge using air pressure or water pressure as the driving force ABrazilian design already utilises a plastic tube in which a pod is moved effortlessly up anddown
Electronic wheelchairs are now available that13 allow the individual to become moreindependent13 as they allow the user to control both propulsion and steering Some modelshave the capability of mounting a pavement13 or a step or even a flight13 of stairs Personalmuscle amplification devices have been developed originally with the intention of helpingpeople who are confined to a wheelchair due to a neurological disorder to perform sometasks from a standing position Indeed the Rex walkerrsquos manufacturers claim that13 anyonewho can propel themselves in a wheelchair could walk by using Rex
Other approaches have focused on the rehabilitation of people after major accidents that13 have caused partial paralysis They quickly extend into exoskeleton designs that13 enableanyone to gain a mechanical advantage and thus to tackle physical tasks that13 would not13 otherwise be possible These suits are the focus of major research projects across theworld Some13 products such as the system developed by Honda are being tested inAssisted Living facilities and are likely to become more and more enabling over the next13 decade
Similar benefits are also occurring outside the home with a number of novel carryingsystems appearing over the past13 few years They are generally termed lsquoscootersrsquo but13 thiscovers a wide range of systems and devices ranging from the Segway a device that13 is amobile platform on which the user stands and navigates through to conventional electricvehicles that13 have been developed from golf buggies There remain a number of issuesconcerning their use on roads or on pavements but13 similar problems will need to beresolved for bicycles to play their full part13 in enabling people to get13 more exercise13 Thepotential for hybrid scooters remains
218 Smart domestic appliances and personal hygiene
The bathroom is a dangerous place and one where many older and disabled people slip andsuffer a fall Many older people recall taking a bath in a tin tub in front13 of an open fireToday the options tend to be a level access shower (ie a type of wet13 room) for anyoneunable to get13 into a bath There are various aids to help people get13 into and out13 of thebath most13 involving a seat13 that13 can be raised or lower with some bath-shy‐tubs having a door
21
There has been some research into alternative methods of keeping the body clean Sanyointroduced a machine in 1970 modelled on a clothes or dish washing machines the personsits on a seat13 inside the machine where13 they are cleaned by a set13 of water jets These havenot13 proved popular and furthermore require the individual to be transported to themachine Thus the technology may find application in nursing homes but13 are unlikely to beattractive to people living independently in the community
The washing needs of people change over time Over the past13 20 years body piercingshave appeared which have demanded additional attention to avoid the problemsassociated with poor hygiene and metals Similarly hair may be permed and dyed usingchemicals which are much stronger and which might13 damage the hair Add to this thepainting of finger and toe nails and the washing needs are rather different13 to what13 theymight13 have been even ten years ago Finally tattoos were once popular only with sailorsToday they are likely to be found on the arms backs and legs of both men and womenNew ways of cleaning these tattoos will be needed especially if they become infected orare sites at which pressure sores develop
Even if a personrsquos body is clean if their clothes are dirty they may become socially isolatedBut13 the washing of clothes can be strenuous even if a launderette is used The need toconserve water has driven research into ultrasound techniques to beat13 the dirt13 out13 ofclothing while some companies are experimenting with polymer chips These13 ldquogreenrdquo13 technologies are quickly maturing and are likely to be standard in the next 10 years
Other smart13 household appliances are already appearing on the market13 and may soonbecome common13 in UK homes13
bull Robovac devices have sensors to enable them to detect13 dirt13 on carpets and to adjust13 their operation accordingly
bull Refrigerators can read bar codes or RFID tags to identify their contents and theirldquouse byrdquo13 dates enabling them to inform the owner that13 they should use theproducts before they are out13 of date They can be linked to the Internet13 to reorderitems as they are consumed or to suggest13 menu options for the individual based ontheir preferences or according to the diet13 required to manage a condition
bull Ovens will automatically switch off if they are left13 without13 attention for too longand drying machines will set13 times automatically
Devices may be linked so that13 they are more efficient and report13 maintenance issues sothat13 they can be repaired (perhaps remotely) before they suffer a catastrophic breakdown
219 Personal and home13 security
It might13 appear perverse but13 people with very little personal wealth and property are morelikely to be the victims of crime than those who have expensive items This may be due towhere poorer people tend to live or because people who have valuable assets take greater
22
steps to protect13 them There can be no doubt13 that13 crime has a very negative effect13 onindividuals and on their families creating a fear factor that13 may be difficult13 to remove Theimpact13 on quality of life is therefore very considerable especially if it13 forces people to stayat home behind locked doors effectively isolating themselves from society
Modern policing places increasing reliance on the use of closed circuit13 television (CCTV)Town centres are covered by cameras used increasingly in the fight13 against13 crime by bothdetecting anti-shy‐social incidents and identifying the people involved They are also used tomonitor the movement13 of cars that13 may be involved in incidents of burglary and violenceand are fast13 becoming the primary mechanism of law enforcement13 agencies to solve crime
CCTV has moved into the home to record movement but13 monitoring the footage is timeconsuming and often not13 practical Cameras are now available which provide an instant13 video feed to a smart13 phone when movement13 is detected These may have intercomcapability allowing someone to remotely speak to an intruder sometimes before they havegained access to a building This may serve as a deterrent13 and when fitted alongside simpledevices that13 switch lights on randomly around the home may force burglars to goelsewhere
As the price of cameras continues to fall the option of carrying a camera13 on the body that13 continuously monitors personal space is becoming more useful Using wireless networksthe data13 collected can be sent13 continuously to the cloud for safe storage It cansubsequently be retrieved to provide evidence (video and audio) of confrontations enablingsuccessful prosecutions to be made The smart13 phone itself is becoming a valuable itemthat13 is attractive to criminals These can be tethered to personal attack buttons usingwireless technology allowing the device to be activated by the pressing of a button if theowner is being attacked The phones can then be tracked and located by the police whilebeing rendered useless to the assailant
Bogus callers are a perennial problem for vulnerable people Video door bells can beconfigured to display images and record the words of visitors before they are admittedallowing remote monitoring centres to oversee the situations and use image recognitionsoftware to confirm the bona13 fide of visitors Such13 arrangements may become13 commonplace13 over13 the13 next five13 or13 six years13 significantly13 improving the safety of peopleliving independently
220 Personal safety
The biggest13 risks to personal safety stem from fires and falls Most13 fires are the result13 ofpoor cooking practices resulting in burns or scalds Floods and gas emissions are caused bya failure to remember to close taps
The current13 approach involves detection of an emergency situation as soon as possible but13 always after a problem has already occurred This responsive approach can minimise therisks provided that13 there is a protocol in place for intervening This could increasingly be an
23
automated response such as the switching off of the gas of water or the switching on of asprinkler system or a water mist13 system
In the future monitoring systems will be more sophisticated and will have sensors and localintelligence to identify activities In this way reminders can be issued before an emergencyoccurs13 This lsquosmart kitchenrsquo approach may become13 an integral part of13 homes of13 vulnerable13 people
A prototype system has been developed at the Culture Lab in Newcastle Sensors havebeen embedded into cooking utensils enabling the kitchen to identify what13 the person istrying to cook or prepare It can provide interventions as messages on an instructionscreen
Accidents also occur out13 of doors People with dementia13 might13 become lost13 and may havepoor road safety awareness Location devices based on GPS have advanced from large andheavy receivers that13 were used on ships and boats to small battery-shy‐operated devices that13 can be carried in the hand or in a handbag The current13 generation of locators has limitedbattery life and are rather too large to be secreted about13 a personrsquos clothing while devicesthat13 are integrated into a wrist-shy‐watch are rather clunky and unattractive
Within 10 years the13 technologies13 will have13 matured and will be13 much smaller13 so that theycan be embedded in shoes in walking sticks hats or any other item of clothing Powerrequirements will have reduced so that13 energy harvesting from the movements of theindividual will be sufficient13 to keep these products working for several weeks without13 theneed for recharging The devices will not13 simply indicate to others where the individualhappens to be but13 will provide subtle guidance cues to direct13 them home
Cameras might13 also form part13 of the personal security systems that13 will protect13 people fromaccidents Data13 may be sent13 to the cloud and analysed in real time if the person is in adangerous location and can provide prompts either to the individual or broadcast13 advice toothers to clear the danger These systems may be embedded in items of clothing (such as ahat) or they may be attached to spectacles
221 Energy and13 portable power supplies
The demands of developing economies for more power will inevitably lead to higherdomestic fuel charges in the UK especially as oil and gas reserves dwindle
By 2018 UK homes should be fitted with new smart13 meters The specifications for these13 devices have yet13 to be finalised but13 will include a means of identifying wasteful use ofenergy including TV sets that13 are left13 on and unattended fridges and freezers that13 are set13 attoo low temperatures and dryers that13 are used for too long or when the weather is suitablefor using a washing line They could be an enabling factor that13 supports changes inbehaviour driven by a need to use less power but13 it13 is unlikely that13 they will offer a bigreduction in costs that13 are already a problem for many vulnerable families
24
More generally the need for power conservation will include devices that13 are moreefficient and a significant13 emphasis on heat13 retention in buildings through betterinsulation
The energy crisis may force many people to spend more time in community settingsincluding shops and public buildings where they can benefit13 from the warmth Increasingreliance on mobile communication devices will lead to increasing demand for batterycharging facilities
Greater use may be made of portable devices for generating power based on solar cellswind or hand motion
222 Smart cities and homes
The Digital City initiatives have been based on information and how it13 can be used most13 effectively to make people aware of what13 is going on around them This means bettercoordination of resources more rapid access to advice and a battery of sensors measuringevery conceivable parameter from sound and light13 levels through to air quality andtemperature fluctuations There are several Digital or Smart13 City initiatives currently beingimplemented both in the UK and across the world They may significantly impact13 the livesof the millions of people living in them but13 the timeframe for outcome benefits to influenceplanning and design elsewhere is likely to be at least13 20 years and therefore outside thetimeframe of the current13 project
Housing plays a big role in the lives of most13 people both through their aspirations to moveup in the world (usually to a bigger property with a garden) and as the heart13 of the familylife which is associated with good quality of life UK properties have a life span approaching100 years which is about13 double that13 of their European counterparts (and certainly longerthan the wooden-shy‐frame buildings built13 in North America13 for example) A shortage ofhouses has plagued improvements in social welfare for the past13 30 years There is anargument13 that13 there are enough houses but13 the wrong size and in the wrong places andthis has some basis in fact13 as demography changes lead to more people (and more olderpeople) living alone However if there are two million homes in Scotland each with alifespan of 100 years then the renewal rate needs only to be 20000 per annum to maintainthe status quo However it13 must13 be clear that13 the impact13 of smart13 house development13 willbe small The focus should therefore be on adapting existing properties to render themmore appropriate for vulnerable people
Housing adaptations are a branch of assistive technologies The technologies for providingdifferent13 forms of accessible bath and level access shower are well-shy‐established with littleresearch considering anything other than alternative building materials and methods formaintaining the temperature of the bathwater Different13 technologies for bathing will beconsidered separately
25
Thus housing technologies are not likely to impact on social work13 within the next 20years13 though13 the use of information13 technology13 to ensure that people are aware of what13 is available is likely to be commonplace well before then
26
3 BEHAVIOUR AND ATTITUDE CHANGES DUE TO TECHNOLOGICALADVANCES
Technology is only one factor that13 will affect13 the way society changes in the next13 10 or 15years This chapter will consider the context13 in which the technological developmentsoutlined in the previous chapter will be supported (or held back) by societal factors
When the impact13 of such factors has been considered we can then apply theseassumptions to a number of case studies listed in Appendix13 A13
The headings selected for this chapter are not13 arbitrary as they reflect13 the context13 in whichtechnological changes must13 be considered They must13 include consideration of factors suchas demography and long-shy‐term conditions already addressed in the introduction to thesepapers together with the aspects of workforce and citizenship considered in the parallelpapers The additional elements here focus on trends that13 are already occurring and whichmay leave people struggling with the changes that13 occur
Finally there is a need to consider the attitudes of people to technology generally andespecially to the issues of privacy and social responsibility that13 could be radically changedby technology In some cases public opinion will prevent13 some forms of technology beingdeveloped if not13 commercialised In other cases some technologies will be fast-shy‐trackedeither at the request13 of government13 or because of a clear public demand for theopportunities that13 it13 can bring
Predictions13 about the13 future13 must inevitably be13 subject to considerable13 uncertainty butthat is no reason to stop thinking what might happen
31 The Welfare State
The UK can be rightly proud of the way that13 its welfare state has developed during the past13 100 years to provide a safety net13 of financial support13 to people and to their families whenthey are unemployed destitute homeless or challenged by crises and emergencies Therange of benefits received is considerable some are complex and many people struggle tounderstand their entitlements Some are universal some are discretionary some apply onlyto parents others to anyone
The total cost13 of providing these benefits continues to rise and when the economy isstagnating there is inevitably both political pressure often supported by popular publicopinion to introduce welfare reform so that13 people who do not13 work cannot13 be better offthan they would be if they were in full-shy‐time employment This strategy requires a universalbenefit13 to be introduced so that13 it13 is easier for claimants to access support13 but13 also easierfor agencies to identify the total benefits received The idea13 of a benefits cap then becomes
27
more practical to introduce especially if all the processes involved in making a claim arehandled electronically Indeed this encourages government13 to insist13 on applications forbenefits to be made on-shy‐line Unfortunately this will marginalise those people who haveneither a computer nor access to the internet thus emphasising the digital divide in amanner which works against13 some of the most13 disadvantaged people in society
There are currently few tangible links between digital technology and welfare provisionThe most13 obvious are universal benefits such as a free television licence (worth pound14550)13 for13 everyone aged 75 or older with blind and visually impaired people entitled to a 50discount13 irrespective of their age The significance of this position is that13 6 of revenuesgenerated through licence fees are to fund BBC on-shy‐line services13 such13 as websites and i-shy‐player In Scotland the BBCrsquos Alba Gaelic language television service is predominantlyfunded13 by MG Alba an organisation funded by the Scottish Government It is thereforeconceivable that13 in the future licence fees may be used to directly subsidise access toinformation and advice through the Internet13 for vulnerable people whether it13 is throughbroadband access or through a set-shy‐top box which removes the need for a computer in thehome to access particular websites or to use e-shy‐mail services
A second age-shy‐related benefit13 available in the UK is the winter fuel subsidy People whoreceive certain benefits receive the payments automatically while others must13 make aclaim Those who are not13 eligible for benefit13 due to a lack of an address for example missout13 on these payments and also on Cold Weather payments of pound25 for each seven dayperiod of very cold weather between 1 November and 31 March
The development13 of new warm home initiatives plus the complex of subsidies that13 theelectricity supply industry and government13 offer to people with solar cells further changesthe economic arguments Global warming may lead to greater variations in weatherextremes but13 might13 also increase the amount13 of electricity that13 can be generated byalternative (green) sources such as wind and solar cells It is estimated that13 energyconsumption in the UK increased by 17 between Christmas and Easter 2013 compared toprevious years as a result13 of cold weather but13 the above subsidy scheme did not13 benefit13 older people because two of the seven day cold periods were after 31st March It must13 beassumed that13 there will be more people living in fuel poverty in the future and this will leadto more cases of cold related illness including influenza13 and stroke
32 Management of long term conditions
The management13 of long term conditions will be improved for patients who are compliant13 with their medication regime so it13 is possible that13 there may be compulsion to adhere tothe prescription Such compulsion may be monitored using technology Indeed the remotemonitoring of vital signs using telehealthcare will become commonplace as the old boxesand sensors are replaced by devices that13 can be worn continuously or which can beembedded into the fabric of homes (including furniture and bedding) or can be worn asvests or patches They will wirelessly transmit13 data13 to smartphones or tablets and mobile
28
transmission and cloud technology will enable real-shy‐time data13 collection analysis andfeedback
One of the diseases which is projected to increase most13 significantly over the comingdecade is Type 2 diabetes Whilst13 there is a hereditary susceptibility to this condition formany people including those from the Middle East13 and the Asian sub-shy‐continent it13 is also adisease which tends to affect13 those people who are overweight13 andor have a sedentarylifestyle If untreated diabetes can lead to dizziness and collapse at any time but13 can alsohave more devastating long term consequences which include kidney failure strokeblindness and in extreme cases lower limb amputations Management13 therefore includesdaily monitoring of blood glucose levels and major dietary changes such as a significant13 reduction in the consumption of carbohydrates as well as a rigid exercise regime
Many newly diagnosed diabetics follow this advice closely and can lead normal lives for 40years or more but13 some struggle to accept13 the change in lifestyle required as well asremembering which foods are allowed and how much exercise they need to takeIndividual support13 plans are now forthcoming and over the next13 ten years best13 practicewill emerge in the form of smartphone apps that13 are personalised and which can becomean individualrsquos health coach This level of support13 will be fine for some people but13 otherswill need incentives so it13 is likely that13 gaming technologies will be introduced perhapsoffering rewards for good compliance There will be a temptation for some people tocheat perhaps allowing others to perform exercise for them or changing theirconsumption details
Many of these opportunities for cheating will be removed through the use of a uniquebiometric identifier a technology that13 will be mature enough to use in place of passwordson smartphones However the biggest13 challenge may be in encouraging older people to usethe technology Many older people have multiple morbidities Indeed a survey of Scottishpatients implied that13 42 of people aged over 80 will suffer from three long termconditions It will be essential for those people to comply with treatment13 regimes if they arenot13 to have the functional deficits that13 follow
33 Finding people who13 donrsquot fit
People who have low social capital are likely to have few relatives and friends with whomthey regularly communicate and are also unlikely to be part13 of community or faithorganisations such as clubs societies and church groups They also die several yearsyounger than most13 of the population often because they donrsquot13 engage with public healthinitiatives such as vaccinations against13 flu regular checks on their blood pressure bloodsugar levels or in the case of women smear tests or mammography The most13 likelyreason for disappearing beneath the radar of such initiatives is their mobility which leadsalmost13 inevitably to them having no fixed abode and no fixed telephone line It thenbecomes very difficult13 for them to be contacted because their mobile telephones are likelyto have Pay-shy‐As-shy‐You-shy‐Go contracts that13 donrsquot13 require validated names addresses and bankaccounts
29
It follows that13 some of the most13 vulnerable people in society including those who live onthe streets are effectively unknown to both the NHS and to social work departments untilthey are referred in a crisis This could be an emergency presentation to a hospital Accident13 and Emergency Department13 where they will come into contact13 with a social worker becausedischarge may be unsafe This often highlights the importance of the prevention agenda13 and the potential for avoiding admissions to hospital by intervening at an earlier stage
The advantages of being able to locate people who are vulnerable to specific diseases willincrease as genetic testing becomes more routine It is already possible to determine whomight13 be most13 at risk of breast13 cancer and prostate cancer as a result13 of family history Addto this the evidence that13 particular diet13 and exposure to environmental factors can furtherincrease risk then it13 is evident13 that13 individuals can be identified and offered treatmentsthat13 could save their lives many years before they become ill In the case of cancersperhaps only the individual is involved but13 for infectious diseases it13 is the whole of societythat13 is at risk if someone contracts one of the new strains of influenza or if someonechooses not13 to be vaccinated against13 rubella In Chinese airports all visitors are screenedfor fever and refused entry if they tested positive in cities the public are monitored in thesame way Similar approaches may be necessary in the UK if potential carriers cannot13 otherwise be identified
34 Volunteering
It is estimated that13 72 per cent13 of people volunteered to perform a charitable act13 at least13 once during 2012 a rise from 65 per cent13 the previous year About13 four out13 of every 10volunteers offer their services formally to one or more organisations The remaindervolunteer informally by helping out13 a friend or a neighbour Around 50 per cent13 volunteered at least13 once a month in the past13 year up from 41 per cent13 on the previous13 year Most13 have retired many of them before the statutory retirement13 age Those whodonrsquot13 feel able to offer time have offered their financial support13 at a time when the fundingavailable from sources such as the National Lottery has been decreasing Despite economicausterity donations to charities have been increasing 74 per cent13 said they had given tocharity at least13 once in the previous month up from 72 per cent13 the previous year
Strikingly 78 per cent13 of people strongly believe that13 they are part13 of their localneighbourhood an increase from 70 per cent13 10 years previously Community cohesion isstronger than ever 87 per cent13 of people believe their local area13 is a place where peoplefrom different13 backgrounds get13 on well together compared to 80 per cent13 in 2003
The role of volunteers in supporting vulnerable people is therefore likely to increase overthe next13 decade perhaps exploiting the success of the army of volunteers that13 was highlysuccessful in London during the Olympic and Paralympic games The greatest13 role for suchvolunteers may be in providing informal care for older people Already the UK has someseven million informal carers whose value in monetary terms has been calculated to be
30
more than the combined budgets of the NHS and social care Maintaining or extending thisprovision will help to support13 services in the future and may be supported by technology
Whilst13 there is ample evidence to suggest13 that13 telecare services support13 informal carers asmuch as (if not13 more than) the people that13 they are caring for it13 is the potential for utilisingthe internet13 and apps to make their role easier to coordinate and hence more effectivethat13 is likely to be most13 successful moving forward
Many of these focus on particular tasks that13 informal carers can help offer to older peoplesuch as organising their medication A pillbox program is just13 one feature of an app calledBalance It also includes sections for caregiving tips notes for the doctor and the patientsappointments plus a lsquolearning sectionrsquo with articles on aspects of Alzheimers and an RSSfeed for news about13 the disease Tyze is another multi-shy‐functional app it13 allows carers to
bull Organise appointmentsbull Plan outingsbull Share storiesbull Send updates to other family members
Another application is Rally Round which helps carers to organise someone to perform littlejobs often on a temporary basis when someone has dementia physical frailty or isrecovering from accident13 or illness Similar applications are MeMaxi and Finerday
35 The High13 Street
The shape and appearance of UK shopping centres have been changing for half a centuryPeople complain that13 centres are losing their identity with one town looking like everyother both in terms of the stores and in terms of the layout But13 there are three trendswhich are having a profound impact13 on many of the most13 vulnerable people in society
bull Centres lock their doors at 6pm or in some cases 10pm -shy‐ thus denying people whosuffer from claustrophobia13 from window shopping at times when other shoppershave left
bull Out13 of town shopping malls -shy‐ these US style centres are ideal for people in carsbecause they offer free parking which is essential for people who want13 to buy largeritems but13 difficult13 for people who have no transport13 and who must13 rely on publictransport13 that13 is often deficient
bull The rise of online shopping -shy‐ which means that13 many potential shoppers only visit13 High Street13 stores to check the prices before returning home to make a purchaseonline
It is the third of these effects that13 has the greatest13 potential for changing the High Street13 forever and it13 is making life for traditional retailers increasingly difficult13 at a time when highrents are crippling stores large and small It is difficult13 to see how this trend is likely tochange because consolidation in banking and estate agencies is already forcing the closure
31
of other High Street13 players while additional pressures on pubs has led to the closure ofthousands of pubs every year
Those figures however demonstrate that13 consumers still value what13 the high street13 canoffer -shy‐ the chance to inspect13 what13 theyrsquore thinking of buying -shy‐ as well as the new opennessof the internet Customer service makes a difference to people especially if there is aproblem and goods need to be returned One of the most13 common reasons for furniture tobe returned for example is that13 when a sofa13 or a wardrobe was delivered it13 couldnrsquot13 fit13 through the front13 door or up the stairs In the future people will be able to benefit from13 visualisation technology they will upload the floor plans of their homes enabling theretailer to inform them of the problem before they try to delivery Augmented reality viewwill similarly allow customers to see what13 a new item of furniture will look like in itsintended place so that13 they can be more informed about13 the effect13 of size and colour
In terms of improving the viability of the High Street stores will have to focus on theimportance of brand which could mean that13 individual independent13 retailers will have topartner with national suppliers to support13 a local tailored offering based on products that13 are designed for a more global market This is a lsquoconnected High Streetrsquo approach whichcould be enabled by the developments in internet13 availability and smart13 phone accessdescribed in the previous section
The overall effect13 of all these changes could mean that13 town centres become smaller but13 more vibrant13 areas They could thrive if people are attracted there in large numbers whichmeans that13 retail must13 be developed alongside restaurants pubs galleries and other leisureopportunities This is possible in new shopping centres which are already being integratedwith transport13 hubs including railway and bus stations but13 may be more of a design13 challenge for older towns and cities with large Victorian buildings To ensure that13 morepeople are welcomed into the new centres they should include attention to green spacesand areas where people can relax without13 feeling that13 they are second class citizensbecause they donrsquot13 have the same buying power
3513 Privacy
To some people privacy is their right13 to live their lives without13 interference they may seethe State as a potential lsquoBig Brotherrsquo spying on their every move and judging their actions13 and activities Other people have fewer concerns about13 the role of the State but13 great13 fearof individuals interfering with and invading their privacy Some embrace the concept13 of lsquomyspacersquo an area13 of a square metre or so into which nobody can enter without13 permissionThis allows them to avoid physical contact13 and to feel safe from any form of threateningbehaviour
Yet13 this idea13 of private space and its potential violation is merely the tip of the iceberg asfar as privacy is concerned more significant13 is the idea13 of personal (and private)information being shared with anyone and everyone This could be related to identityopinion or image for an individual who wants to remain anonymous or even secretive thisis going to become an increasing problem as technology provides the means of taking
32
photographs recording conversations and capturing environment13 with something as smalland ubiquitous as a mobile phone The fact13 that13 this information can then be shared withthe rest13 of the world using e-shy‐mail Twitter and Facebook makes the problem all the moredifficult So the threat13 is no longer solely from the long lenses of the Paparazzi but13 fromanyone (and that13 means everyone) who has even the most13 basic of mobile phones
This relates to the changing views of society on what13 information should remain privateand what13 should be shared with others The success of social media13 has been based on anattitude of lsquosharing everythingrsquo with either your friends or the world This has introduced anaiumlve idea13 in the minds of some younger people (especially those known as Millennials ieaged 18-shy‐30) that13 everyone can be their friends whilst13 perhaps failing to reinforce the bondsof genuine friendship with any form of test13 or restriction Technology could play a role indefining these friendships and allowing individuals to understand what13 makes a goodfriend but13 this approach has yet13 to be developed and may be slow to overcome the needfor some people to measure their own popularity simply as the number of people that13 theycan list13 as friends on their Facebook page
It follows that13 there may be a need for a new definition of privacy that13 is in keeping withthe web and its ability to display images and opinion in an unregulated manner This needsto embrace past13 concerns about13 the ability of an individual to live without13 the threat13 ofothers being able to watch them whilst13 offering some protection from random postingsabout13 them online Perhaps this could include a right13 to be able to edit13 or remove anythingrelating to themselves on the Web including images that13 are not13 news-shy‐worthy Theownership of image rights may be an associated issue that13 needs to be addressedespecially as modern technology can remove an individual from a group (or a background)13 view provide digital touch-shy‐up or air-shy‐brushing and then republish it13 in a different13 contextHowever there is general agreement13 that13 personal information (such as contact13 details andbank codes) should not13 have a place on the web Surprisingly few people take proactivemeasures to prevent13 tracking functions being activated
It follows that13 too much privacy could lead to younger people fearing that13 they maybecome lost13 in a digital world It is not13 surprising then that13 they are prepared to make lots13 of personal information available often with no fear of how it13 might13 be used by othersWhen Google glasses and similar technologies become available during the next13 few yearsthey will have the potential to identify a stranger walking down the street and to find manyof their secrets to present13 to the wearer in a fraction of a second They could know moreabout13 them than their genuine friends know -shy‐ so who will be their friends in the future
36 Data sharing and13 protection
By lsquodata13 sharingrsquo we mean the disclosure of data13 held by one organisation on an individualto a third party organisation(s) or the sharing of data13 between different13 parts of anorganisation Some data13 sharing doesnrsquot13 involve personal data13 because it13 has beenanonymised in such a way that13 the statistics can be used for the collective good without13 theidentification of the individual The Data13 Protection Act13 (DPA) is in place to provide a legal
33
framework that13 ensures that13 organisations that13 hold personal data13 must13 act13 responsibly atall times These principles adequately describe the position of public and government13 bodies especially social services departments who are responsible for the informationconcerning the health and well-shy‐being of individuals -shy‐ and hence by implication thesensitive data13 relating to their vulnerability
The legal framework that13 applies to private and third sector organisations differs from that13 which applies to public sector organisations which may only act13 within the defined limits oftheir statutory powers However all bodies must13 comply fully with the data13 protectionprinciples and this situation is unlikely to change within the next13 10 to 15 years In someprivate sector contexts there are legal constraints on the disclosure of personal dataHowever most13 private and third sector organisations have a general ability to shareinformation provided this does not13 breach the DPA or any other law It is advisable for acompany to check its constitutional documents such as its memorandum and articles13 ofassociation to make sure there are no restrictions that13 would prevent13 it13 from sharingpersonal data13 in a particular context The type of data13 held is therefore a subject13 ofconcern as it13 may be difficult13 for legislation to keep up with the additional layers of data13 created on-shy‐line and through the Internet13 of Things
Private and third sector organisations should have regard to any industry-shy‐specific regulationor guidance about13 handling individualsrsquo information as this may affect13 the organisationrsquosability to share information They should also be aware of the legal issues that13 can arisewhen sharing personal data13 with public sector bodies This becomes more of an issue asprivate and third sector bodies are carrying out13 a wider range of traditionally public sectorfunctions Opportunities for inappropriate sharing of sensitive data13 will therefore inevitablyincrease
Public authorities must13 comply with the Human Rights Act13 (HRA) legislation in theperformance of their functions The HRA also applies to organisations in the private sectorinsofar as they carry out13 functions of a public nature which could include delivering a socialcare activity Where the HRA applies organisations must13 not13 act13 in a way that13 would beincompatible with rights under the European Convention on Human Rights Article 8 of theConvention giving everyone the right13 to respect13 for their private and family life their homeand their correspondence is especially relevant13 to sharing personal data If personal data13 isdisclosed or shared in ways that13 comply with the DPA the sharing or disclosure of that13 information is also likely to comply with the HRA The problem may still be in policing theActs and the rights of an individual if they believe that13 their personal data13 has been sharedor accessed by an inappropriate organisation or individual
A legal industry may be born to deal with such matters but13 this is unlikely to benefit13 peoplewho cannot13 afford the fees involved They would require either legal aid or to employ13 more13 lsquono win no feersquo companies Public attitudes to such costs might13 become negative unlessthey prove successful in preventing breaches of data13 security There may need to belegislation to provide a stronger basis for forcing compliance with privacy laws
34
37 Connecting with13 people
We are social creatures most13 of us rely on our friendships and interactions with friendsand families to share our happiest13 moments and experiences Research suggests that13 thishappiness is infectious at all levels and leads to a 15 increase in the happiness of a closecontact 10 for a second degree contact13 such as the friendrsquos spouse and a 6 increase fora friend of a friend It is hardly surprising that13 the success of social media13 such as Facebookis intimately related to the ability of people to quickly share their happiest13 moments with asmany of their friends and connections as possible
All this has happened during the rise of the Internet13 and the corresponding increase inopportunities for connecting online ie this is a 21st Century phenomenon which has beenfacilitated by Information and Communications Technology But13 the Internet13 remains in itsinfancy and we are only beginning to understand and exploit13 its potential In terms ofaccessing the Internet there are now perhaps two billion people who have access with99 of them having gained this during the past13 decade This number will have doubled bythe period 2020 to 2025 It is likely that13 everyone who wants to be connected in the UK willby then be connected Turning this on its head only those who donrsquot13 want13 to be online willnot13 be on the Internet13 within a decade Connecting with the unconnected will therefore bea case of identifying those people who donrsquot13 want13 to be found unfortunately these mayinclude many people who need the support13 of social care organisations It means that13 theywill be looking for support13 only when they are in crisis unless other ways of finding andormonitoring them are found
While the number of people connected via the Internet13 has exploded this might13 bedwarfed by the number of connected lsquothingsrsquo During 2009 the number of thingsconnected to the Internet13 surpassed the number of connected people at which point13 webegan to experience what13 this report13 has described as the lsquoInternet13 of Thingsrsquo Yet 99 ofall physical objects that13 could join this network are not13 yet13 connected but13 the number couldgrow by 25 every year for the next13 decade so that13 there could be 100 billion connectedobjects by 2025 some of which will be owned or used by everyone in the UK includingthose people who donrsquot13 want13 to be connected themselves We will then have an Internet13 of Everything which will be the smart13 connection of people data events and actions
With each new person object or data13 that13 comes online the connection possibilitiesbetween all these elements grows exponentially The rise of big data mobile networkingcloud storage and data13 mining technologies will all play a critical role in the Internet13 ofEverything The result13 will be new capabilities richer experiences and unprecedentedvalue for individuals businesses communities and countries everywhere The lsquonetworkeffectrsquo of the Internet13 of Everything will be a very powerful thing the true impact13 of whichwe wonrsquot13 fully understand for several years As it13 develops however those who are not13 connected will feel even more digitally and socially excluded There will be a need to reachout13 to vulnerable people unless the process of claiming requires proof of online identityand the payments to be received can only be redeemed using a chipped card or adownloaded app onto a smartphone This is of course the way that13 welfare arrangementsare already developing thus it13 might13 prove impossible to make a successful claim without13
35
already being connected to lsquothe systemrsquo either through an online presence or through theInternet13 of Things
38 Downloading everything
Sixty years ago information was discovered by reading books often in a library wherenotes had to be made because the books or journals couldnrsquot13 be removed Then in theearly 1960s the first13 office photocopying machines were introduced into the UK theyimmediately meant13 that13 pages or articles from books could be copied and taken away to beread and summarised later Within a few years photocopying became a replacement13 forreading as researchers became less adept13 at selecting a few sentences and every deskbecame a depository for reams of printed paper Paper became the means of recordingeverything from bank statements through to music
We now appreciate that13 printing everything is a waste of both the ink (or toner) used tocreate the black print13 and of paper which requires trees to be chopped down and pulpedbefore it13 can be pressed into thin sheets Saving paper is therefore seen as green and goodfor the planet Fortunately we no longer need to print13 everything because computermemory is unlimited thanks to the cloud and we can then view pages and articles onportable or fixed screens
The internet13 has everything and it13 is all available instantly for downloading providing thereis a device available to accept13 it and there is sufficient13 communication bandwidth toperform the transfer of data13 sufficiently quickly Thus we can record all text13 articles that13 are relevant13 to us including digital records of birth certificates qualifications and passportsand the need for original printed versions will decline But13 we can also do this forphotographs Most13 handheld computing devices include at least13 one camera so they cangenerate enormous number of pictures which can be kept13 for posterity without13 having toconsume inks and special papers to print13 them
But13 the materials that13 can be downloaded donrsquot13 stop at pictures software is available that13 can grab TV shows after they air and movies as soon as theyre released In the same wayit13 is possible to schedule music comic books video games and practically anything else asa download with minimal effort People will need enormous hard drives if they want13 theirown digital copies of these files so will more than likely make use of cloud storage that13 willbe available from many organisations The location of the servers may become sensitivedue to border restrictions as will the security of the data13 and the way that13 it13 is backed up sothat13 it13 is resilient13 to failures
It may be evident13 that13 application forms for all types of welfare payment13 will be availableonly for downloading so that once digitised they can be processed by computer andrecords sent13 to various servers for subsequent13 storage and processing Some people maywant13 to keep their data13 on them once it13 has been downloaded Pen drives can already holdseveral GB of data so it13 is likely that13 people will be able to carry their downloaded data13 withthem at all times irrespective of the size and complexities of the information
36
39 Health13 and13 well-shy‐being
The general health of the population is unlikely to deteriorate noticeably within 10 to 20years Indeed expectations of the population are that13 things must13 improve as surgicaltechniques mature and as pharmaceutical interventions become more personalised andpowerful However the rising demand for health services due to an ageing population andthe increasing cost13 of providing sophisticated therapies will make delivering a free anduniversal health service difficult13 without13 substantial increases in taxation This is unlikely tohappen in the UK even though spending on health services will be protected against13 thecuts facing other services
There will have to be changes in how the NHS works For twenty years hospitals have beenclosed and replaced by fewer new facilities so that13 the bed count13 is reduced This has led toa significant13 shift13 in resources to primary care and community care supporting shorter staysin hospital and speedier transfer back home for people after surgery or illness This hasbeen13 successful but13 there remain problems with demand for GP services especially out-shy‐of-shy‐hours and at weekends Indeed despite the introduction of NHS24 and similar help-shy‐linesthe demand for GP appointments continues to increase Delays are inevitable and this willincrease system failures with more unnecessary deaths and a failure for people to access adiagnosis that13 might13 lead to early interventions and ultimately lower delivery costs Over250 more patients are added to waiting lists every day
This will lead to a new model of primary care consistent13 with existing changes which haveseen surgeries move from High Street13 locations to medical centres close to bus routes andwith more parking for patients The process of making an appointment13 is changing from atelephone-shy‐based interview process dominated by a medically-shy‐unqualified receptionist13 to achoose and book approach using an online process linked to electronic patient13 records Thiswill give patients more convenience but13 will allow priority for those who have Internet13 access at the expensive of those who are digitally excluded Making the process of bookingan appointment13 quick and easy may also increase demand from people who do not13 need tobe seen as it13 will fail to identify those in greatest13 need
A greater use of telehealth and telecare technologies will be inevitable beginning with thefirst13 contact13 as an encounter using the telephone e-shy‐mail or video conferencing -shy‐ a visit13 tothe GP surgery should be a last13 resort and should involve a nurse consultation in the first13 instance This would be consistent13 with three quarters of appointments currently involvinga chronic disease or long term condition which relates to improved self-shy‐care The support13 ofthese patients at home should be prioritised through tele-shy‐ and web-shy‐based technologies andshould involve training and coaching through a network of nurse practitioners Home visitsshould generally be unnecessary through the use of these technologies but13 could besupplemented by satellite surgeries manned by nursing in community premises or inpharmacies nurseries and Internet13 cafes
The homes13 of people who13 need13 closer monitoring can then become part13 of virtual wardswith real or electronic visits by health professionals University Hospital Southampton NHSFoundation Trust13 already looks after patients who have undergone surgery such as a hip orknee13 replacements in virtual wards with high levels of satisfaction The Royal Free London
37
NHS Foundation Trust13 offers a similar service but13 plans to add the possibility of videoconsultations between patient13 and consultant
310 Attitudes to public health issues ndash obesity smoking alcohol abuse drugs
As self-shy‐care becomes the focus of the NHS the public will increasingly understand that13 thecosts and availability of services are being harmed by the poor health behaviour ofrelatively small numbers of people The link between public health initiatives today andhealthcare needs and costs in the future will become increasingly evident13 as a result13 of theway that13 information is presented Thus the overweight13 smoker who currently attractsconcern and pity when they are diagnosed with diabetes and COPD is increasingly beingseen as the victim of their own stupidity or lack of self-shy‐discipline If they continue to neglect13 medical advice and continue with an unhealthy lifestyle then the way that13 they receivetreatment13 and consume resources will become a matter for the entire population
Obesity is seen as due to a combination of poor diet13 and a sedentary lifestyle No longer isthe idea13 that13 people are lsquobig bonedrsquo acceptable Governments will respond initially byrequiring manufacturers and food processors to provide nutritional information onpackaging and on menus in restaurants But13 people can choose not13 to read the data13 and toneglect13 both the importance of food quality content13 and quantity This will increasepressure to introduce fat13 or sugar taxes and these are likely to be in force within a decade
Although the high taxes on tobacco products has forced some smokers to reduce theirconsumption or to give up altogether the impact13 has been reduced by the smuggling ofproducts from overseas and by the availability of duty-shy‐free cigarettes for people returningfrom foreign holidays and business meetings Further measures are planned to changepackaging and to include even more graphic images and warnings on cigarette packages tomake smokers aware of the effects of smoking on their health and well-shy‐being There is asyet little evidence of how successful this might13 be More effective has been the banning ofsmoking in public places including trains and aircraft Expensive medical interventions suchas heart13 transplants will be denied to individuals until they change their lifestyle behaviourSmokers might13 therefore be increasingly ostracised leading to a loss of esteem This mayhave a particular impact13 on people who already suffer from mental health problems whoare more likely to smoke
The overuse of alcohol is being recognised as a major factor in hospital admissions withNHS figures showing an increase of over 40 in such admissions over the past13 decadeLinked to this has been a 75 increase in prescriptions to treat13 alcohol dependency Fewpeople have sympathy for those who waste their limited income on booze If they havechildren or other dependents they will be the ones who suffer and who may need thesupport13 of social care
Drug users are already significant13 users of social services as their habit13 is likely to makethem unemployable They receive little sympathy from the general public because they areseen as criminals and people who waste public resources Levels of drug abuse have been
38
slowly increasing over the years but13 this trend is slowly being reversed Indeed the numberof people using drugs during the past13 year has fallen to its lowest13 level for nearly 20 years(below 9) with cannabis being most13 likely often following excessive drinking Aselectronic noses and other technologies can detect13 traces of drugs it13 seems likely that13 success in overcoming addiction can be measured objectively This may become a two-shy‐edged sword rewarding those who can turn around their lives but13 further marginalisingthose who canrsquot13 or wont13 accept13 the lsquocold turkeyrsquo
311 Attitudes to surveillance
Issues associated with privacy confidentiality and data13 security have been discussedpreviously in the context13 of information technology the World Wide Web and the ease ofcollecting recording recalling analysing and displaying data The monitoring of individualsand their methods of using this information can be regarded as surveillance As thequantities of data13 increase along with the number of devices that13 can be used to access itthe surveillance tools will also increase in their sophistication Indeed the Big Data13 approaches described in the previous section will enable the combination of structureddata13 (such as the information held in databases) to be married with unstructured data13 fromimages in such a way that13 it13 can be mined
Whilst13 the lsquodigital surveillancersquo methods described above may cause most13 concern topeople because of its impact13 on anonymity it13 is the collection and analysis of images that13 are the major concern to people as they contemplate the ways that13 lsquoBig Brotherrsquo maydevelop to restrict13 freedom Every major UK city and town centre has an array of CCTVcameras that13 continually record activities from every angle If it13 used to be true that13 nobody in London was more than 10 yards from a rat it13 is certainly the case today that13 nobody can be more than this distance from being in view of a surveillance camera Yetthey receive so much positive publicity from TV programmes where their footage is used todetect13 vehicles close to a crime scene or to monitor the movements of suspects that13 theyare now accepted by the public as a deterrent13 in the same way as lsquobobbies on the beatrsquowere seen 25 years ago There is therefore little public reaction to the expansion in the useof video surveillance except13 for the practical observation of how so many views can beinspected and recorded
Looking to the future the tumbling cost13 of video technology will surely lead to anotherincrease in the number of devices The aerial views taken from towers will besupplemented by more local views taken by devices that13 are embedded in the fabric ofbuildings or carried by individuals either on their person (for example on clothing orspectacles) or in the bags that13 they carry The time and date-shy‐stamped images as Big Datawill be recorded to lsquothe Cloudrsquo where it13 can be added to other data It can then be usedwhen an incident13 has occurred or to provide further detail of night-shy‐time activities
It follows that13 there will be no hiding place for people who simply want13 to disappear Theymay respond by wearing clothing (such as hoodies) that13 hide their faces or which make it13 difficult13 to distinguish gait13 or mannerisms from which they might13 be identified New forms
39
of clothing may be designed to make shapes more difficult13 to analyse and these might13 become the uniforms of a class of person who wants to live in a way that13 they donrsquot13 interact13 with officials from any ministry or local government13 department If they also obstruct13 services then they will be considered to be anarchists of some form sparking protests fromother sectors of society
31213 Attitudes to driving
Motor cars have been a feature of UK roads for over a century but13 it13 is only during the past13 50 years that13 they have become a resource that13 most13 families have had access to enablingthem to travel without13 the restrictions imposed by a limited railway network and non-shy‐integrated bus transport People who have had a car throughout13 their lives often see theircars as an important13 factor in enabling them to remain independent13 and to exercise choicesrelating to where they shop and where they spend their leisure time This extends to theirspouse and to friends and neighbours that13 they might13 take with them on their variousexpeditions
Unfortunately there are incidents involving older drivers who perhaps go down amotorway in the wrong direction who are taken ill at the wheel or who are involved in anaccident13 involving no other vehicles These are small in number but13 often lead to a reactionthat13 they shouldnrsquot13 be allowed to drive lsquoat13 their agersquo Age itself is not13 an indicator ofdriving quality but13 because old age also brings more chance of having limited long termconditions and other illnesses it13 is easy to make a link between driving ability and age Thelicensing system does require continued driving to be linked with medical advice andforbids people with poor eyesight epilepsy and other conditions to hold a licence in oldage
Yet13 statistically older drivers cause far fewer accidents than younger drivers The reasonsfor this may be complex and are likely to include the fact13 that13 they drive less often covershorter distances and donrsquot13 go out13 in the dark or in poor weather However it13 does not13 wholly explain why the UKrsquos drivers aged over 70 and who represent13 some 8 of all driversare involved in only 4 of accidents that13 cause injury This compares favourably with the15 of13 drivers aged between 17 and 29 who are involved in over a third of crashes that13 result13 in injury
By 2020 the number of drivers aged over 70 on UK roads is likely to increase to over 7million This will require a new national strategy perhaps involving support13 for olderdrivers further training raising awareness of issues and making more use of adaptivetechnologies to support13 the driver in avoiding collision or forgetting to check on the statusof their vehicle Poor eyesight13 could be enhanced by camera technologies rather thanforcing people off the road if they are unable to read a licence plate
The International Longevity Centre has found that13 one in four Britons thought13 driversshould be made to switch off the ignition for good somewhere between the ages of 70 and75 The numbers may decrease as the population ages and as cars become safer Forcing
40
older people off the road may be a natural consequence of providing free bus passes andsubsidised rail fares but13 the growth in the pavement13 scooter industry demonstrates that13 older people value their independence and will do almost13 anything to get13 out13 and aboutPerhaps legislation will result13 in more regulation of electric vehicles and where they cantravel
There can be no doubt13 that13 getting out13 will be associated with better quality of life andwell-shy‐being and this is likely to be supported in the future as evidence of improvedoutcomes emerges It is to be hoped that13 positive stories will be publicised so that13 publicattitudes arenrsquot13 hardened This may be supported by more in-shy‐car monitoring of drivers andthe linking of performance with on-shy‐line driving records and licences These could throughremotely monitored ignition systems prevent13 the use of motor vehicles by people without13 a licence or without13 insurance
313 Climate change
There is a general view that13 the emissions of carbon gases are contributing to globalwarming in a manner that13 will change the UK climate in such a way that13 the climate maybecome more Mediterranean However some scientists believe that13 manrsquos impact13 on theenvironment13 may be small compared with natural variations caused for example bycyclical changes in the sunrsquos energy output13 or by the effects of volcanoes and earthquakesRecent13 evidence has suggested that13 we are going through a phase of changing extremesand that13 this is more likely to cause storms periods of excessive rainfall and unusualseasonal trends with snow and frost13 in the spring and warmer winters Considerableuncertainty remains and it13 might13 be necessary to plan for a number of different13 scenariosand for the impact13 on vulnerable people
I Colder winters UK properties are poorly insulated resulting in excess mortalitiesduring cold spells due to an increased number of people suffering from stroke aswell as bronchitis and other pulmonary diseases The cost13 of heating continues toincrease putting more households into a state of fuel poverty Any further coolingduring the winter months will result13 in more people living in unhealthy coldconditions Winter fuel payments are likely to be restricted to the poorest13 peoplebut13 this might13 exclude people who live in larger properties that13 are more difficult13 toheat
II More storms excessive winds and rain can cause flooding at any time of the yearMany UK communities are built13 close to rivers and these can surge during heavyrainfall causing houses to be filled with water and furniture and carpets lostInsurance can be problematic for properties built13 on flood plains which can blight13 properties and prevent13 owners from being able to sell and move on High winds canrip off roofs causing injury and also causing families to be left13 homeless anddependent13 on social services
III Hot13 summers Europe suffered high temperatures during the summers of 2003 and2004 leading to heat13 stroke and hypothermia The UK has not13 previously sufferedfrom such problems but13 might13 be expected to experience days of extreme
41
temperature and humidity at times Older people may not13 be prepared for suchweather Street13 dwellers may be unable to find shade and supplies of drinkingwater
Irrespective of what13 combination of weather scenarios arise it13 must13 be concluded that13 any extremes will have a major negative impact13 on vulnerable people especially if theyare not13 prepared because they havenrsquot13 received the weather warnings and advice that13 can be broadcast13 using the TV radio and online services Once again the digitallyexcluded will suffer and will pay a high cost Society will continue to pick up the bill interms of demands on social care services unless preventive actions are taken in theform of connecting these people to each other and to formal services
42
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
s13 13
13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
n13 13
13 s13
r13 n13
e13 at13
e13 y13 e13 ld13
ly13
13 e13 t13 e13
s13 er13 e13
f13
rt13 13
13 13
13
r13 13
s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
e13 g13 13
e13
13 13 ial13
13
d13
13 d13 h13 r13
d13 13
s13 y13
e13
13
rd13 r13 e13
13
13
13
e13
e13
d13 13
13
13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
The 1990s saw the emergence of home computing the BBC Micro and gaming machinessuch as the Commodore 64 and the Attari Electronic mail (e-shy‐mail) until then the preserveof academic and research institutions moved into the mainstream at first13 connecting via13 (relatively slow) modems and ordinary telephone lines One drawback was that13 thetelephone could not13 be used at the same time as the computer was connected to theinternet a frequent13 cause of family friction In the late 1990s and early 2000s this problemwas solved when broadband became more widely available and cheaper allowing fasterspeeds an always-shy‐on facility and the ability to use the telephone at the same time
As broadband speed and capacity continued to increase so did the ability to use theinternet13 to access video music and all kinds of electronic commerce (for example shoppingtravel)
Perhaps even more dramatic have been the improvements made in mobilecommunications Third Generation (3G) phones allow us to use the Internet13 lsquoon the moversquovia13 smart13 phones and tablet13 devices Fourth Generation (4G) began rolling out13 in 2012offering faster access
By 2025 one can13 confidently13 predict13 that wireless13 communications13 will13 be available across13 the UK and with a bandwidth which13 can13 support13 both audio and video13 services
Effectively anyone who wants to speak to people will be able to do so and the only peoplewho will not13 be able to do this will be those who wish to hide or to avoid contact
25 The internet of things and the Quantified13 Self
The internet13 works by connecting computers around the world Each computer connectedto the internet13 has a unique address (known as an IP -shy‐ Internet13 Protocol -shy‐ number) Manydevices13 now contain some kind of microchip which makes such a device in effect acomputer
This means that13 electrical appliances from washing machines to refrigerators cancommunicate with other machines also connected to the Internet Indeed manufacturershave provided this facility for a number of years in order to monitor performance and tocheck remotely on their operational status The same principle can be applied inagriculture a cow on a farm could be identified by an IP address allowing the farmer and adairy to its monitor its milk output13 or its health
As more and more devices acquire an internet13 address we talk about13 the lsquointernet13 ofthingsrsquo lsquoequipping all objects in the world with minuscule identifying devicesrsquo(httpenwikipediaorgwikiInternet_of_Things) These things might13 include buildingsthe home healthcare and transport healthcare providers cars and emergency serviceslocations such as industrial parks hospitals car parks and police stations and devices suchas tablet13 computers and cash machines
7
The development13 of small and relatively low-shy‐cost13 medical devices for measuring relevant13 vital signs or medical parameters such as pulse rate and blood sugar level means that13 individuals can take their own measurements and then take responsibility forunderstanding their meaning (with appropriate support13 where necessary) and modifyingtheir behaviour accordingly
The availability of smart13 phones capable of running apps (specialised lsquoapplications) has ledto the development13 of new measures of well-shy‐being that13 are based on the individualinputting information on location the way that13 they feel and their interactions with othersThe smartphone can provide additional context13 automatically including location thenumber of conversations the distance travelled and external parameters such as theweather and the temperature This supports the idea13 of a life that13 can be measured in asensitive manner many times a day and without13 being seen as intrusive This leads to theconcept13 of the Quantified Self
Knowing how one feels and how one lives in a way that13 can be measured and easilycompared with other people can have both benefits and disadvantages The benefits tosociety mainly stem from an ability to identify people who are unhealthy both with respect13 to acute needs and from a predictive point13 of view those who are likely to be unwell atsome time in the future In the mental health space people who have bipolar disorder canbe monitored and supported more efficiently perhaps leading to a reduction in self-shy‐harmand suicide
There are likely to be some people who rebel against13 the need for measuring their owncondition daily and for ever They could view the measurement13 regime as being arestriction on their own lives preventing them from doing what13 they want13 to do because ofthe need to compete with their own measurements This could lead them to walk awayfrom treatment13 regimes resulting in a sudden decline in their well-shy‐being
26 Social networks
Social capital1 refers to the collective or economic benefits derived from cooperationbetween individuals and groups and highlights the importance of social networks that13 linkfamily friends neighbours and communities Wellbeing can be affected by connectivitypeople who have low social capital are likely to be lonely but13 also are more likely to reject13 public health initiatives such as flu jabs which could be beneficial to their health and well-shy‐being
The number of older people who live alone has been increasing for many decades By 2025two out13 of every five older people are likely to live alone Their quality of life may dependon them being able to build strong social networks Traditionally these networks were built13
1 lsquoJust as a screwdriver (physical capital) or a university education (cultural capital or human capital) can increase productivity (both individual and collective) so do social contacts affect theproductivity of individuals and groupsrsquo httpenwikipediaorgwikiSocial_capital
8
on neighbourhoods clubs and pubs and religious groups Meetings became social eventsand absence either signified a rejection of the group or a trigger for other members tobegin to visit But13 what13 happens when a network starts to disintegrate because of death orgeographic dispersal or because the individual loses physical capacity Can web-shy‐basedsocial networks compensate by nullifying geographic separation or by building newnetworks
Skype arguably demonstrates that13 lsquogeography is historyrsquo by making possible free real timevideo communication with family and friends thousands miles and continents apart Thebarrier of course is being able to afford a computer and a broadband connection whichmay limit13 use by lower socio-shy‐economic groups However its potential as a support13 mechanism should not13 be underestimated the technology is simple and it13 works we needonly the social economic and political will to make it13 happen In Scotland older peopleenjoy free bus travel why not13 free broadband
Social networks such as Friends Reunited and more significantly Facebook have emergedas vehicles that13 can not13 only link friends together but13 can also become a means of appealingfor associations and linkages that13 can be supported by the sharing of personal information
The inclusion of a camera13 on smartphones makes it13 easy to share photographs which canenrich communication For example proud parents may announce the arrival of a newbaby with a picture that13 everyone might13 wish to see On the other hand employers might13 also see evidence of why someone who has phoned in sick is unavailable for work on aparticular day Being aware of and able to set13 privacy levels is therefore important13 in orderto control who can see your personal information and news young people and vulnerableadults in particular may admit13 more people as lsquofriendsrsquo (or connections) than might13 beadvisable
The lifetime of major social networks is likely to be limited to a few years as new businessmodels13 emerge and new promotional strategies offer benefits to subscribers This mayoffer an opportunity for new networks to be created to deal specifically with those peoplewho are excluded in any way including those who will be referred to social services forassessment13 and support
27 Entertainment
Many people still remember the coronation of Queen Elizabeth in 1953 being shown live ontelevision This was an important13 milestone in establishing this new medium as acompetitor to radio and the cinema13 as a source of entertainment The arrival of colour TVin the late 1960s contributed to the declining popularity of cinemas and theatres many ofwhich closed
Today many homes have a TV in every room and technology has advanced to deliver highdefinition and 3D pictures on very large screens or lsquohome cinemasrsquo with surround sound
9
Paradoxically perhaps radio is more popular than ever and cinema13 has bounced back fromdecline to once again become an important13 element13 in the social lives of many people
Video images still or moving can be displayed also on laptops tablet13 devices andsmartphones which means that13 people can be entertained or informed on the move Sometrain operators have followed airlines in providing an lsquoat13 seatrsquo entertainment13 experience13 which can be offered with certain choices though many passengers prefer to use their owndevices and content In the future it13 seems likely that13 access to both audio and videoentertainment13 will be possible at any location and in a way that13 doesnrsquot13 interfere with theenvironment13 of other passengers
For those who want13 neither video nor audio (eg music) entertainment reading mayremain the entertainment13 of choice Many older people have struggled to find suitablereading materials as a result13 of the closure of local public and mobile libraries Some peoplecannot13 support13 the weight13 of a book while others lack the dexterity to turn the pagesOthers have sight13 problems which prevent13 them from reading small print All theseproblems can be overcome using either text13 to speech technologies (which are replacingtalking books) or by using e-shy‐reader devices which allow font13 sizes to be increased easily andwhich offer simple interfacing for moving pages backwards or forwards
In the future it13 must13 be assumed that13 all entertainment13 media13 will be held in the lsquocloud2rsquoand will be downloadable to an appropriate device on payment13 of a fee provided that13 acommunications contract13 is in place
The pre-shy‐requisites will bebull A device (eg PC laptop tablet Kindle)bull A contract13 with a telecoms provider (eg BT Virgin Sky) for broadbandbull A contract13 or contracts with media13 provider(s) (eg Netflix iTunes)
Those who lack any of these components may be entertainment13 excluded
28 Cash13 and13 money
Cash has been king since the abolition of the gold standard It is an expensive method oftransferring money between people and organisations and is a considerable overhead forindustry and for individuals travelling between different13 countries The highest13 denominations are lightweight13 and easily lost stolen or destroyed while the smallest13 denominations are heavy dirty and difficult13 to handle It is surprising that13 physical cashcontinues to be used It can only be a matter of time before it13 is digitised and replaced byvirtual cash
2 This means the material (book film or whatever) is stored in a remote computer (thecloud) and downloaded (or lsquostreamedrsquo) to your device on demand and possibly onlytemporarily
10
Large payments were previously made by cheque They are expensive to process by thebanks because people can write them by hand which makes them difficult13 to readelectronically and automatically Consequently they require human intervention and this isnot13 what13 modern banks wish to do so they want13 to promote greater use of debit13 and credit13 cards The latter were used initially as a cheque guarantee but13 are now being used almost13 exclusively as a means of withdrawing cash from ATMs and for making paymentselectronically UK banks wanted to do away with cheques by mid-shy‐2012 but13 they had toperform a u-shy‐turn under pressure from charities representing older people It is apparent13 that13 digital cheques and other cheque-shy‐replacement13 strategies will be introduced soon that13 satisfy the most13 pressing concerns of older people
It was difficult13 to see how cash could be replaced for payments for lower cost13 items such asnewspapers and sweets until the era13 of contactless payments Near field communicationsystems are likely to replace bar-shy‐codes to carry product13 identification information Theycan be read by electronic receivers The same technology can be two-shy‐directional allowinginformation to be passed from a smart13 phone to a reader and back again The smart13 phoneeffectively becomes a wallet13 which can be digitally filled by the owner and then emptiedwhen making purchases For small sums of money this approach is ideal and is likely to berolled out If cash disappears then begging will become difficult13 and welfare paymentsmade on a card Such cards are already used by social services as a means of providingclaimants with a means of receiving self directed care and support By restricting use of thecard to outlets that13 can provide care and support13 services opportunities for spending thecash inappropriately are restricted
It follows that13 many users of social services will need to have a smart13 phone as well as acard that13 can be used to buy services In the future smart13 phones may be provided as aloan item to claimants for social care This could include a digital wallet13 facility as well asthe communications and information ecosystem that13 would allow these people to receive awhole range of other services that13 would prevent13 their social exclusion and which could beused directly to provide them with information and access to entertainment
29 Biometrics and fraud13 prevention
Identity theft13 is used by criminals to pretend to be someone else in order to accessresources or obtain credit13 and other benefits in that13 persons name Although the concept13 has been around for centuries it13 is a growing concern in the digital world as we acquiremultiple online identities for bank accounts social networks and using public services such13 as paying tax electoral registration etc
Passwords are fraught13 with difficulty typically they are hard for humans to remember andeasy for machines to crack Efforts are therefore focused on other forms of provingidentity for example
11
bull Fingerprints have been accepted for over two thousand years to confirm identitymostly in criminal justice The technique has been applied to door-shy‐lock opening insome supported housing schemes There are practical problems associated withregistering lsquoallowedrsquo fingerprints and the useful lifetime of such products is also onlyabout13 three or four years
bull Retinal imaging and DNA analysis have been relatively slow to follow but13 only dueto the sophistication required for measurements and the time taken for testing Acombination of retinal imaging with facial gestures and blinking is possible in the labbut13 currently takes half a minute to achieve a match -shy‐ and this is achieved only withthe use of considerable computer processing power This sort13 of time makesapplications in mass people transfer impossible
Current13 research in this area13 is focusing on the uniqueness of other body parts such as earsand knees as biometric indicators The ears have great13 potential because they are usuallyexposed though hidden sometimes behind hair and other times by hats and other clothingOn the other hand the knees are rarely visible and however unique they may be there willbe cultural and religious obstacles to overcome before scanning could become a regularpart13 of identity confirmation The cameras which are central to such systems used to beexpensive but as the cost13 of high quality cameras continues to fall (there is one in nearlyevery mobile phone) it13 becomes feasible to devise identification devices that13 use multiplecameras to simultaneously recognise the eye and the ear
Movement analysis can be used to identify people by their walk gait13 and other biorhythmsprovide unique signatures It is possible to learn someone elsersquos gait13 though and injury orillness13 can have a temporary effect13 on gait
Over the next13 ten years with more sophisticated databases and image processing facilitiesthe cost13 of implementing advanced biometrics will fall enabling their application acrossmore diverse areas and in more social opportunities Potentially cameras will use cloud-shy‐technologies to provide individuals with instant13 recognition of anyone approaching them inthe street This could prompt13 a name or the occasion when they were last13 seen or spokento as a secondary method of control in much the same way as Internet13 banking seeks toavoid fraud This13 has13 the13 potential to remove13 the13 need for13 passwords13 and might13 then be13 the basis of machine-shy‐based13 communication13 either in front13 of a laptop or tablet13 device orwhen using13 a smart13 phone
There will need to be special measures introduced to support13 people with any form ofdisability as they might13 well have one or more sensory deficits Similarly people maystruggle to communicate following a stroke or a serious accident Nevertheless it13 may bereasonable to conclude that13 such systems will be both available and acceptable within thenext13 10 to 12 years
12
210 Health13 information
Health records in the form of written documents x-shy‐ray images and clinical observations arean important13 means of making all interventions efficient13 and safe Increasingly people havemany different13 conditions (comorbidities) and may be treated by several specialists Asthese physical records are moved inevitably some get13 lost estimates suggest13 that13 one inthree records is lsquolostrsquo at any one time
The best13 resource for information about13 a patient13 is his or her primary care record which isheld by the GP The UK was an early adopter of electronic primary care records and can beproud of the way that13 these have enabled population-shy‐based information to be collectedand analysed Scotland (and to a lesser extent13 Wales) has led the way in ensuring that13 allthese records are accessible through anonymised approaches that13 allow researchers toexamine trends and improve analysis of performance Fundamental to this has been theallocation of a unique identifier At13 the same time individuals can access these recordsboth to check for accuracy and to see what13 their doctor has said about13 them
This13 has13 the potential to make people more responsible for their own conditions andmight lead to better13 self-shy‐care13 and changes in behaviour13 that might reduce13 the13 incidence13 or severity13 of chronic conditions13 that are related13 to lifestyle
In the future we can expect13 the primary electronic health record to be linked with hospitaladministration systems picture archiving systems and other records held by hospitals sothat13 appropriate medical staff can have access to all relevant13 data
When the social care record is added to the mix then this will mean fewer but13 shorter andbetter assessments for social workers and for healthcare staff They will knowcircumstances and factors that13 could influence the choice of approaches This supports theidea13 of there being only one record consisting of several components all of which areaccessible by an appropriate professional at any time and in any place
The13 ambitions13 described above13 are not13 limited by technology most13 of the interoperabilityissues between rival commercial record systems have been resolved and databaseproviders are being compelled to support13 joint13 working The English NHS Mandate requiresTrusts to effectively replicate arrangements already in place in Scotland and in Wales andthis will go a long way towards achieving a genuinely paperless NHS well before 2020 Withnew biometric identification technologies individual records will be available to out-shy‐of-shy‐hours physicians and to those working in an AampE department13 irrespective of theconsciousness state of a patient
New telecare and telehealth technologies will produce significant13 more volumes of data13 which are currently held in different13 places and owned by different13 organisations rarely thepatient These data13 will also need to be shared but13 only in a manner that13 is acceptable toeveryone Patients may not13 want13 all their mental health information published in a formthat13 can be viewed by social workers GPs may not13 want13 to have access to all the data13 that13 might13 suggest13 that13 there is a domestic crisis to which they had neither the wish nor capacity
13
to respond Monitoring systems that13 support13 the lsquoquantified13 selfrsquo may also offer data13 that13 may or may not be added to the full recordThe future of health information might13 therefore be about13 providing individuals with themeans of producing relevant13 information storing it13 somewhere secure and then viewing it13 at a later time but13 in a format13 (or with advice) that13 is acceptable
See also httpmydexorg lsquoMydex gives individuals back control over their personal datarsquo
(see also Digital Scotland 2020 Achieving World-shy‐Class digital infrastructure a final report13 tothe Scottish Government13 httpwwwscotlandgovukPublications2013029054lsquoconnectivity by any device anywhere and anytimersquo)
211 The Future of Healthcare
The strains on our healthcare delivery system are becoming greater as they are in otherdeveloped countries as a result13 of an aging population rising expectations and unhealthylifestyles The necessary changes will require a significant13 shift13 in resources13 fromsecondary13 care13 where unit costs13 are high to community13 carewhere people can generallybe treated at home
The future must13 therefore necessarily involve efficiencies in hospitals and in the way that13 people can be treated in less expensive locations ultimately in their own homes Hospitalswill use more sophisticated diagnostic tools including scanners of all types to non-shy‐invasivelyprobe inside peoplersquos bodies This will result13 in more day cases and hospital stays (alreadyaveraging under a week) to even shorter periods with on-shy‐going support13 provided inintermediate care settings that13 might13 include hotels care homes or the personrsquos own homeif it13 is clean safe secure and has all the necessary amenities (include access to theInternet)
Advances in medical technology will allow more treatments to be delivered in the homeThis will mean fewer visits by clinical staff and fewer opportunities to attend primary carecentres Pharmacists will become suppliers of information as well as drugs so the balanceof care will shift13 significantly away from doctors who will work in different13 ways relying13 increasingly on telemedicine to bring the specialist13 to the patient13 for an online consultation13 For example if a patient13 complains of nausea13 and severe headaches a virtual consultationcan be offered almost13 immediately and without13 having to send a patient13 with a potentiallyserious and acute condition on a potentially long journey to a hospital
In the above example a neurologist13 may ask further questions as well as conduct13 acomplete neurological examination using videoconferencing technology Airedale GeneralHospital consultants have new contracts that13 require them all to be available for virtualconsultations The first13 benefit13 has been in reducing the need for prisoners at local jails tobe brought13 into AampE (which may need to be locked down depending on the circumstancesand the potential for violence of the individuals involved) potentially saving hundreds of
14
pounds in security costs It also avoids the need for healthcare staff to have to go into aprison environment
The principles described above are already saving lives through telestroke services whichlead to more people being thrombolysed appropriately and avoiding long term support13 that13 often follows a stroke incident Teledermatology has been practised for a number of yearsand results in rapid diagnosis and resolution of problems that13 previously required significant13 time for remedy
212 Gadgets and13 DIY13 healthcare
There are at least13 three elements to healthcare
bull Gathering information on symptoms and physiological parametersbull Interpreting the information andbull Responding to the diagnosis with treatment
Many people choose to exercise self-shy‐care because this gives them control whilst13 avoidingthe need to share their concerns and personal details with others A lsquodo It yourselfrsquoapproach might13 even be encouraged by the NHS as a viable way of using scare resources
Medical devices that monitor vital signs are mature and have been miniaturised so that13 they can be used in the home by individuals with little or no medical training Indeed bloodsugar monitors are being produced specifically for use outside the hospital and in such away that13 they can be used reliably by people with advice and training being provided onlinevia13 YouTube
Many medical monitoring devices do no more than produce a single measure which theuser may record or respond to Others link wirelessly to smart13 phones allowing data13 to bestored and entered into a personal health record where trending opportunities existingIndeed individuals can easily enter their data13 into an app running on their laptop tablet13 orsmart13 phone This trending information may be useful13 for self-shy‐care and could be passed onto a physician though the volume of data13 produced in this way and doubts about13 thequality of the data are likely to persuade GPs to discount13 data13 produced in this way
This gap in knowledge can be filled with advice information and diagnosis that13 can beobtained online using a lsquoDoctor Googlersquo approach The quality of such diagnosis may varysignificantly although there are many sources of information that13 are both supported andapproved by the NHS (and by similar sources in other countries) However with a data-shy‐richapproach and a choice of diagnosis people may be empowered to take a greater role inhealthcare
15
The final component13 for the DIY enthusiast13 is the treatment13 option Many people fear longterm use of medication produced by the big pharmaceutical industry and prefer morenatural remedies which are available over the counter More medical treatment13 devicesare available that13 stimulate blood flow and counter pain through the use of electrical andphysical stimulation
The evidence may be weak at present13 but13 might13 grow as more people use them and as theircost13 drops The13 impact13 of13 such technologies13 on vulnerable13 people13 is13 difficult13 to gauge
213 Telecare
Support13 provided at a distance to people in their own homes is known as telecare Thename implies remote monitoring and interaction and includes the monitoring of the homeenvironment13 and of the individual as well as the interaction of the individual with thisenvironment Definitions have become difficult13 due to some US medical devicemanufacturers introducing the term telehealth to describe medical telecare such as remotemeasurement13 and collection of vital signs data
In the UK telecare alarm services have matured quickly using the robust13 platform andinfrastructure of social alarm systems which were originally used by tenants in shelteredhousing schemes to seek help when they didnrsquot13 own a telephone The majority of telecareservice users today live in their own homes and use dispersed alarm units to link with amonitoring centre through the telephone network Improved assessments of needs andrisks to independence have resulted in combinations of sensors being used to support13 theoption of staying put13 rather than moving into residential care or having increasing levels ofdomiciliary support They support13 the policy of bringing care closer to home and ofencouraging people to become partners in their long term support13 arrangements
Telecare services developments over the past13 decade include standalone items such asautomatic lights which have achieved significant13 efficiencies especially for people who arefrail and prone to falling and to those suffering from mild cognitive impairment epilepsyand anxiety People who have long term conditions including chronic conditions such asdiabetes and hypertension can also be managed more effectively through telecare supportThe benefits of telecare services include a relief of stress for family caregivers enablingthem to continue to provide unpaid support13 while holding down a job and maintaining theirquality of life
New developments enable continuous monitoring of behaviour and smart13 devices that13 canfor example remotely control the cooker the water supply and door entry Such13 monitoring may detect13 incidents early and prevent13 emergencies arising Devices arebecoming smaller and easier to embed quickly within the home environment making themmore acceptable and less noticeable Longer battery life means less frequent13 maintenancevisits
16
The13 monitoring13 centre13 becomes13 an information hub13 offering13 both advice13 and a vehicle13 for checking that someone is coping especially following a trigger event such as a stay inhospital or the illness13 of an informal13 carer
New systems utilise web technology that13 allows family members to be more proactive inthe monitoring of their relatives This can lead to greater interaction with them especiallywhen the relatives live a considerable distance away (perhaps in another country) Thesenext13 generation systems might13 include video conferencing and the use of tablets smart13 phones or smart13 TVs but13 when an emergency response is required (perhaps to lift13 someoneup after a non-shy‐injurious fall) there remains a need for human intervention
The13 future13 of13 telecare13 might therefore13 include13 an increasing13 dependence13 on volunteersfrom13 the13 community to provide13 the13 required support Social networking may need to beused13 to support13 telecare technologies
214 Mobile healthcare
While telecare can support13 people effectively in their own homes it13 is now recognised that13 being able to go out13 to enjoy open spaces and to overcome the fear that13 the home is aprison is an important13 part13 of improving well being and supporting a higher quality of lifeExtending telecare technologies to operate outside the home is known as mobile healthcare(or mCare) and is based on mobile telephone networks rather than landlines
The simplest13 form of mCare requires only a basic mobile phone to deliver telephone callsvoice13 messages and SMS (text13 messages) The technology is mature and there are countlessapplications in use both in the UK and in developing countries such as Africa13 and India13 where mobile telephones have already achieved a saturation level and where fixedtelephone infrastructures are not13 likely to be established at any time Such telephones areuniversally available in the UK and are used by the vast13 majority of people including manyolder people especially if they have been introduced to the low cost13 (pound30) devices that13 have large buttons large displays and a separate large button for calling an emergencynumber
Smart13 phones are rapidly replacing basic phones and allow the use of a large range of lsquoappsrsquothat13 are being developed to provide information and for enhanced experiences In thehealthcare space Skype FaceTime Vidyo and GoToMeeting with HD Faces are all current13 examples of video conferencing software available on tablets and smartphones
The specific software will depend on the nature of the communication desired
bull Skype will13 manage a simple video phone callbull Where an AampE physician needs to share a CT scan of head with a Neurologist13 on call
from home GoToMeeting would be more appropriate
17
bull If the physician would rather have a dedicated online meeting room that13 patientsand colleagues can simply drop in for a virtual meeting a Vidyo virtual room may bemore appropriate
This technology can suit13 any form of lifestyle including many people with complex needswhose lifestyle is not13 consistent13 with a fixed address
Social care apps are available already to deal with problems of sensory deficit
bull Guiding a blind person through GPS navigation and reading signs through appslinked to the devicersquos camera13
bull The microphone can be used as a hearing aidbull Speech recognition software can be used either to replay speech at a slower speed
or for translation into a language of choicebull Speech can also be selected for people who have a stammer or who have a problem
with their larynxbull Apps are becoming contextually aware recognising situations and locations and are
thus becoming a personal assistant13 for people with disabilities
By 2020 it is therefore possible that a smartphone may13 be prescribed13 for people who13 need13 social13 care13 together with13 a range of apps that have been13 selected13 to meet13 theirassessed13 needs
Whilst13 smart13 phones tablet13 devices and apps may become an important13 part13 of anindividualrsquos personal support13 armoury the potential of mCare will be limited only by anindividualrsquos ability to make use of all its functions Each device could become a part13 of anindividualrsquos personality supporting them to improve behaviour take exercise avoidtemptation and manage their own health and well-shy‐being Potentially mCare could becomethe most13 important13 element13 of social care and support13 within 10 years
215 Artificial Sensing and Enhancement Devices
bull It is estimated that13 one in seven people has imperfect13 hearingbull The numbers who are born deaf are quite small and many of these people may
have some form of hearing restored through surgery or through technologybull Similarly while there may be nearly a million people registered as blind or having a
severe visual impairment the vast13 majority lose their sight13 during their lives as aresult13 of disease
bull New treatments will deliver sight13 recovery or restoration over the course of the next13 10 to 20 years
Fortunately technology can provide excellent13 sensing capabilities that13 are already providingpeople with external portable devices for enhancing their lives The simple hearing aid is anexcellent13 example of a device which has been improved through both miniaturisation
18
personalisation and enhanced performance Today digital hearing aids use sub-shy‐miniaturemicrophones that13 can be unidirectional or omnidirectional and which can be adjusted insensitivity over an extended range Tomorrowrsquos devices can be switched between modesby the user so that13 they can benefit13 from hearing perfectly in any environment Indeedthey can be used with adaptive filtering technologies (as used by helicopter pilot13 headsets)to eliminate some sounds so that13 the rich speech (or music) components alone remainFuture developments will be on optimising control so that13 the user can switch seamlesslybetween different13 amplification applications without13 appearing to be distracted A smart13 phone or mp3 music player may be used as either a processing unit13 or as a ubiquitousoutput13 device that13 looks cool and natural
These same technologies will also be developed for use within the home environment13 fortimes when a deaf user isnrsquot13 present13 or is asleep Acoustic signatures associated withadverse events and incidents such as the hiss of a gas leak the crackle of a fire the sound ofa smoke detector the drip or a water leak or the sound of breaking glass can be directlyassociated with programmed actions Speech will be recognised interpreted translatedsimplified or displayed so that13 an individual knows what13 is said and can be provided withclear instructions on how to respond
Video cameras have become smaller and cheaper and capable of producing high definitionimages The problem of storing and editing these large image files is being solved by thearrival of cloud computing
Electronic noses are already capable of detecting the quality of wine and fresh fruit Similartechnology will be based in smart13 phones and will be able to analyse the air to warn of13 foodthat is no longer fresh and of other indicators of danger including gases that13 have13 little13 natural13 smell These13 devices13 could support13 people with13 cognitive impairment13 -shy‐ whose13 sense of smell13 tends13 to deteriorate -shy‐ to live independently
Many older and vulnerable people are at risk of hypothermia during the winter Sensordevices can provide warnings of low temperature In the same way heat13 stress can be adanger during the summer months so sensors can alert13 people of the need to openwindows or to operate a fanFinally people who have damaged13 their fingers13 or hands will be able to wear sensorsembedded in artificial skin or in gloves that13 will enable them to identify textures and shapesand be able to dress and undress without13 the assistance of carers
216 Robotics
We may recoil at the idea13 of personal care being delivered by robotic devices but13 it13 is likelythat13 within a decade personal assistants will exist13 to assist13 with household tasks These areunlikely to be humanoid and are more likely to be machines dedicated to helping frailpeople to support13 their own weight13 and to carry trays of food around the home
19
There are four broad classes of robot13 under development13 that13 are likely to mature within 10to 12 years
1 Miniature industrial robots that13 have been programmed to perform specific taskswith precision They are likely to be relatively heavy enabling them to bear weight13 but13 still have the necessary flexibility to carry an individual over short13 distancesplacing them in a chair or on a bed They will have sensors and cameras to provideimmediate feedback and to adjust13 rapidly in response to verbal commands or cues13 from the user Some designs may build on existing assistive devices such as abathroom hoist13 or a bathing aid to become intelligent13 extensions of productsalready on the market A stair lift13 with intelligence is already being designed by a UKcompany and is aimed at providing the user with more control of the journeybetween floors of a house
2 The second group of devices might13 be described as intelligent13 furniture Beds andchairs are already available that13 adjust13 to make the user more comfortable and also13 to help them get13 into or out13 of bed The control units are fairly cumbersome andare suited to operation by a carer Voice activated controls and built-shy‐in intelligencewill give the user more control and independence Other items of furniture to whichintelligence might13 be added would be tables whose height13 can adjust13 and whichhold items of food and medicine securely The table would recognise these objectsand could provide prompts or reminders
3 Mobile robots form the third group These could be goffers that13 can either fetchand carry items such as newspapers drinks or trays or which can accompany theuser when they move between rooms providing them with support13 or prompts Thistype of robot13 could be an intelligent13 walking frame with wheels which13 could13 doubleup as a smart13 wheelchair when necessary
4 Finally there are companion robots These might13 be in the form of an electronicpet typically a cat13 or a dog though the Japanese Paro robot13 is a seal Pets canrespond to stroking and being patted they can also remind their owners that13 theyneed to take exercise and to eat drink and take their medication Various designsare already available which provide feedback but13 future models would includecameras and a screen to provide a mobile means of information and interactionwith other people over the Internet Intelligence within the device could allow themto have a personality of their own and gain knowledge by scraping data13 fromwebsites so that13 they can generate speech and have conversations about13 the newsthe weather or sports results
217 Transport and transfer technologies
Walking is good exercise and is a no-shy‐cost13 form of transport13 that13 is encouraged because of itsimpact13 on well-shy‐being For an individual with a chronic disability or suffering from theeffects of an accident13 or an injury this becomes impractical without13 an assistive technology(AT) A walking stick is the simplest13 example of AT
20
Within the home the stair lift13 has enabled people who live in conventional properties that13 are on two or more floors to continue to use facilities on different13 floors when climbing thestairs has become too difficult This is often the case for people who have arthritis a lowerlimb amputation a long term condition such as Chronic Obstructive Pulmonary Disease orpeople approaching the end of life and who have chosen to die in their own homes
Designs have improved so that13 a curved staircase is no longer an issue and the reliabilityhas reached a level where breakdown is a rare occurrence13 Through-shy‐floor lifts have been analternative proposition but13 they remain too large for most13 properties Alternativeapproaches may emerge using air pressure or water pressure as the driving force ABrazilian design already utilises a plastic tube in which a pod is moved effortlessly up anddown
Electronic wheelchairs are now available that13 allow the individual to become moreindependent13 as they allow the user to control both propulsion and steering Some modelshave the capability of mounting a pavement13 or a step or even a flight13 of stairs Personalmuscle amplification devices have been developed originally with the intention of helpingpeople who are confined to a wheelchair due to a neurological disorder to perform sometasks from a standing position Indeed the Rex walkerrsquos manufacturers claim that13 anyonewho can propel themselves in a wheelchair could walk by using Rex
Other approaches have focused on the rehabilitation of people after major accidents that13 have caused partial paralysis They quickly extend into exoskeleton designs that13 enableanyone to gain a mechanical advantage and thus to tackle physical tasks that13 would not13 otherwise be possible These suits are the focus of major research projects across theworld Some13 products such as the system developed by Honda are being tested inAssisted Living facilities and are likely to become more and more enabling over the next13 decade
Similar benefits are also occurring outside the home with a number of novel carryingsystems appearing over the past13 few years They are generally termed lsquoscootersrsquo but13 thiscovers a wide range of systems and devices ranging from the Segway a device that13 is amobile platform on which the user stands and navigates through to conventional electricvehicles that13 have been developed from golf buggies There remain a number of issuesconcerning their use on roads or on pavements but13 similar problems will need to beresolved for bicycles to play their full part13 in enabling people to get13 more exercise13 Thepotential for hybrid scooters remains
218 Smart domestic appliances and personal hygiene
The bathroom is a dangerous place and one where many older and disabled people slip andsuffer a fall Many older people recall taking a bath in a tin tub in front13 of an open fireToday the options tend to be a level access shower (ie a type of wet13 room) for anyoneunable to get13 into a bath There are various aids to help people get13 into and out13 of thebath most13 involving a seat13 that13 can be raised or lower with some bath-shy‐tubs having a door
21
There has been some research into alternative methods of keeping the body clean Sanyointroduced a machine in 1970 modelled on a clothes or dish washing machines the personsits on a seat13 inside the machine where13 they are cleaned by a set13 of water jets These havenot13 proved popular and furthermore require the individual to be transported to themachine Thus the technology may find application in nursing homes but13 are unlikely to beattractive to people living independently in the community
The washing needs of people change over time Over the past13 20 years body piercingshave appeared which have demanded additional attention to avoid the problemsassociated with poor hygiene and metals Similarly hair may be permed and dyed usingchemicals which are much stronger and which might13 damage the hair Add to this thepainting of finger and toe nails and the washing needs are rather different13 to what13 theymight13 have been even ten years ago Finally tattoos were once popular only with sailorsToday they are likely to be found on the arms backs and legs of both men and womenNew ways of cleaning these tattoos will be needed especially if they become infected orare sites at which pressure sores develop
Even if a personrsquos body is clean if their clothes are dirty they may become socially isolatedBut13 the washing of clothes can be strenuous even if a launderette is used The need toconserve water has driven research into ultrasound techniques to beat13 the dirt13 out13 ofclothing while some companies are experimenting with polymer chips These13 ldquogreenrdquo13 technologies are quickly maturing and are likely to be standard in the next 10 years
Other smart13 household appliances are already appearing on the market13 and may soonbecome common13 in UK homes13
bull Robovac devices have sensors to enable them to detect13 dirt13 on carpets and to adjust13 their operation accordingly
bull Refrigerators can read bar codes or RFID tags to identify their contents and theirldquouse byrdquo13 dates enabling them to inform the owner that13 they should use theproducts before they are out13 of date They can be linked to the Internet13 to reorderitems as they are consumed or to suggest13 menu options for the individual based ontheir preferences or according to the diet13 required to manage a condition
bull Ovens will automatically switch off if they are left13 without13 attention for too longand drying machines will set13 times automatically
Devices may be linked so that13 they are more efficient and report13 maintenance issues sothat13 they can be repaired (perhaps remotely) before they suffer a catastrophic breakdown
219 Personal and home13 security
It might13 appear perverse but13 people with very little personal wealth and property are morelikely to be the victims of crime than those who have expensive items This may be due towhere poorer people tend to live or because people who have valuable assets take greater
22
steps to protect13 them There can be no doubt13 that13 crime has a very negative effect13 onindividuals and on their families creating a fear factor that13 may be difficult13 to remove Theimpact13 on quality of life is therefore very considerable especially if it13 forces people to stayat home behind locked doors effectively isolating themselves from society
Modern policing places increasing reliance on the use of closed circuit13 television (CCTV)Town centres are covered by cameras used increasingly in the fight13 against13 crime by bothdetecting anti-shy‐social incidents and identifying the people involved They are also used tomonitor the movement13 of cars that13 may be involved in incidents of burglary and violenceand are fast13 becoming the primary mechanism of law enforcement13 agencies to solve crime
CCTV has moved into the home to record movement but13 monitoring the footage is timeconsuming and often not13 practical Cameras are now available which provide an instant13 video feed to a smart13 phone when movement13 is detected These may have intercomcapability allowing someone to remotely speak to an intruder sometimes before they havegained access to a building This may serve as a deterrent13 and when fitted alongside simpledevices that13 switch lights on randomly around the home may force burglars to goelsewhere
As the price of cameras continues to fall the option of carrying a camera13 on the body that13 continuously monitors personal space is becoming more useful Using wireless networksthe data13 collected can be sent13 continuously to the cloud for safe storage It cansubsequently be retrieved to provide evidence (video and audio) of confrontations enablingsuccessful prosecutions to be made The smart13 phone itself is becoming a valuable itemthat13 is attractive to criminals These can be tethered to personal attack buttons usingwireless technology allowing the device to be activated by the pressing of a button if theowner is being attacked The phones can then be tracked and located by the police whilebeing rendered useless to the assailant
Bogus callers are a perennial problem for vulnerable people Video door bells can beconfigured to display images and record the words of visitors before they are admittedallowing remote monitoring centres to oversee the situations and use image recognitionsoftware to confirm the bona13 fide of visitors Such13 arrangements may become13 commonplace13 over13 the13 next five13 or13 six years13 significantly13 improving the safety of peopleliving independently
220 Personal safety
The biggest13 risks to personal safety stem from fires and falls Most13 fires are the result13 ofpoor cooking practices resulting in burns or scalds Floods and gas emissions are caused bya failure to remember to close taps
The current13 approach involves detection of an emergency situation as soon as possible but13 always after a problem has already occurred This responsive approach can minimise therisks provided that13 there is a protocol in place for intervening This could increasingly be an
23
automated response such as the switching off of the gas of water or the switching on of asprinkler system or a water mist13 system
In the future monitoring systems will be more sophisticated and will have sensors and localintelligence to identify activities In this way reminders can be issued before an emergencyoccurs13 This lsquosmart kitchenrsquo approach may become13 an integral part of13 homes of13 vulnerable13 people
A prototype system has been developed at the Culture Lab in Newcastle Sensors havebeen embedded into cooking utensils enabling the kitchen to identify what13 the person istrying to cook or prepare It can provide interventions as messages on an instructionscreen
Accidents also occur out13 of doors People with dementia13 might13 become lost13 and may havepoor road safety awareness Location devices based on GPS have advanced from large andheavy receivers that13 were used on ships and boats to small battery-shy‐operated devices that13 can be carried in the hand or in a handbag The current13 generation of locators has limitedbattery life and are rather too large to be secreted about13 a personrsquos clothing while devicesthat13 are integrated into a wrist-shy‐watch are rather clunky and unattractive
Within 10 years the13 technologies13 will have13 matured and will be13 much smaller13 so that theycan be embedded in shoes in walking sticks hats or any other item of clothing Powerrequirements will have reduced so that13 energy harvesting from the movements of theindividual will be sufficient13 to keep these products working for several weeks without13 theneed for recharging The devices will not13 simply indicate to others where the individualhappens to be but13 will provide subtle guidance cues to direct13 them home
Cameras might13 also form part13 of the personal security systems that13 will protect13 people fromaccidents Data13 may be sent13 to the cloud and analysed in real time if the person is in adangerous location and can provide prompts either to the individual or broadcast13 advice toothers to clear the danger These systems may be embedded in items of clothing (such as ahat) or they may be attached to spectacles
221 Energy and13 portable power supplies
The demands of developing economies for more power will inevitably lead to higherdomestic fuel charges in the UK especially as oil and gas reserves dwindle
By 2018 UK homes should be fitted with new smart13 meters The specifications for these13 devices have yet13 to be finalised but13 will include a means of identifying wasteful use ofenergy including TV sets that13 are left13 on and unattended fridges and freezers that13 are set13 attoo low temperatures and dryers that13 are used for too long or when the weather is suitablefor using a washing line They could be an enabling factor that13 supports changes inbehaviour driven by a need to use less power but13 it13 is unlikely that13 they will offer a bigreduction in costs that13 are already a problem for many vulnerable families
24
More generally the need for power conservation will include devices that13 are moreefficient and a significant13 emphasis on heat13 retention in buildings through betterinsulation
The energy crisis may force many people to spend more time in community settingsincluding shops and public buildings where they can benefit13 from the warmth Increasingreliance on mobile communication devices will lead to increasing demand for batterycharging facilities
Greater use may be made of portable devices for generating power based on solar cellswind or hand motion
222 Smart cities and homes
The Digital City initiatives have been based on information and how it13 can be used most13 effectively to make people aware of what13 is going on around them This means bettercoordination of resources more rapid access to advice and a battery of sensors measuringevery conceivable parameter from sound and light13 levels through to air quality andtemperature fluctuations There are several Digital or Smart13 City initiatives currently beingimplemented both in the UK and across the world They may significantly impact13 the livesof the millions of people living in them but13 the timeframe for outcome benefits to influenceplanning and design elsewhere is likely to be at least13 20 years and therefore outside thetimeframe of the current13 project
Housing plays a big role in the lives of most13 people both through their aspirations to moveup in the world (usually to a bigger property with a garden) and as the heart13 of the familylife which is associated with good quality of life UK properties have a life span approaching100 years which is about13 double that13 of their European counterparts (and certainly longerthan the wooden-shy‐frame buildings built13 in North America13 for example) A shortage ofhouses has plagued improvements in social welfare for the past13 30 years There is anargument13 that13 there are enough houses but13 the wrong size and in the wrong places andthis has some basis in fact13 as demography changes lead to more people (and more olderpeople) living alone However if there are two million homes in Scotland each with alifespan of 100 years then the renewal rate needs only to be 20000 per annum to maintainthe status quo However it13 must13 be clear that13 the impact13 of smart13 house development13 willbe small The focus should therefore be on adapting existing properties to render themmore appropriate for vulnerable people
Housing adaptations are a branch of assistive technologies The technologies for providingdifferent13 forms of accessible bath and level access shower are well-shy‐established with littleresearch considering anything other than alternative building materials and methods formaintaining the temperature of the bathwater Different13 technologies for bathing will beconsidered separately
25
Thus housing technologies are not likely to impact on social work13 within the next 20years13 though13 the use of information13 technology13 to ensure that people are aware of what13 is available is likely to be commonplace well before then
26
3 BEHAVIOUR AND ATTITUDE CHANGES DUE TO TECHNOLOGICALADVANCES
Technology is only one factor that13 will affect13 the way society changes in the next13 10 or 15years This chapter will consider the context13 in which the technological developmentsoutlined in the previous chapter will be supported (or held back) by societal factors
When the impact13 of such factors has been considered we can then apply theseassumptions to a number of case studies listed in Appendix13 A13
The headings selected for this chapter are not13 arbitrary as they reflect13 the context13 in whichtechnological changes must13 be considered They must13 include consideration of factors suchas demography and long-shy‐term conditions already addressed in the introduction to thesepapers together with the aspects of workforce and citizenship considered in the parallelpapers The additional elements here focus on trends that13 are already occurring and whichmay leave people struggling with the changes that13 occur
Finally there is a need to consider the attitudes of people to technology generally andespecially to the issues of privacy and social responsibility that13 could be radically changedby technology In some cases public opinion will prevent13 some forms of technology beingdeveloped if not13 commercialised In other cases some technologies will be fast-shy‐trackedeither at the request13 of government13 or because of a clear public demand for theopportunities that13 it13 can bring
Predictions13 about the13 future13 must inevitably be13 subject to considerable13 uncertainty butthat is no reason to stop thinking what might happen
31 The Welfare State
The UK can be rightly proud of the way that13 its welfare state has developed during the past13 100 years to provide a safety net13 of financial support13 to people and to their families whenthey are unemployed destitute homeless or challenged by crises and emergencies Therange of benefits received is considerable some are complex and many people struggle tounderstand their entitlements Some are universal some are discretionary some apply onlyto parents others to anyone
The total cost13 of providing these benefits continues to rise and when the economy isstagnating there is inevitably both political pressure often supported by popular publicopinion to introduce welfare reform so that13 people who do not13 work cannot13 be better offthan they would be if they were in full-shy‐time employment This strategy requires a universalbenefit13 to be introduced so that13 it13 is easier for claimants to access support13 but13 also easierfor agencies to identify the total benefits received The idea13 of a benefits cap then becomes
27
more practical to introduce especially if all the processes involved in making a claim arehandled electronically Indeed this encourages government13 to insist13 on applications forbenefits to be made on-shy‐line Unfortunately this will marginalise those people who haveneither a computer nor access to the internet thus emphasising the digital divide in amanner which works against13 some of the most13 disadvantaged people in society
There are currently few tangible links between digital technology and welfare provisionThe most13 obvious are universal benefits such as a free television licence (worth pound14550)13 for13 everyone aged 75 or older with blind and visually impaired people entitled to a 50discount13 irrespective of their age The significance of this position is that13 6 of revenuesgenerated through licence fees are to fund BBC on-shy‐line services13 such13 as websites and i-shy‐player In Scotland the BBCrsquos Alba Gaelic language television service is predominantlyfunded13 by MG Alba an organisation funded by the Scottish Government It is thereforeconceivable that13 in the future licence fees may be used to directly subsidise access toinformation and advice through the Internet13 for vulnerable people whether it13 is throughbroadband access or through a set-shy‐top box which removes the need for a computer in thehome to access particular websites or to use e-shy‐mail services
A second age-shy‐related benefit13 available in the UK is the winter fuel subsidy People whoreceive certain benefits receive the payments automatically while others must13 make aclaim Those who are not13 eligible for benefit13 due to a lack of an address for example missout13 on these payments and also on Cold Weather payments of pound25 for each seven dayperiod of very cold weather between 1 November and 31 March
The development13 of new warm home initiatives plus the complex of subsidies that13 theelectricity supply industry and government13 offer to people with solar cells further changesthe economic arguments Global warming may lead to greater variations in weatherextremes but13 might13 also increase the amount13 of electricity that13 can be generated byalternative (green) sources such as wind and solar cells It is estimated that13 energyconsumption in the UK increased by 17 between Christmas and Easter 2013 compared toprevious years as a result13 of cold weather but13 the above subsidy scheme did not13 benefit13 older people because two of the seven day cold periods were after 31st March It must13 beassumed that13 there will be more people living in fuel poverty in the future and this will leadto more cases of cold related illness including influenza13 and stroke
32 Management of long term conditions
The management13 of long term conditions will be improved for patients who are compliant13 with their medication regime so it13 is possible that13 there may be compulsion to adhere tothe prescription Such compulsion may be monitored using technology Indeed the remotemonitoring of vital signs using telehealthcare will become commonplace as the old boxesand sensors are replaced by devices that13 can be worn continuously or which can beembedded into the fabric of homes (including furniture and bedding) or can be worn asvests or patches They will wirelessly transmit13 data13 to smartphones or tablets and mobile
28
transmission and cloud technology will enable real-shy‐time data13 collection analysis andfeedback
One of the diseases which is projected to increase most13 significantly over the comingdecade is Type 2 diabetes Whilst13 there is a hereditary susceptibility to this condition formany people including those from the Middle East13 and the Asian sub-shy‐continent it13 is also adisease which tends to affect13 those people who are overweight13 andor have a sedentarylifestyle If untreated diabetes can lead to dizziness and collapse at any time but13 can alsohave more devastating long term consequences which include kidney failure strokeblindness and in extreme cases lower limb amputations Management13 therefore includesdaily monitoring of blood glucose levels and major dietary changes such as a significant13 reduction in the consumption of carbohydrates as well as a rigid exercise regime
Many newly diagnosed diabetics follow this advice closely and can lead normal lives for 40years or more but13 some struggle to accept13 the change in lifestyle required as well asremembering which foods are allowed and how much exercise they need to takeIndividual support13 plans are now forthcoming and over the next13 ten years best13 practicewill emerge in the form of smartphone apps that13 are personalised and which can becomean individualrsquos health coach This level of support13 will be fine for some people but13 otherswill need incentives so it13 is likely that13 gaming technologies will be introduced perhapsoffering rewards for good compliance There will be a temptation for some people tocheat perhaps allowing others to perform exercise for them or changing theirconsumption details
Many of these opportunities for cheating will be removed through the use of a uniquebiometric identifier a technology that13 will be mature enough to use in place of passwordson smartphones However the biggest13 challenge may be in encouraging older people to usethe technology Many older people have multiple morbidities Indeed a survey of Scottishpatients implied that13 42 of people aged over 80 will suffer from three long termconditions It will be essential for those people to comply with treatment13 regimes if they arenot13 to have the functional deficits that13 follow
33 Finding people who13 donrsquot fit
People who have low social capital are likely to have few relatives and friends with whomthey regularly communicate and are also unlikely to be part13 of community or faithorganisations such as clubs societies and church groups They also die several yearsyounger than most13 of the population often because they donrsquot13 engage with public healthinitiatives such as vaccinations against13 flu regular checks on their blood pressure bloodsugar levels or in the case of women smear tests or mammography The most13 likelyreason for disappearing beneath the radar of such initiatives is their mobility which leadsalmost13 inevitably to them having no fixed abode and no fixed telephone line It thenbecomes very difficult13 for them to be contacted because their mobile telephones are likelyto have Pay-shy‐As-shy‐You-shy‐Go contracts that13 donrsquot13 require validated names addresses and bankaccounts
29
It follows that13 some of the most13 vulnerable people in society including those who live onthe streets are effectively unknown to both the NHS and to social work departments untilthey are referred in a crisis This could be an emergency presentation to a hospital Accident13 and Emergency Department13 where they will come into contact13 with a social worker becausedischarge may be unsafe This often highlights the importance of the prevention agenda13 and the potential for avoiding admissions to hospital by intervening at an earlier stage
The advantages of being able to locate people who are vulnerable to specific diseases willincrease as genetic testing becomes more routine It is already possible to determine whomight13 be most13 at risk of breast13 cancer and prostate cancer as a result13 of family history Addto this the evidence that13 particular diet13 and exposure to environmental factors can furtherincrease risk then it13 is evident13 that13 individuals can be identified and offered treatmentsthat13 could save their lives many years before they become ill In the case of cancersperhaps only the individual is involved but13 for infectious diseases it13 is the whole of societythat13 is at risk if someone contracts one of the new strains of influenza or if someonechooses not13 to be vaccinated against13 rubella In Chinese airports all visitors are screenedfor fever and refused entry if they tested positive in cities the public are monitored in thesame way Similar approaches may be necessary in the UK if potential carriers cannot13 otherwise be identified
34 Volunteering
It is estimated that13 72 per cent13 of people volunteered to perform a charitable act13 at least13 once during 2012 a rise from 65 per cent13 the previous year About13 four out13 of every 10volunteers offer their services formally to one or more organisations The remaindervolunteer informally by helping out13 a friend or a neighbour Around 50 per cent13 volunteered at least13 once a month in the past13 year up from 41 per cent13 on the previous13 year Most13 have retired many of them before the statutory retirement13 age Those whodonrsquot13 feel able to offer time have offered their financial support13 at a time when the fundingavailable from sources such as the National Lottery has been decreasing Despite economicausterity donations to charities have been increasing 74 per cent13 said they had given tocharity at least13 once in the previous month up from 72 per cent13 the previous year
Strikingly 78 per cent13 of people strongly believe that13 they are part13 of their localneighbourhood an increase from 70 per cent13 10 years previously Community cohesion isstronger than ever 87 per cent13 of people believe their local area13 is a place where peoplefrom different13 backgrounds get13 on well together compared to 80 per cent13 in 2003
The role of volunteers in supporting vulnerable people is therefore likely to increase overthe next13 decade perhaps exploiting the success of the army of volunteers that13 was highlysuccessful in London during the Olympic and Paralympic games The greatest13 role for suchvolunteers may be in providing informal care for older people Already the UK has someseven million informal carers whose value in monetary terms has been calculated to be
30
more than the combined budgets of the NHS and social care Maintaining or extending thisprovision will help to support13 services in the future and may be supported by technology
Whilst13 there is ample evidence to suggest13 that13 telecare services support13 informal carers asmuch as (if not13 more than) the people that13 they are caring for it13 is the potential for utilisingthe internet13 and apps to make their role easier to coordinate and hence more effectivethat13 is likely to be most13 successful moving forward
Many of these focus on particular tasks that13 informal carers can help offer to older peoplesuch as organising their medication A pillbox program is just13 one feature of an app calledBalance It also includes sections for caregiving tips notes for the doctor and the patientsappointments plus a lsquolearning sectionrsquo with articles on aspects of Alzheimers and an RSSfeed for news about13 the disease Tyze is another multi-shy‐functional app it13 allows carers to
bull Organise appointmentsbull Plan outingsbull Share storiesbull Send updates to other family members
Another application is Rally Round which helps carers to organise someone to perform littlejobs often on a temporary basis when someone has dementia physical frailty or isrecovering from accident13 or illness Similar applications are MeMaxi and Finerday
35 The High13 Street
The shape and appearance of UK shopping centres have been changing for half a centuryPeople complain that13 centres are losing their identity with one town looking like everyother both in terms of the stores and in terms of the layout But13 there are three trendswhich are having a profound impact13 on many of the most13 vulnerable people in society
bull Centres lock their doors at 6pm or in some cases 10pm -shy‐ thus denying people whosuffer from claustrophobia13 from window shopping at times when other shoppershave left
bull Out13 of town shopping malls -shy‐ these US style centres are ideal for people in carsbecause they offer free parking which is essential for people who want13 to buy largeritems but13 difficult13 for people who have no transport13 and who must13 rely on publictransport13 that13 is often deficient
bull The rise of online shopping -shy‐ which means that13 many potential shoppers only visit13 High Street13 stores to check the prices before returning home to make a purchaseonline
It is the third of these effects that13 has the greatest13 potential for changing the High Street13 forever and it13 is making life for traditional retailers increasingly difficult13 at a time when highrents are crippling stores large and small It is difficult13 to see how this trend is likely tochange because consolidation in banking and estate agencies is already forcing the closure
31
of other High Street13 players while additional pressures on pubs has led to the closure ofthousands of pubs every year
Those figures however demonstrate that13 consumers still value what13 the high street13 canoffer -shy‐ the chance to inspect13 what13 theyrsquore thinking of buying -shy‐ as well as the new opennessof the internet Customer service makes a difference to people especially if there is aproblem and goods need to be returned One of the most13 common reasons for furniture tobe returned for example is that13 when a sofa13 or a wardrobe was delivered it13 couldnrsquot13 fit13 through the front13 door or up the stairs In the future people will be able to benefit from13 visualisation technology they will upload the floor plans of their homes enabling theretailer to inform them of the problem before they try to delivery Augmented reality viewwill similarly allow customers to see what13 a new item of furniture will look like in itsintended place so that13 they can be more informed about13 the effect13 of size and colour
In terms of improving the viability of the High Street stores will have to focus on theimportance of brand which could mean that13 individual independent13 retailers will have topartner with national suppliers to support13 a local tailored offering based on products that13 are designed for a more global market This is a lsquoconnected High Streetrsquo approach whichcould be enabled by the developments in internet13 availability and smart13 phone accessdescribed in the previous section
The overall effect13 of all these changes could mean that13 town centres become smaller but13 more vibrant13 areas They could thrive if people are attracted there in large numbers whichmeans that13 retail must13 be developed alongside restaurants pubs galleries and other leisureopportunities This is possible in new shopping centres which are already being integratedwith transport13 hubs including railway and bus stations but13 may be more of a design13 challenge for older towns and cities with large Victorian buildings To ensure that13 morepeople are welcomed into the new centres they should include attention to green spacesand areas where people can relax without13 feeling that13 they are second class citizensbecause they donrsquot13 have the same buying power
3513 Privacy
To some people privacy is their right13 to live their lives without13 interference they may seethe State as a potential lsquoBig Brotherrsquo spying on their every move and judging their actions13 and activities Other people have fewer concerns about13 the role of the State but13 great13 fearof individuals interfering with and invading their privacy Some embrace the concept13 of lsquomyspacersquo an area13 of a square metre or so into which nobody can enter without13 permissionThis allows them to avoid physical contact13 and to feel safe from any form of threateningbehaviour
Yet13 this idea13 of private space and its potential violation is merely the tip of the iceberg asfar as privacy is concerned more significant13 is the idea13 of personal (and private)information being shared with anyone and everyone This could be related to identityopinion or image for an individual who wants to remain anonymous or even secretive thisis going to become an increasing problem as technology provides the means of taking
32
photographs recording conversations and capturing environment13 with something as smalland ubiquitous as a mobile phone The fact13 that13 this information can then be shared withthe rest13 of the world using e-shy‐mail Twitter and Facebook makes the problem all the moredifficult So the threat13 is no longer solely from the long lenses of the Paparazzi but13 fromanyone (and that13 means everyone) who has even the most13 basic of mobile phones
This relates to the changing views of society on what13 information should remain privateand what13 should be shared with others The success of social media13 has been based on anattitude of lsquosharing everythingrsquo with either your friends or the world This has introduced anaiumlve idea13 in the minds of some younger people (especially those known as Millennials ieaged 18-shy‐30) that13 everyone can be their friends whilst13 perhaps failing to reinforce the bondsof genuine friendship with any form of test13 or restriction Technology could play a role indefining these friendships and allowing individuals to understand what13 makes a goodfriend but13 this approach has yet13 to be developed and may be slow to overcome the needfor some people to measure their own popularity simply as the number of people that13 theycan list13 as friends on their Facebook page
It follows that13 there may be a need for a new definition of privacy that13 is in keeping withthe web and its ability to display images and opinion in an unregulated manner This needsto embrace past13 concerns about13 the ability of an individual to live without13 the threat13 ofothers being able to watch them whilst13 offering some protection from random postingsabout13 them online Perhaps this could include a right13 to be able to edit13 or remove anythingrelating to themselves on the Web including images that13 are not13 news-shy‐worthy Theownership of image rights may be an associated issue that13 needs to be addressedespecially as modern technology can remove an individual from a group (or a background)13 view provide digital touch-shy‐up or air-shy‐brushing and then republish it13 in a different13 contextHowever there is general agreement13 that13 personal information (such as contact13 details andbank codes) should not13 have a place on the web Surprisingly few people take proactivemeasures to prevent13 tracking functions being activated
It follows that13 too much privacy could lead to younger people fearing that13 they maybecome lost13 in a digital world It is not13 surprising then that13 they are prepared to make lots13 of personal information available often with no fear of how it13 might13 be used by othersWhen Google glasses and similar technologies become available during the next13 few yearsthey will have the potential to identify a stranger walking down the street and to find manyof their secrets to present13 to the wearer in a fraction of a second They could know moreabout13 them than their genuine friends know -shy‐ so who will be their friends in the future
36 Data sharing and13 protection
By lsquodata13 sharingrsquo we mean the disclosure of data13 held by one organisation on an individualto a third party organisation(s) or the sharing of data13 between different13 parts of anorganisation Some data13 sharing doesnrsquot13 involve personal data13 because it13 has beenanonymised in such a way that13 the statistics can be used for the collective good without13 theidentification of the individual The Data13 Protection Act13 (DPA) is in place to provide a legal
33
framework that13 ensures that13 organisations that13 hold personal data13 must13 act13 responsibly atall times These principles adequately describe the position of public and government13 bodies especially social services departments who are responsible for the informationconcerning the health and well-shy‐being of individuals -shy‐ and hence by implication thesensitive data13 relating to their vulnerability
The legal framework that13 applies to private and third sector organisations differs from that13 which applies to public sector organisations which may only act13 within the defined limits oftheir statutory powers However all bodies must13 comply fully with the data13 protectionprinciples and this situation is unlikely to change within the next13 10 to 15 years In someprivate sector contexts there are legal constraints on the disclosure of personal dataHowever most13 private and third sector organisations have a general ability to shareinformation provided this does not13 breach the DPA or any other law It is advisable for acompany to check its constitutional documents such as its memorandum and articles13 ofassociation to make sure there are no restrictions that13 would prevent13 it13 from sharingpersonal data13 in a particular context The type of data13 held is therefore a subject13 ofconcern as it13 may be difficult13 for legislation to keep up with the additional layers of data13 created on-shy‐line and through the Internet13 of Things
Private and third sector organisations should have regard to any industry-shy‐specific regulationor guidance about13 handling individualsrsquo information as this may affect13 the organisationrsquosability to share information They should also be aware of the legal issues that13 can arisewhen sharing personal data13 with public sector bodies This becomes more of an issue asprivate and third sector bodies are carrying out13 a wider range of traditionally public sectorfunctions Opportunities for inappropriate sharing of sensitive data13 will therefore inevitablyincrease
Public authorities must13 comply with the Human Rights Act13 (HRA) legislation in theperformance of their functions The HRA also applies to organisations in the private sectorinsofar as they carry out13 functions of a public nature which could include delivering a socialcare activity Where the HRA applies organisations must13 not13 act13 in a way that13 would beincompatible with rights under the European Convention on Human Rights Article 8 of theConvention giving everyone the right13 to respect13 for their private and family life their homeand their correspondence is especially relevant13 to sharing personal data If personal data13 isdisclosed or shared in ways that13 comply with the DPA the sharing or disclosure of that13 information is also likely to comply with the HRA The problem may still be in policing theActs and the rights of an individual if they believe that13 their personal data13 has been sharedor accessed by an inappropriate organisation or individual
A legal industry may be born to deal with such matters but13 this is unlikely to benefit13 peoplewho cannot13 afford the fees involved They would require either legal aid or to employ13 more13 lsquono win no feersquo companies Public attitudes to such costs might13 become negative unlessthey prove successful in preventing breaches of data13 security There may need to belegislation to provide a stronger basis for forcing compliance with privacy laws
34
37 Connecting with13 people
We are social creatures most13 of us rely on our friendships and interactions with friendsand families to share our happiest13 moments and experiences Research suggests that13 thishappiness is infectious at all levels and leads to a 15 increase in the happiness of a closecontact 10 for a second degree contact13 such as the friendrsquos spouse and a 6 increase fora friend of a friend It is hardly surprising that13 the success of social media13 such as Facebookis intimately related to the ability of people to quickly share their happiest13 moments with asmany of their friends and connections as possible
All this has happened during the rise of the Internet13 and the corresponding increase inopportunities for connecting online ie this is a 21st Century phenomenon which has beenfacilitated by Information and Communications Technology But13 the Internet13 remains in itsinfancy and we are only beginning to understand and exploit13 its potential In terms ofaccessing the Internet there are now perhaps two billion people who have access with99 of them having gained this during the past13 decade This number will have doubled bythe period 2020 to 2025 It is likely that13 everyone who wants to be connected in the UK willby then be connected Turning this on its head only those who donrsquot13 want13 to be online willnot13 be on the Internet13 within a decade Connecting with the unconnected will therefore bea case of identifying those people who donrsquot13 want13 to be found unfortunately these mayinclude many people who need the support13 of social care organisations It means that13 theywill be looking for support13 only when they are in crisis unless other ways of finding andormonitoring them are found
While the number of people connected via the Internet13 has exploded this might13 bedwarfed by the number of connected lsquothingsrsquo During 2009 the number of thingsconnected to the Internet13 surpassed the number of connected people at which point13 webegan to experience what13 this report13 has described as the lsquoInternet13 of Thingsrsquo Yet 99 ofall physical objects that13 could join this network are not13 yet13 connected but13 the number couldgrow by 25 every year for the next13 decade so that13 there could be 100 billion connectedobjects by 2025 some of which will be owned or used by everyone in the UK includingthose people who donrsquot13 want13 to be connected themselves We will then have an Internet13 of Everything which will be the smart13 connection of people data events and actions
With each new person object or data13 that13 comes online the connection possibilitiesbetween all these elements grows exponentially The rise of big data mobile networkingcloud storage and data13 mining technologies will all play a critical role in the Internet13 ofEverything The result13 will be new capabilities richer experiences and unprecedentedvalue for individuals businesses communities and countries everywhere The lsquonetworkeffectrsquo of the Internet13 of Everything will be a very powerful thing the true impact13 of whichwe wonrsquot13 fully understand for several years As it13 develops however those who are not13 connected will feel even more digitally and socially excluded There will be a need to reachout13 to vulnerable people unless the process of claiming requires proof of online identityand the payments to be received can only be redeemed using a chipped card or adownloaded app onto a smartphone This is of course the way that13 welfare arrangementsare already developing thus it13 might13 prove impossible to make a successful claim without13
35
already being connected to lsquothe systemrsquo either through an online presence or through theInternet13 of Things
38 Downloading everything
Sixty years ago information was discovered by reading books often in a library wherenotes had to be made because the books or journals couldnrsquot13 be removed Then in theearly 1960s the first13 office photocopying machines were introduced into the UK theyimmediately meant13 that13 pages or articles from books could be copied and taken away to beread and summarised later Within a few years photocopying became a replacement13 forreading as researchers became less adept13 at selecting a few sentences and every deskbecame a depository for reams of printed paper Paper became the means of recordingeverything from bank statements through to music
We now appreciate that13 printing everything is a waste of both the ink (or toner) used tocreate the black print13 and of paper which requires trees to be chopped down and pulpedbefore it13 can be pressed into thin sheets Saving paper is therefore seen as green and goodfor the planet Fortunately we no longer need to print13 everything because computermemory is unlimited thanks to the cloud and we can then view pages and articles onportable or fixed screens
The internet13 has everything and it13 is all available instantly for downloading providing thereis a device available to accept13 it and there is sufficient13 communication bandwidth toperform the transfer of data13 sufficiently quickly Thus we can record all text13 articles that13 are relevant13 to us including digital records of birth certificates qualifications and passportsand the need for original printed versions will decline But13 we can also do this forphotographs Most13 handheld computing devices include at least13 one camera so they cangenerate enormous number of pictures which can be kept13 for posterity without13 having toconsume inks and special papers to print13 them
But13 the materials that13 can be downloaded donrsquot13 stop at pictures software is available that13 can grab TV shows after they air and movies as soon as theyre released In the same wayit13 is possible to schedule music comic books video games and practically anything else asa download with minimal effort People will need enormous hard drives if they want13 theirown digital copies of these files so will more than likely make use of cloud storage that13 willbe available from many organisations The location of the servers may become sensitivedue to border restrictions as will the security of the data13 and the way that13 it13 is backed up sothat13 it13 is resilient13 to failures
It may be evident13 that13 application forms for all types of welfare payment13 will be availableonly for downloading so that once digitised they can be processed by computer andrecords sent13 to various servers for subsequent13 storage and processing Some people maywant13 to keep their data13 on them once it13 has been downloaded Pen drives can already holdseveral GB of data so it13 is likely that13 people will be able to carry their downloaded data13 withthem at all times irrespective of the size and complexities of the information
36
39 Health13 and13 well-shy‐being
The general health of the population is unlikely to deteriorate noticeably within 10 to 20years Indeed expectations of the population are that13 things must13 improve as surgicaltechniques mature and as pharmaceutical interventions become more personalised andpowerful However the rising demand for health services due to an ageing population andthe increasing cost13 of providing sophisticated therapies will make delivering a free anduniversal health service difficult13 without13 substantial increases in taxation This is unlikely tohappen in the UK even though spending on health services will be protected against13 thecuts facing other services
There will have to be changes in how the NHS works For twenty years hospitals have beenclosed and replaced by fewer new facilities so that13 the bed count13 is reduced This has led toa significant13 shift13 in resources to primary care and community care supporting shorter staysin hospital and speedier transfer back home for people after surgery or illness This hasbeen13 successful but13 there remain problems with demand for GP services especially out-shy‐of-shy‐hours and at weekends Indeed despite the introduction of NHS24 and similar help-shy‐linesthe demand for GP appointments continues to increase Delays are inevitable and this willincrease system failures with more unnecessary deaths and a failure for people to access adiagnosis that13 might13 lead to early interventions and ultimately lower delivery costs Over250 more patients are added to waiting lists every day
This will lead to a new model of primary care consistent13 with existing changes which haveseen surgeries move from High Street13 locations to medical centres close to bus routes andwith more parking for patients The process of making an appointment13 is changing from atelephone-shy‐based interview process dominated by a medically-shy‐unqualified receptionist13 to achoose and book approach using an online process linked to electronic patient13 records Thiswill give patients more convenience but13 will allow priority for those who have Internet13 access at the expensive of those who are digitally excluded Making the process of bookingan appointment13 quick and easy may also increase demand from people who do not13 need tobe seen as it13 will fail to identify those in greatest13 need
A greater use of telehealth and telecare technologies will be inevitable beginning with thefirst13 contact13 as an encounter using the telephone e-shy‐mail or video conferencing -shy‐ a visit13 tothe GP surgery should be a last13 resort and should involve a nurse consultation in the first13 instance This would be consistent13 with three quarters of appointments currently involvinga chronic disease or long term condition which relates to improved self-shy‐care The support13 ofthese patients at home should be prioritised through tele-shy‐ and web-shy‐based technologies andshould involve training and coaching through a network of nurse practitioners Home visitsshould generally be unnecessary through the use of these technologies but13 could besupplemented by satellite surgeries manned by nursing in community premises or inpharmacies nurseries and Internet13 cafes
The homes13 of people who13 need13 closer monitoring can then become part13 of virtual wardswith real or electronic visits by health professionals University Hospital Southampton NHSFoundation Trust13 already looks after patients who have undergone surgery such as a hip orknee13 replacements in virtual wards with high levels of satisfaction The Royal Free London
37
NHS Foundation Trust13 offers a similar service but13 plans to add the possibility of videoconsultations between patient13 and consultant
310 Attitudes to public health issues ndash obesity smoking alcohol abuse drugs
As self-shy‐care becomes the focus of the NHS the public will increasingly understand that13 thecosts and availability of services are being harmed by the poor health behaviour ofrelatively small numbers of people The link between public health initiatives today andhealthcare needs and costs in the future will become increasingly evident13 as a result13 of theway that13 information is presented Thus the overweight13 smoker who currently attractsconcern and pity when they are diagnosed with diabetes and COPD is increasingly beingseen as the victim of their own stupidity or lack of self-shy‐discipline If they continue to neglect13 medical advice and continue with an unhealthy lifestyle then the way that13 they receivetreatment13 and consume resources will become a matter for the entire population
Obesity is seen as due to a combination of poor diet13 and a sedentary lifestyle No longer isthe idea13 that13 people are lsquobig bonedrsquo acceptable Governments will respond initially byrequiring manufacturers and food processors to provide nutritional information onpackaging and on menus in restaurants But13 people can choose not13 to read the data13 and toneglect13 both the importance of food quality content13 and quantity This will increasepressure to introduce fat13 or sugar taxes and these are likely to be in force within a decade
Although the high taxes on tobacco products has forced some smokers to reduce theirconsumption or to give up altogether the impact13 has been reduced by the smuggling ofproducts from overseas and by the availability of duty-shy‐free cigarettes for people returningfrom foreign holidays and business meetings Further measures are planned to changepackaging and to include even more graphic images and warnings on cigarette packages tomake smokers aware of the effects of smoking on their health and well-shy‐being There is asyet little evidence of how successful this might13 be More effective has been the banning ofsmoking in public places including trains and aircraft Expensive medical interventions suchas heart13 transplants will be denied to individuals until they change their lifestyle behaviourSmokers might13 therefore be increasingly ostracised leading to a loss of esteem This mayhave a particular impact13 on people who already suffer from mental health problems whoare more likely to smoke
The overuse of alcohol is being recognised as a major factor in hospital admissions withNHS figures showing an increase of over 40 in such admissions over the past13 decadeLinked to this has been a 75 increase in prescriptions to treat13 alcohol dependency Fewpeople have sympathy for those who waste their limited income on booze If they havechildren or other dependents they will be the ones who suffer and who may need thesupport13 of social care
Drug users are already significant13 users of social services as their habit13 is likely to makethem unemployable They receive little sympathy from the general public because they areseen as criminals and people who waste public resources Levels of drug abuse have been
38
slowly increasing over the years but13 this trend is slowly being reversed Indeed the numberof people using drugs during the past13 year has fallen to its lowest13 level for nearly 20 years(below 9) with cannabis being most13 likely often following excessive drinking Aselectronic noses and other technologies can detect13 traces of drugs it13 seems likely that13 success in overcoming addiction can be measured objectively This may become a two-shy‐edged sword rewarding those who can turn around their lives but13 further marginalisingthose who canrsquot13 or wont13 accept13 the lsquocold turkeyrsquo
311 Attitudes to surveillance
Issues associated with privacy confidentiality and data13 security have been discussedpreviously in the context13 of information technology the World Wide Web and the ease ofcollecting recording recalling analysing and displaying data The monitoring of individualsand their methods of using this information can be regarded as surveillance As thequantities of data13 increase along with the number of devices that13 can be used to access itthe surveillance tools will also increase in their sophistication Indeed the Big Data13 approaches described in the previous section will enable the combination of structureddata13 (such as the information held in databases) to be married with unstructured data13 fromimages in such a way that13 it13 can be mined
Whilst13 the lsquodigital surveillancersquo methods described above may cause most13 concern topeople because of its impact13 on anonymity it13 is the collection and analysis of images that13 are the major concern to people as they contemplate the ways that13 lsquoBig Brotherrsquo maydevelop to restrict13 freedom Every major UK city and town centre has an array of CCTVcameras that13 continually record activities from every angle If it13 used to be true that13 nobody in London was more than 10 yards from a rat it13 is certainly the case today that13 nobody can be more than this distance from being in view of a surveillance camera Yetthey receive so much positive publicity from TV programmes where their footage is used todetect13 vehicles close to a crime scene or to monitor the movements of suspects that13 theyare now accepted by the public as a deterrent13 in the same way as lsquobobbies on the beatrsquowere seen 25 years ago There is therefore little public reaction to the expansion in the useof video surveillance except13 for the practical observation of how so many views can beinspected and recorded
Looking to the future the tumbling cost13 of video technology will surely lead to anotherincrease in the number of devices The aerial views taken from towers will besupplemented by more local views taken by devices that13 are embedded in the fabric ofbuildings or carried by individuals either on their person (for example on clothing orspectacles) or in the bags that13 they carry The time and date-shy‐stamped images as Big Datawill be recorded to lsquothe Cloudrsquo where it13 can be added to other data It can then be usedwhen an incident13 has occurred or to provide further detail of night-shy‐time activities
It follows that13 there will be no hiding place for people who simply want13 to disappear Theymay respond by wearing clothing (such as hoodies) that13 hide their faces or which make it13 difficult13 to distinguish gait13 or mannerisms from which they might13 be identified New forms
39
of clothing may be designed to make shapes more difficult13 to analyse and these might13 become the uniforms of a class of person who wants to live in a way that13 they donrsquot13 interact13 with officials from any ministry or local government13 department If they also obstruct13 services then they will be considered to be anarchists of some form sparking protests fromother sectors of society
31213 Attitudes to driving
Motor cars have been a feature of UK roads for over a century but13 it13 is only during the past13 50 years that13 they have become a resource that13 most13 families have had access to enablingthem to travel without13 the restrictions imposed by a limited railway network and non-shy‐integrated bus transport People who have had a car throughout13 their lives often see theircars as an important13 factor in enabling them to remain independent13 and to exercise choicesrelating to where they shop and where they spend their leisure time This extends to theirspouse and to friends and neighbours that13 they might13 take with them on their variousexpeditions
Unfortunately there are incidents involving older drivers who perhaps go down amotorway in the wrong direction who are taken ill at the wheel or who are involved in anaccident13 involving no other vehicles These are small in number but13 often lead to a reactionthat13 they shouldnrsquot13 be allowed to drive lsquoat13 their agersquo Age itself is not13 an indicator ofdriving quality but13 because old age also brings more chance of having limited long termconditions and other illnesses it13 is easy to make a link between driving ability and age Thelicensing system does require continued driving to be linked with medical advice andforbids people with poor eyesight epilepsy and other conditions to hold a licence in oldage
Yet13 statistically older drivers cause far fewer accidents than younger drivers The reasonsfor this may be complex and are likely to include the fact13 that13 they drive less often covershorter distances and donrsquot13 go out13 in the dark or in poor weather However it13 does not13 wholly explain why the UKrsquos drivers aged over 70 and who represent13 some 8 of all driversare involved in only 4 of accidents that13 cause injury This compares favourably with the15 of13 drivers aged between 17 and 29 who are involved in over a third of crashes that13 result13 in injury
By 2020 the number of drivers aged over 70 on UK roads is likely to increase to over 7million This will require a new national strategy perhaps involving support13 for olderdrivers further training raising awareness of issues and making more use of adaptivetechnologies to support13 the driver in avoiding collision or forgetting to check on the statusof their vehicle Poor eyesight13 could be enhanced by camera technologies rather thanforcing people off the road if they are unable to read a licence plate
The International Longevity Centre has found that13 one in four Britons thought13 driversshould be made to switch off the ignition for good somewhere between the ages of 70 and75 The numbers may decrease as the population ages and as cars become safer Forcing
40
older people off the road may be a natural consequence of providing free bus passes andsubsidised rail fares but13 the growth in the pavement13 scooter industry demonstrates that13 older people value their independence and will do almost13 anything to get13 out13 and aboutPerhaps legislation will result13 in more regulation of electric vehicles and where they cantravel
There can be no doubt13 that13 getting out13 will be associated with better quality of life andwell-shy‐being and this is likely to be supported in the future as evidence of improvedoutcomes emerges It is to be hoped that13 positive stories will be publicised so that13 publicattitudes arenrsquot13 hardened This may be supported by more in-shy‐car monitoring of drivers andthe linking of performance with on-shy‐line driving records and licences These could throughremotely monitored ignition systems prevent13 the use of motor vehicles by people without13 a licence or without13 insurance
313 Climate change
There is a general view that13 the emissions of carbon gases are contributing to globalwarming in a manner that13 will change the UK climate in such a way that13 the climate maybecome more Mediterranean However some scientists believe that13 manrsquos impact13 on theenvironment13 may be small compared with natural variations caused for example bycyclical changes in the sunrsquos energy output13 or by the effects of volcanoes and earthquakesRecent13 evidence has suggested that13 we are going through a phase of changing extremesand that13 this is more likely to cause storms periods of excessive rainfall and unusualseasonal trends with snow and frost13 in the spring and warmer winters Considerableuncertainty remains and it13 might13 be necessary to plan for a number of different13 scenariosand for the impact13 on vulnerable people
I Colder winters UK properties are poorly insulated resulting in excess mortalitiesduring cold spells due to an increased number of people suffering from stroke aswell as bronchitis and other pulmonary diseases The cost13 of heating continues toincrease putting more households into a state of fuel poverty Any further coolingduring the winter months will result13 in more people living in unhealthy coldconditions Winter fuel payments are likely to be restricted to the poorest13 peoplebut13 this might13 exclude people who live in larger properties that13 are more difficult13 toheat
II More storms excessive winds and rain can cause flooding at any time of the yearMany UK communities are built13 close to rivers and these can surge during heavyrainfall causing houses to be filled with water and furniture and carpets lostInsurance can be problematic for properties built13 on flood plains which can blight13 properties and prevent13 owners from being able to sell and move on High winds canrip off roofs causing injury and also causing families to be left13 homeless anddependent13 on social services
III Hot13 summers Europe suffered high temperatures during the summers of 2003 and2004 leading to heat13 stroke and hypothermia The UK has not13 previously sufferedfrom such problems but13 might13 be expected to experience days of extreme
41
temperature and humidity at times Older people may not13 be prepared for suchweather Street13 dwellers may be unable to find shade and supplies of drinkingwater
Irrespective of what13 combination of weather scenarios arise it13 must13 be concluded that13 any extremes will have a major negative impact13 on vulnerable people especially if theyare not13 prepared because they havenrsquot13 received the weather warnings and advice that13 can be broadcast13 using the TV radio and online services Once again the digitallyexcluded will suffer and will pay a high cost Society will continue to pick up the bill interms of demands on social care services unless preventive actions are taken in theform of connecting these people to each other and to formal services
42
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
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13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
n13 13
13 s13
r13 n13
e13 at13
e13 y13 e13 ld13
ly13
13 e13 t13 e13
s13 er13 e13
f13
rt13 13
13 13
13
r13 13
s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
e13 g13 13
e13
13 13 ial13
13
d13
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d13 13
s13 y13
e13
13
rd13 r13 e13
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e13
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13
13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
The development13 of small and relatively low-shy‐cost13 medical devices for measuring relevant13 vital signs or medical parameters such as pulse rate and blood sugar level means that13 individuals can take their own measurements and then take responsibility forunderstanding their meaning (with appropriate support13 where necessary) and modifyingtheir behaviour accordingly
The availability of smart13 phones capable of running apps (specialised lsquoapplications) has ledto the development13 of new measures of well-shy‐being that13 are based on the individualinputting information on location the way that13 they feel and their interactions with othersThe smartphone can provide additional context13 automatically including location thenumber of conversations the distance travelled and external parameters such as theweather and the temperature This supports the idea13 of a life that13 can be measured in asensitive manner many times a day and without13 being seen as intrusive This leads to theconcept13 of the Quantified Self
Knowing how one feels and how one lives in a way that13 can be measured and easilycompared with other people can have both benefits and disadvantages The benefits tosociety mainly stem from an ability to identify people who are unhealthy both with respect13 to acute needs and from a predictive point13 of view those who are likely to be unwell atsome time in the future In the mental health space people who have bipolar disorder canbe monitored and supported more efficiently perhaps leading to a reduction in self-shy‐harmand suicide
There are likely to be some people who rebel against13 the need for measuring their owncondition daily and for ever They could view the measurement13 regime as being arestriction on their own lives preventing them from doing what13 they want13 to do because ofthe need to compete with their own measurements This could lead them to walk awayfrom treatment13 regimes resulting in a sudden decline in their well-shy‐being
26 Social networks
Social capital1 refers to the collective or economic benefits derived from cooperationbetween individuals and groups and highlights the importance of social networks that13 linkfamily friends neighbours and communities Wellbeing can be affected by connectivitypeople who have low social capital are likely to be lonely but13 also are more likely to reject13 public health initiatives such as flu jabs which could be beneficial to their health and well-shy‐being
The number of older people who live alone has been increasing for many decades By 2025two out13 of every five older people are likely to live alone Their quality of life may dependon them being able to build strong social networks Traditionally these networks were built13
1 lsquoJust as a screwdriver (physical capital) or a university education (cultural capital or human capital) can increase productivity (both individual and collective) so do social contacts affect theproductivity of individuals and groupsrsquo httpenwikipediaorgwikiSocial_capital
8
on neighbourhoods clubs and pubs and religious groups Meetings became social eventsand absence either signified a rejection of the group or a trigger for other members tobegin to visit But13 what13 happens when a network starts to disintegrate because of death orgeographic dispersal or because the individual loses physical capacity Can web-shy‐basedsocial networks compensate by nullifying geographic separation or by building newnetworks
Skype arguably demonstrates that13 lsquogeography is historyrsquo by making possible free real timevideo communication with family and friends thousands miles and continents apart Thebarrier of course is being able to afford a computer and a broadband connection whichmay limit13 use by lower socio-shy‐economic groups However its potential as a support13 mechanism should not13 be underestimated the technology is simple and it13 works we needonly the social economic and political will to make it13 happen In Scotland older peopleenjoy free bus travel why not13 free broadband
Social networks such as Friends Reunited and more significantly Facebook have emergedas vehicles that13 can not13 only link friends together but13 can also become a means of appealingfor associations and linkages that13 can be supported by the sharing of personal information
The inclusion of a camera13 on smartphones makes it13 easy to share photographs which canenrich communication For example proud parents may announce the arrival of a newbaby with a picture that13 everyone might13 wish to see On the other hand employers might13 also see evidence of why someone who has phoned in sick is unavailable for work on aparticular day Being aware of and able to set13 privacy levels is therefore important13 in orderto control who can see your personal information and news young people and vulnerableadults in particular may admit13 more people as lsquofriendsrsquo (or connections) than might13 beadvisable
The lifetime of major social networks is likely to be limited to a few years as new businessmodels13 emerge and new promotional strategies offer benefits to subscribers This mayoffer an opportunity for new networks to be created to deal specifically with those peoplewho are excluded in any way including those who will be referred to social services forassessment13 and support
27 Entertainment
Many people still remember the coronation of Queen Elizabeth in 1953 being shown live ontelevision This was an important13 milestone in establishing this new medium as acompetitor to radio and the cinema13 as a source of entertainment The arrival of colour TVin the late 1960s contributed to the declining popularity of cinemas and theatres many ofwhich closed
Today many homes have a TV in every room and technology has advanced to deliver highdefinition and 3D pictures on very large screens or lsquohome cinemasrsquo with surround sound
9
Paradoxically perhaps radio is more popular than ever and cinema13 has bounced back fromdecline to once again become an important13 element13 in the social lives of many people
Video images still or moving can be displayed also on laptops tablet13 devices andsmartphones which means that13 people can be entertained or informed on the move Sometrain operators have followed airlines in providing an lsquoat13 seatrsquo entertainment13 experience13 which can be offered with certain choices though many passengers prefer to use their owndevices and content In the future it13 seems likely that13 access to both audio and videoentertainment13 will be possible at any location and in a way that13 doesnrsquot13 interfere with theenvironment13 of other passengers
For those who want13 neither video nor audio (eg music) entertainment reading mayremain the entertainment13 of choice Many older people have struggled to find suitablereading materials as a result13 of the closure of local public and mobile libraries Some peoplecannot13 support13 the weight13 of a book while others lack the dexterity to turn the pagesOthers have sight13 problems which prevent13 them from reading small print All theseproblems can be overcome using either text13 to speech technologies (which are replacingtalking books) or by using e-shy‐reader devices which allow font13 sizes to be increased easily andwhich offer simple interfacing for moving pages backwards or forwards
In the future it13 must13 be assumed that13 all entertainment13 media13 will be held in the lsquocloud2rsquoand will be downloadable to an appropriate device on payment13 of a fee provided that13 acommunications contract13 is in place
The pre-shy‐requisites will bebull A device (eg PC laptop tablet Kindle)bull A contract13 with a telecoms provider (eg BT Virgin Sky) for broadbandbull A contract13 or contracts with media13 provider(s) (eg Netflix iTunes)
Those who lack any of these components may be entertainment13 excluded
28 Cash13 and13 money
Cash has been king since the abolition of the gold standard It is an expensive method oftransferring money between people and organisations and is a considerable overhead forindustry and for individuals travelling between different13 countries The highest13 denominations are lightweight13 and easily lost stolen or destroyed while the smallest13 denominations are heavy dirty and difficult13 to handle It is surprising that13 physical cashcontinues to be used It can only be a matter of time before it13 is digitised and replaced byvirtual cash
2 This means the material (book film or whatever) is stored in a remote computer (thecloud) and downloaded (or lsquostreamedrsquo) to your device on demand and possibly onlytemporarily
10
Large payments were previously made by cheque They are expensive to process by thebanks because people can write them by hand which makes them difficult13 to readelectronically and automatically Consequently they require human intervention and this isnot13 what13 modern banks wish to do so they want13 to promote greater use of debit13 and credit13 cards The latter were used initially as a cheque guarantee but13 are now being used almost13 exclusively as a means of withdrawing cash from ATMs and for making paymentselectronically UK banks wanted to do away with cheques by mid-shy‐2012 but13 they had toperform a u-shy‐turn under pressure from charities representing older people It is apparent13 that13 digital cheques and other cheque-shy‐replacement13 strategies will be introduced soon that13 satisfy the most13 pressing concerns of older people
It was difficult13 to see how cash could be replaced for payments for lower cost13 items such asnewspapers and sweets until the era13 of contactless payments Near field communicationsystems are likely to replace bar-shy‐codes to carry product13 identification information Theycan be read by electronic receivers The same technology can be two-shy‐directional allowinginformation to be passed from a smart13 phone to a reader and back again The smart13 phoneeffectively becomes a wallet13 which can be digitally filled by the owner and then emptiedwhen making purchases For small sums of money this approach is ideal and is likely to berolled out If cash disappears then begging will become difficult13 and welfare paymentsmade on a card Such cards are already used by social services as a means of providingclaimants with a means of receiving self directed care and support By restricting use of thecard to outlets that13 can provide care and support13 services opportunities for spending thecash inappropriately are restricted
It follows that13 many users of social services will need to have a smart13 phone as well as acard that13 can be used to buy services In the future smart13 phones may be provided as aloan item to claimants for social care This could include a digital wallet13 facility as well asthe communications and information ecosystem that13 would allow these people to receive awhole range of other services that13 would prevent13 their social exclusion and which could beused directly to provide them with information and access to entertainment
29 Biometrics and fraud13 prevention
Identity theft13 is used by criminals to pretend to be someone else in order to accessresources or obtain credit13 and other benefits in that13 persons name Although the concept13 has been around for centuries it13 is a growing concern in the digital world as we acquiremultiple online identities for bank accounts social networks and using public services such13 as paying tax electoral registration etc
Passwords are fraught13 with difficulty typically they are hard for humans to remember andeasy for machines to crack Efforts are therefore focused on other forms of provingidentity for example
11
bull Fingerprints have been accepted for over two thousand years to confirm identitymostly in criminal justice The technique has been applied to door-shy‐lock opening insome supported housing schemes There are practical problems associated withregistering lsquoallowedrsquo fingerprints and the useful lifetime of such products is also onlyabout13 three or four years
bull Retinal imaging and DNA analysis have been relatively slow to follow but13 only dueto the sophistication required for measurements and the time taken for testing Acombination of retinal imaging with facial gestures and blinking is possible in the labbut13 currently takes half a minute to achieve a match -shy‐ and this is achieved only withthe use of considerable computer processing power This sort13 of time makesapplications in mass people transfer impossible
Current13 research in this area13 is focusing on the uniqueness of other body parts such as earsand knees as biometric indicators The ears have great13 potential because they are usuallyexposed though hidden sometimes behind hair and other times by hats and other clothingOn the other hand the knees are rarely visible and however unique they may be there willbe cultural and religious obstacles to overcome before scanning could become a regularpart13 of identity confirmation The cameras which are central to such systems used to beexpensive but as the cost13 of high quality cameras continues to fall (there is one in nearlyevery mobile phone) it13 becomes feasible to devise identification devices that13 use multiplecameras to simultaneously recognise the eye and the ear
Movement analysis can be used to identify people by their walk gait13 and other biorhythmsprovide unique signatures It is possible to learn someone elsersquos gait13 though and injury orillness13 can have a temporary effect13 on gait
Over the next13 ten years with more sophisticated databases and image processing facilitiesthe cost13 of implementing advanced biometrics will fall enabling their application acrossmore diverse areas and in more social opportunities Potentially cameras will use cloud-shy‐technologies to provide individuals with instant13 recognition of anyone approaching them inthe street This could prompt13 a name or the occasion when they were last13 seen or spokento as a secondary method of control in much the same way as Internet13 banking seeks toavoid fraud This13 has13 the13 potential to remove13 the13 need for13 passwords13 and might13 then be13 the basis of machine-shy‐based13 communication13 either in front13 of a laptop or tablet13 device orwhen using13 a smart13 phone
There will need to be special measures introduced to support13 people with any form ofdisability as they might13 well have one or more sensory deficits Similarly people maystruggle to communicate following a stroke or a serious accident Nevertheless it13 may bereasonable to conclude that13 such systems will be both available and acceptable within thenext13 10 to 12 years
12
210 Health13 information
Health records in the form of written documents x-shy‐ray images and clinical observations arean important13 means of making all interventions efficient13 and safe Increasingly people havemany different13 conditions (comorbidities) and may be treated by several specialists Asthese physical records are moved inevitably some get13 lost estimates suggest13 that13 one inthree records is lsquolostrsquo at any one time
The best13 resource for information about13 a patient13 is his or her primary care record which isheld by the GP The UK was an early adopter of electronic primary care records and can beproud of the way that13 these have enabled population-shy‐based information to be collectedand analysed Scotland (and to a lesser extent13 Wales) has led the way in ensuring that13 allthese records are accessible through anonymised approaches that13 allow researchers toexamine trends and improve analysis of performance Fundamental to this has been theallocation of a unique identifier At13 the same time individuals can access these recordsboth to check for accuracy and to see what13 their doctor has said about13 them
This13 has13 the potential to make people more responsible for their own conditions andmight lead to better13 self-shy‐care13 and changes in behaviour13 that might reduce13 the13 incidence13 or severity13 of chronic conditions13 that are related13 to lifestyle
In the future we can expect13 the primary electronic health record to be linked with hospitaladministration systems picture archiving systems and other records held by hospitals sothat13 appropriate medical staff can have access to all relevant13 data
When the social care record is added to the mix then this will mean fewer but13 shorter andbetter assessments for social workers and for healthcare staff They will knowcircumstances and factors that13 could influence the choice of approaches This supports theidea13 of there being only one record consisting of several components all of which areaccessible by an appropriate professional at any time and in any place
The13 ambitions13 described above13 are not13 limited by technology most13 of the interoperabilityissues between rival commercial record systems have been resolved and databaseproviders are being compelled to support13 joint13 working The English NHS Mandate requiresTrusts to effectively replicate arrangements already in place in Scotland and in Wales andthis will go a long way towards achieving a genuinely paperless NHS well before 2020 Withnew biometric identification technologies individual records will be available to out-shy‐of-shy‐hours physicians and to those working in an AampE department13 irrespective of theconsciousness state of a patient
New telecare and telehealth technologies will produce significant13 more volumes of data13 which are currently held in different13 places and owned by different13 organisations rarely thepatient These data13 will also need to be shared but13 only in a manner that13 is acceptable toeveryone Patients may not13 want13 all their mental health information published in a formthat13 can be viewed by social workers GPs may not13 want13 to have access to all the data13 that13 might13 suggest13 that13 there is a domestic crisis to which they had neither the wish nor capacity
13
to respond Monitoring systems that13 support13 the lsquoquantified13 selfrsquo may also offer data13 that13 may or may not be added to the full recordThe future of health information might13 therefore be about13 providing individuals with themeans of producing relevant13 information storing it13 somewhere secure and then viewing it13 at a later time but13 in a format13 (or with advice) that13 is acceptable
See also httpmydexorg lsquoMydex gives individuals back control over their personal datarsquo
(see also Digital Scotland 2020 Achieving World-shy‐Class digital infrastructure a final report13 tothe Scottish Government13 httpwwwscotlandgovukPublications2013029054lsquoconnectivity by any device anywhere and anytimersquo)
211 The Future of Healthcare
The strains on our healthcare delivery system are becoming greater as they are in otherdeveloped countries as a result13 of an aging population rising expectations and unhealthylifestyles The necessary changes will require a significant13 shift13 in resources13 fromsecondary13 care13 where unit costs13 are high to community13 carewhere people can generallybe treated at home
The future must13 therefore necessarily involve efficiencies in hospitals and in the way that13 people can be treated in less expensive locations ultimately in their own homes Hospitalswill use more sophisticated diagnostic tools including scanners of all types to non-shy‐invasivelyprobe inside peoplersquos bodies This will result13 in more day cases and hospital stays (alreadyaveraging under a week) to even shorter periods with on-shy‐going support13 provided inintermediate care settings that13 might13 include hotels care homes or the personrsquos own homeif it13 is clean safe secure and has all the necessary amenities (include access to theInternet)
Advances in medical technology will allow more treatments to be delivered in the homeThis will mean fewer visits by clinical staff and fewer opportunities to attend primary carecentres Pharmacists will become suppliers of information as well as drugs so the balanceof care will shift13 significantly away from doctors who will work in different13 ways relying13 increasingly on telemedicine to bring the specialist13 to the patient13 for an online consultation13 For example if a patient13 complains of nausea13 and severe headaches a virtual consultationcan be offered almost13 immediately and without13 having to send a patient13 with a potentiallyserious and acute condition on a potentially long journey to a hospital
In the above example a neurologist13 may ask further questions as well as conduct13 acomplete neurological examination using videoconferencing technology Airedale GeneralHospital consultants have new contracts that13 require them all to be available for virtualconsultations The first13 benefit13 has been in reducing the need for prisoners at local jails tobe brought13 into AampE (which may need to be locked down depending on the circumstancesand the potential for violence of the individuals involved) potentially saving hundreds of
14
pounds in security costs It also avoids the need for healthcare staff to have to go into aprison environment
The principles described above are already saving lives through telestroke services whichlead to more people being thrombolysed appropriately and avoiding long term support13 that13 often follows a stroke incident Teledermatology has been practised for a number of yearsand results in rapid diagnosis and resolution of problems that13 previously required significant13 time for remedy
212 Gadgets and13 DIY13 healthcare
There are at least13 three elements to healthcare
bull Gathering information on symptoms and physiological parametersbull Interpreting the information andbull Responding to the diagnosis with treatment
Many people choose to exercise self-shy‐care because this gives them control whilst13 avoidingthe need to share their concerns and personal details with others A lsquodo It yourselfrsquoapproach might13 even be encouraged by the NHS as a viable way of using scare resources
Medical devices that monitor vital signs are mature and have been miniaturised so that13 they can be used in the home by individuals with little or no medical training Indeed bloodsugar monitors are being produced specifically for use outside the hospital and in such away that13 they can be used reliably by people with advice and training being provided onlinevia13 YouTube
Many medical monitoring devices do no more than produce a single measure which theuser may record or respond to Others link wirelessly to smart13 phones allowing data13 to bestored and entered into a personal health record where trending opportunities existingIndeed individuals can easily enter their data13 into an app running on their laptop tablet13 orsmart13 phone This trending information may be useful13 for self-shy‐care and could be passed onto a physician though the volume of data13 produced in this way and doubts about13 thequality of the data are likely to persuade GPs to discount13 data13 produced in this way
This gap in knowledge can be filled with advice information and diagnosis that13 can beobtained online using a lsquoDoctor Googlersquo approach The quality of such diagnosis may varysignificantly although there are many sources of information that13 are both supported andapproved by the NHS (and by similar sources in other countries) However with a data-shy‐richapproach and a choice of diagnosis people may be empowered to take a greater role inhealthcare
15
The final component13 for the DIY enthusiast13 is the treatment13 option Many people fear longterm use of medication produced by the big pharmaceutical industry and prefer morenatural remedies which are available over the counter More medical treatment13 devicesare available that13 stimulate blood flow and counter pain through the use of electrical andphysical stimulation
The evidence may be weak at present13 but13 might13 grow as more people use them and as theircost13 drops The13 impact13 of13 such technologies13 on vulnerable13 people13 is13 difficult13 to gauge
213 Telecare
Support13 provided at a distance to people in their own homes is known as telecare Thename implies remote monitoring and interaction and includes the monitoring of the homeenvironment13 and of the individual as well as the interaction of the individual with thisenvironment Definitions have become difficult13 due to some US medical devicemanufacturers introducing the term telehealth to describe medical telecare such as remotemeasurement13 and collection of vital signs data
In the UK telecare alarm services have matured quickly using the robust13 platform andinfrastructure of social alarm systems which were originally used by tenants in shelteredhousing schemes to seek help when they didnrsquot13 own a telephone The majority of telecareservice users today live in their own homes and use dispersed alarm units to link with amonitoring centre through the telephone network Improved assessments of needs andrisks to independence have resulted in combinations of sensors being used to support13 theoption of staying put13 rather than moving into residential care or having increasing levels ofdomiciliary support They support13 the policy of bringing care closer to home and ofencouraging people to become partners in their long term support13 arrangements
Telecare services developments over the past13 decade include standalone items such asautomatic lights which have achieved significant13 efficiencies especially for people who arefrail and prone to falling and to those suffering from mild cognitive impairment epilepsyand anxiety People who have long term conditions including chronic conditions such asdiabetes and hypertension can also be managed more effectively through telecare supportThe benefits of telecare services include a relief of stress for family caregivers enablingthem to continue to provide unpaid support13 while holding down a job and maintaining theirquality of life
New developments enable continuous monitoring of behaviour and smart13 devices that13 canfor example remotely control the cooker the water supply and door entry Such13 monitoring may detect13 incidents early and prevent13 emergencies arising Devices arebecoming smaller and easier to embed quickly within the home environment making themmore acceptable and less noticeable Longer battery life means less frequent13 maintenancevisits
16
The13 monitoring13 centre13 becomes13 an information hub13 offering13 both advice13 and a vehicle13 for checking that someone is coping especially following a trigger event such as a stay inhospital or the illness13 of an informal13 carer
New systems utilise web technology that13 allows family members to be more proactive inthe monitoring of their relatives This can lead to greater interaction with them especiallywhen the relatives live a considerable distance away (perhaps in another country) Thesenext13 generation systems might13 include video conferencing and the use of tablets smart13 phones or smart13 TVs but13 when an emergency response is required (perhaps to lift13 someoneup after a non-shy‐injurious fall) there remains a need for human intervention
The13 future13 of13 telecare13 might therefore13 include13 an increasing13 dependence13 on volunteersfrom13 the13 community to provide13 the13 required support Social networking may need to beused13 to support13 telecare technologies
214 Mobile healthcare
While telecare can support13 people effectively in their own homes it13 is now recognised that13 being able to go out13 to enjoy open spaces and to overcome the fear that13 the home is aprison is an important13 part13 of improving well being and supporting a higher quality of lifeExtending telecare technologies to operate outside the home is known as mobile healthcare(or mCare) and is based on mobile telephone networks rather than landlines
The simplest13 form of mCare requires only a basic mobile phone to deliver telephone callsvoice13 messages and SMS (text13 messages) The technology is mature and there are countlessapplications in use both in the UK and in developing countries such as Africa13 and India13 where mobile telephones have already achieved a saturation level and where fixedtelephone infrastructures are not13 likely to be established at any time Such telephones areuniversally available in the UK and are used by the vast13 majority of people including manyolder people especially if they have been introduced to the low cost13 (pound30) devices that13 have large buttons large displays and a separate large button for calling an emergencynumber
Smart13 phones are rapidly replacing basic phones and allow the use of a large range of lsquoappsrsquothat13 are being developed to provide information and for enhanced experiences In thehealthcare space Skype FaceTime Vidyo and GoToMeeting with HD Faces are all current13 examples of video conferencing software available on tablets and smartphones
The specific software will depend on the nature of the communication desired
bull Skype will13 manage a simple video phone callbull Where an AampE physician needs to share a CT scan of head with a Neurologist13 on call
from home GoToMeeting would be more appropriate
17
bull If the physician would rather have a dedicated online meeting room that13 patientsand colleagues can simply drop in for a virtual meeting a Vidyo virtual room may bemore appropriate
This technology can suit13 any form of lifestyle including many people with complex needswhose lifestyle is not13 consistent13 with a fixed address
Social care apps are available already to deal with problems of sensory deficit
bull Guiding a blind person through GPS navigation and reading signs through appslinked to the devicersquos camera13
bull The microphone can be used as a hearing aidbull Speech recognition software can be used either to replay speech at a slower speed
or for translation into a language of choicebull Speech can also be selected for people who have a stammer or who have a problem
with their larynxbull Apps are becoming contextually aware recognising situations and locations and are
thus becoming a personal assistant13 for people with disabilities
By 2020 it is therefore possible that a smartphone may13 be prescribed13 for people who13 need13 social13 care13 together with13 a range of apps that have been13 selected13 to meet13 theirassessed13 needs
Whilst13 smart13 phones tablet13 devices and apps may become an important13 part13 of anindividualrsquos personal support13 armoury the potential of mCare will be limited only by anindividualrsquos ability to make use of all its functions Each device could become a part13 of anindividualrsquos personality supporting them to improve behaviour take exercise avoidtemptation and manage their own health and well-shy‐being Potentially mCare could becomethe most13 important13 element13 of social care and support13 within 10 years
215 Artificial Sensing and Enhancement Devices
bull It is estimated that13 one in seven people has imperfect13 hearingbull The numbers who are born deaf are quite small and many of these people may
have some form of hearing restored through surgery or through technologybull Similarly while there may be nearly a million people registered as blind or having a
severe visual impairment the vast13 majority lose their sight13 during their lives as aresult13 of disease
bull New treatments will deliver sight13 recovery or restoration over the course of the next13 10 to 20 years
Fortunately technology can provide excellent13 sensing capabilities that13 are already providingpeople with external portable devices for enhancing their lives The simple hearing aid is anexcellent13 example of a device which has been improved through both miniaturisation
18
personalisation and enhanced performance Today digital hearing aids use sub-shy‐miniaturemicrophones that13 can be unidirectional or omnidirectional and which can be adjusted insensitivity over an extended range Tomorrowrsquos devices can be switched between modesby the user so that13 they can benefit13 from hearing perfectly in any environment Indeedthey can be used with adaptive filtering technologies (as used by helicopter pilot13 headsets)to eliminate some sounds so that13 the rich speech (or music) components alone remainFuture developments will be on optimising control so that13 the user can switch seamlesslybetween different13 amplification applications without13 appearing to be distracted A smart13 phone or mp3 music player may be used as either a processing unit13 or as a ubiquitousoutput13 device that13 looks cool and natural
These same technologies will also be developed for use within the home environment13 fortimes when a deaf user isnrsquot13 present13 or is asleep Acoustic signatures associated withadverse events and incidents such as the hiss of a gas leak the crackle of a fire the sound ofa smoke detector the drip or a water leak or the sound of breaking glass can be directlyassociated with programmed actions Speech will be recognised interpreted translatedsimplified or displayed so that13 an individual knows what13 is said and can be provided withclear instructions on how to respond
Video cameras have become smaller and cheaper and capable of producing high definitionimages The problem of storing and editing these large image files is being solved by thearrival of cloud computing
Electronic noses are already capable of detecting the quality of wine and fresh fruit Similartechnology will be based in smart13 phones and will be able to analyse the air to warn of13 foodthat is no longer fresh and of other indicators of danger including gases that13 have13 little13 natural13 smell These13 devices13 could support13 people with13 cognitive impairment13 -shy‐ whose13 sense of smell13 tends13 to deteriorate -shy‐ to live independently
Many older and vulnerable people are at risk of hypothermia during the winter Sensordevices can provide warnings of low temperature In the same way heat13 stress can be adanger during the summer months so sensors can alert13 people of the need to openwindows or to operate a fanFinally people who have damaged13 their fingers13 or hands will be able to wear sensorsembedded in artificial skin or in gloves that13 will enable them to identify textures and shapesand be able to dress and undress without13 the assistance of carers
216 Robotics
We may recoil at the idea13 of personal care being delivered by robotic devices but13 it13 is likelythat13 within a decade personal assistants will exist13 to assist13 with household tasks These areunlikely to be humanoid and are more likely to be machines dedicated to helping frailpeople to support13 their own weight13 and to carry trays of food around the home
19
There are four broad classes of robot13 under development13 that13 are likely to mature within 10to 12 years
1 Miniature industrial robots that13 have been programmed to perform specific taskswith precision They are likely to be relatively heavy enabling them to bear weight13 but13 still have the necessary flexibility to carry an individual over short13 distancesplacing them in a chair or on a bed They will have sensors and cameras to provideimmediate feedback and to adjust13 rapidly in response to verbal commands or cues13 from the user Some designs may build on existing assistive devices such as abathroom hoist13 or a bathing aid to become intelligent13 extensions of productsalready on the market A stair lift13 with intelligence is already being designed by a UKcompany and is aimed at providing the user with more control of the journeybetween floors of a house
2 The second group of devices might13 be described as intelligent13 furniture Beds andchairs are already available that13 adjust13 to make the user more comfortable and also13 to help them get13 into or out13 of bed The control units are fairly cumbersome andare suited to operation by a carer Voice activated controls and built-shy‐in intelligencewill give the user more control and independence Other items of furniture to whichintelligence might13 be added would be tables whose height13 can adjust13 and whichhold items of food and medicine securely The table would recognise these objectsand could provide prompts or reminders
3 Mobile robots form the third group These could be goffers that13 can either fetchand carry items such as newspapers drinks or trays or which can accompany theuser when they move between rooms providing them with support13 or prompts Thistype of robot13 could be an intelligent13 walking frame with wheels which13 could13 doubleup as a smart13 wheelchair when necessary
4 Finally there are companion robots These might13 be in the form of an electronicpet typically a cat13 or a dog though the Japanese Paro robot13 is a seal Pets canrespond to stroking and being patted they can also remind their owners that13 theyneed to take exercise and to eat drink and take their medication Various designsare already available which provide feedback but13 future models would includecameras and a screen to provide a mobile means of information and interactionwith other people over the Internet Intelligence within the device could allow themto have a personality of their own and gain knowledge by scraping data13 fromwebsites so that13 they can generate speech and have conversations about13 the newsthe weather or sports results
217 Transport and transfer technologies
Walking is good exercise and is a no-shy‐cost13 form of transport13 that13 is encouraged because of itsimpact13 on well-shy‐being For an individual with a chronic disability or suffering from theeffects of an accident13 or an injury this becomes impractical without13 an assistive technology(AT) A walking stick is the simplest13 example of AT
20
Within the home the stair lift13 has enabled people who live in conventional properties that13 are on two or more floors to continue to use facilities on different13 floors when climbing thestairs has become too difficult This is often the case for people who have arthritis a lowerlimb amputation a long term condition such as Chronic Obstructive Pulmonary Disease orpeople approaching the end of life and who have chosen to die in their own homes
Designs have improved so that13 a curved staircase is no longer an issue and the reliabilityhas reached a level where breakdown is a rare occurrence13 Through-shy‐floor lifts have been analternative proposition but13 they remain too large for most13 properties Alternativeapproaches may emerge using air pressure or water pressure as the driving force ABrazilian design already utilises a plastic tube in which a pod is moved effortlessly up anddown
Electronic wheelchairs are now available that13 allow the individual to become moreindependent13 as they allow the user to control both propulsion and steering Some modelshave the capability of mounting a pavement13 or a step or even a flight13 of stairs Personalmuscle amplification devices have been developed originally with the intention of helpingpeople who are confined to a wheelchair due to a neurological disorder to perform sometasks from a standing position Indeed the Rex walkerrsquos manufacturers claim that13 anyonewho can propel themselves in a wheelchair could walk by using Rex
Other approaches have focused on the rehabilitation of people after major accidents that13 have caused partial paralysis They quickly extend into exoskeleton designs that13 enableanyone to gain a mechanical advantage and thus to tackle physical tasks that13 would not13 otherwise be possible These suits are the focus of major research projects across theworld Some13 products such as the system developed by Honda are being tested inAssisted Living facilities and are likely to become more and more enabling over the next13 decade
Similar benefits are also occurring outside the home with a number of novel carryingsystems appearing over the past13 few years They are generally termed lsquoscootersrsquo but13 thiscovers a wide range of systems and devices ranging from the Segway a device that13 is amobile platform on which the user stands and navigates through to conventional electricvehicles that13 have been developed from golf buggies There remain a number of issuesconcerning their use on roads or on pavements but13 similar problems will need to beresolved for bicycles to play their full part13 in enabling people to get13 more exercise13 Thepotential for hybrid scooters remains
218 Smart domestic appliances and personal hygiene
The bathroom is a dangerous place and one where many older and disabled people slip andsuffer a fall Many older people recall taking a bath in a tin tub in front13 of an open fireToday the options tend to be a level access shower (ie a type of wet13 room) for anyoneunable to get13 into a bath There are various aids to help people get13 into and out13 of thebath most13 involving a seat13 that13 can be raised or lower with some bath-shy‐tubs having a door
21
There has been some research into alternative methods of keeping the body clean Sanyointroduced a machine in 1970 modelled on a clothes or dish washing machines the personsits on a seat13 inside the machine where13 they are cleaned by a set13 of water jets These havenot13 proved popular and furthermore require the individual to be transported to themachine Thus the technology may find application in nursing homes but13 are unlikely to beattractive to people living independently in the community
The washing needs of people change over time Over the past13 20 years body piercingshave appeared which have demanded additional attention to avoid the problemsassociated with poor hygiene and metals Similarly hair may be permed and dyed usingchemicals which are much stronger and which might13 damage the hair Add to this thepainting of finger and toe nails and the washing needs are rather different13 to what13 theymight13 have been even ten years ago Finally tattoos were once popular only with sailorsToday they are likely to be found on the arms backs and legs of both men and womenNew ways of cleaning these tattoos will be needed especially if they become infected orare sites at which pressure sores develop
Even if a personrsquos body is clean if their clothes are dirty they may become socially isolatedBut13 the washing of clothes can be strenuous even if a launderette is used The need toconserve water has driven research into ultrasound techniques to beat13 the dirt13 out13 ofclothing while some companies are experimenting with polymer chips These13 ldquogreenrdquo13 technologies are quickly maturing and are likely to be standard in the next 10 years
Other smart13 household appliances are already appearing on the market13 and may soonbecome common13 in UK homes13
bull Robovac devices have sensors to enable them to detect13 dirt13 on carpets and to adjust13 their operation accordingly
bull Refrigerators can read bar codes or RFID tags to identify their contents and theirldquouse byrdquo13 dates enabling them to inform the owner that13 they should use theproducts before they are out13 of date They can be linked to the Internet13 to reorderitems as they are consumed or to suggest13 menu options for the individual based ontheir preferences or according to the diet13 required to manage a condition
bull Ovens will automatically switch off if they are left13 without13 attention for too longand drying machines will set13 times automatically
Devices may be linked so that13 they are more efficient and report13 maintenance issues sothat13 they can be repaired (perhaps remotely) before they suffer a catastrophic breakdown
219 Personal and home13 security
It might13 appear perverse but13 people with very little personal wealth and property are morelikely to be the victims of crime than those who have expensive items This may be due towhere poorer people tend to live or because people who have valuable assets take greater
22
steps to protect13 them There can be no doubt13 that13 crime has a very negative effect13 onindividuals and on their families creating a fear factor that13 may be difficult13 to remove Theimpact13 on quality of life is therefore very considerable especially if it13 forces people to stayat home behind locked doors effectively isolating themselves from society
Modern policing places increasing reliance on the use of closed circuit13 television (CCTV)Town centres are covered by cameras used increasingly in the fight13 against13 crime by bothdetecting anti-shy‐social incidents and identifying the people involved They are also used tomonitor the movement13 of cars that13 may be involved in incidents of burglary and violenceand are fast13 becoming the primary mechanism of law enforcement13 agencies to solve crime
CCTV has moved into the home to record movement but13 monitoring the footage is timeconsuming and often not13 practical Cameras are now available which provide an instant13 video feed to a smart13 phone when movement13 is detected These may have intercomcapability allowing someone to remotely speak to an intruder sometimes before they havegained access to a building This may serve as a deterrent13 and when fitted alongside simpledevices that13 switch lights on randomly around the home may force burglars to goelsewhere
As the price of cameras continues to fall the option of carrying a camera13 on the body that13 continuously monitors personal space is becoming more useful Using wireless networksthe data13 collected can be sent13 continuously to the cloud for safe storage It cansubsequently be retrieved to provide evidence (video and audio) of confrontations enablingsuccessful prosecutions to be made The smart13 phone itself is becoming a valuable itemthat13 is attractive to criminals These can be tethered to personal attack buttons usingwireless technology allowing the device to be activated by the pressing of a button if theowner is being attacked The phones can then be tracked and located by the police whilebeing rendered useless to the assailant
Bogus callers are a perennial problem for vulnerable people Video door bells can beconfigured to display images and record the words of visitors before they are admittedallowing remote monitoring centres to oversee the situations and use image recognitionsoftware to confirm the bona13 fide of visitors Such13 arrangements may become13 commonplace13 over13 the13 next five13 or13 six years13 significantly13 improving the safety of peopleliving independently
220 Personal safety
The biggest13 risks to personal safety stem from fires and falls Most13 fires are the result13 ofpoor cooking practices resulting in burns or scalds Floods and gas emissions are caused bya failure to remember to close taps
The current13 approach involves detection of an emergency situation as soon as possible but13 always after a problem has already occurred This responsive approach can minimise therisks provided that13 there is a protocol in place for intervening This could increasingly be an
23
automated response such as the switching off of the gas of water or the switching on of asprinkler system or a water mist13 system
In the future monitoring systems will be more sophisticated and will have sensors and localintelligence to identify activities In this way reminders can be issued before an emergencyoccurs13 This lsquosmart kitchenrsquo approach may become13 an integral part of13 homes of13 vulnerable13 people
A prototype system has been developed at the Culture Lab in Newcastle Sensors havebeen embedded into cooking utensils enabling the kitchen to identify what13 the person istrying to cook or prepare It can provide interventions as messages on an instructionscreen
Accidents also occur out13 of doors People with dementia13 might13 become lost13 and may havepoor road safety awareness Location devices based on GPS have advanced from large andheavy receivers that13 were used on ships and boats to small battery-shy‐operated devices that13 can be carried in the hand or in a handbag The current13 generation of locators has limitedbattery life and are rather too large to be secreted about13 a personrsquos clothing while devicesthat13 are integrated into a wrist-shy‐watch are rather clunky and unattractive
Within 10 years the13 technologies13 will have13 matured and will be13 much smaller13 so that theycan be embedded in shoes in walking sticks hats or any other item of clothing Powerrequirements will have reduced so that13 energy harvesting from the movements of theindividual will be sufficient13 to keep these products working for several weeks without13 theneed for recharging The devices will not13 simply indicate to others where the individualhappens to be but13 will provide subtle guidance cues to direct13 them home
Cameras might13 also form part13 of the personal security systems that13 will protect13 people fromaccidents Data13 may be sent13 to the cloud and analysed in real time if the person is in adangerous location and can provide prompts either to the individual or broadcast13 advice toothers to clear the danger These systems may be embedded in items of clothing (such as ahat) or they may be attached to spectacles
221 Energy and13 portable power supplies
The demands of developing economies for more power will inevitably lead to higherdomestic fuel charges in the UK especially as oil and gas reserves dwindle
By 2018 UK homes should be fitted with new smart13 meters The specifications for these13 devices have yet13 to be finalised but13 will include a means of identifying wasteful use ofenergy including TV sets that13 are left13 on and unattended fridges and freezers that13 are set13 attoo low temperatures and dryers that13 are used for too long or when the weather is suitablefor using a washing line They could be an enabling factor that13 supports changes inbehaviour driven by a need to use less power but13 it13 is unlikely that13 they will offer a bigreduction in costs that13 are already a problem for many vulnerable families
24
More generally the need for power conservation will include devices that13 are moreefficient and a significant13 emphasis on heat13 retention in buildings through betterinsulation
The energy crisis may force many people to spend more time in community settingsincluding shops and public buildings where they can benefit13 from the warmth Increasingreliance on mobile communication devices will lead to increasing demand for batterycharging facilities
Greater use may be made of portable devices for generating power based on solar cellswind or hand motion
222 Smart cities and homes
The Digital City initiatives have been based on information and how it13 can be used most13 effectively to make people aware of what13 is going on around them This means bettercoordination of resources more rapid access to advice and a battery of sensors measuringevery conceivable parameter from sound and light13 levels through to air quality andtemperature fluctuations There are several Digital or Smart13 City initiatives currently beingimplemented both in the UK and across the world They may significantly impact13 the livesof the millions of people living in them but13 the timeframe for outcome benefits to influenceplanning and design elsewhere is likely to be at least13 20 years and therefore outside thetimeframe of the current13 project
Housing plays a big role in the lives of most13 people both through their aspirations to moveup in the world (usually to a bigger property with a garden) and as the heart13 of the familylife which is associated with good quality of life UK properties have a life span approaching100 years which is about13 double that13 of their European counterparts (and certainly longerthan the wooden-shy‐frame buildings built13 in North America13 for example) A shortage ofhouses has plagued improvements in social welfare for the past13 30 years There is anargument13 that13 there are enough houses but13 the wrong size and in the wrong places andthis has some basis in fact13 as demography changes lead to more people (and more olderpeople) living alone However if there are two million homes in Scotland each with alifespan of 100 years then the renewal rate needs only to be 20000 per annum to maintainthe status quo However it13 must13 be clear that13 the impact13 of smart13 house development13 willbe small The focus should therefore be on adapting existing properties to render themmore appropriate for vulnerable people
Housing adaptations are a branch of assistive technologies The technologies for providingdifferent13 forms of accessible bath and level access shower are well-shy‐established with littleresearch considering anything other than alternative building materials and methods formaintaining the temperature of the bathwater Different13 technologies for bathing will beconsidered separately
25
Thus housing technologies are not likely to impact on social work13 within the next 20years13 though13 the use of information13 technology13 to ensure that people are aware of what13 is available is likely to be commonplace well before then
26
3 BEHAVIOUR AND ATTITUDE CHANGES DUE TO TECHNOLOGICALADVANCES
Technology is only one factor that13 will affect13 the way society changes in the next13 10 or 15years This chapter will consider the context13 in which the technological developmentsoutlined in the previous chapter will be supported (or held back) by societal factors
When the impact13 of such factors has been considered we can then apply theseassumptions to a number of case studies listed in Appendix13 A13
The headings selected for this chapter are not13 arbitrary as they reflect13 the context13 in whichtechnological changes must13 be considered They must13 include consideration of factors suchas demography and long-shy‐term conditions already addressed in the introduction to thesepapers together with the aspects of workforce and citizenship considered in the parallelpapers The additional elements here focus on trends that13 are already occurring and whichmay leave people struggling with the changes that13 occur
Finally there is a need to consider the attitudes of people to technology generally andespecially to the issues of privacy and social responsibility that13 could be radically changedby technology In some cases public opinion will prevent13 some forms of technology beingdeveloped if not13 commercialised In other cases some technologies will be fast-shy‐trackedeither at the request13 of government13 or because of a clear public demand for theopportunities that13 it13 can bring
Predictions13 about the13 future13 must inevitably be13 subject to considerable13 uncertainty butthat is no reason to stop thinking what might happen
31 The Welfare State
The UK can be rightly proud of the way that13 its welfare state has developed during the past13 100 years to provide a safety net13 of financial support13 to people and to their families whenthey are unemployed destitute homeless or challenged by crises and emergencies Therange of benefits received is considerable some are complex and many people struggle tounderstand their entitlements Some are universal some are discretionary some apply onlyto parents others to anyone
The total cost13 of providing these benefits continues to rise and when the economy isstagnating there is inevitably both political pressure often supported by popular publicopinion to introduce welfare reform so that13 people who do not13 work cannot13 be better offthan they would be if they were in full-shy‐time employment This strategy requires a universalbenefit13 to be introduced so that13 it13 is easier for claimants to access support13 but13 also easierfor agencies to identify the total benefits received The idea13 of a benefits cap then becomes
27
more practical to introduce especially if all the processes involved in making a claim arehandled electronically Indeed this encourages government13 to insist13 on applications forbenefits to be made on-shy‐line Unfortunately this will marginalise those people who haveneither a computer nor access to the internet thus emphasising the digital divide in amanner which works against13 some of the most13 disadvantaged people in society
There are currently few tangible links between digital technology and welfare provisionThe most13 obvious are universal benefits such as a free television licence (worth pound14550)13 for13 everyone aged 75 or older with blind and visually impaired people entitled to a 50discount13 irrespective of their age The significance of this position is that13 6 of revenuesgenerated through licence fees are to fund BBC on-shy‐line services13 such13 as websites and i-shy‐player In Scotland the BBCrsquos Alba Gaelic language television service is predominantlyfunded13 by MG Alba an organisation funded by the Scottish Government It is thereforeconceivable that13 in the future licence fees may be used to directly subsidise access toinformation and advice through the Internet13 for vulnerable people whether it13 is throughbroadband access or through a set-shy‐top box which removes the need for a computer in thehome to access particular websites or to use e-shy‐mail services
A second age-shy‐related benefit13 available in the UK is the winter fuel subsidy People whoreceive certain benefits receive the payments automatically while others must13 make aclaim Those who are not13 eligible for benefit13 due to a lack of an address for example missout13 on these payments and also on Cold Weather payments of pound25 for each seven dayperiod of very cold weather between 1 November and 31 March
The development13 of new warm home initiatives plus the complex of subsidies that13 theelectricity supply industry and government13 offer to people with solar cells further changesthe economic arguments Global warming may lead to greater variations in weatherextremes but13 might13 also increase the amount13 of electricity that13 can be generated byalternative (green) sources such as wind and solar cells It is estimated that13 energyconsumption in the UK increased by 17 between Christmas and Easter 2013 compared toprevious years as a result13 of cold weather but13 the above subsidy scheme did not13 benefit13 older people because two of the seven day cold periods were after 31st March It must13 beassumed that13 there will be more people living in fuel poverty in the future and this will leadto more cases of cold related illness including influenza13 and stroke
32 Management of long term conditions
The management13 of long term conditions will be improved for patients who are compliant13 with their medication regime so it13 is possible that13 there may be compulsion to adhere tothe prescription Such compulsion may be monitored using technology Indeed the remotemonitoring of vital signs using telehealthcare will become commonplace as the old boxesand sensors are replaced by devices that13 can be worn continuously or which can beembedded into the fabric of homes (including furniture and bedding) or can be worn asvests or patches They will wirelessly transmit13 data13 to smartphones or tablets and mobile
28
transmission and cloud technology will enable real-shy‐time data13 collection analysis andfeedback
One of the diseases which is projected to increase most13 significantly over the comingdecade is Type 2 diabetes Whilst13 there is a hereditary susceptibility to this condition formany people including those from the Middle East13 and the Asian sub-shy‐continent it13 is also adisease which tends to affect13 those people who are overweight13 andor have a sedentarylifestyle If untreated diabetes can lead to dizziness and collapse at any time but13 can alsohave more devastating long term consequences which include kidney failure strokeblindness and in extreme cases lower limb amputations Management13 therefore includesdaily monitoring of blood glucose levels and major dietary changes such as a significant13 reduction in the consumption of carbohydrates as well as a rigid exercise regime
Many newly diagnosed diabetics follow this advice closely and can lead normal lives for 40years or more but13 some struggle to accept13 the change in lifestyle required as well asremembering which foods are allowed and how much exercise they need to takeIndividual support13 plans are now forthcoming and over the next13 ten years best13 practicewill emerge in the form of smartphone apps that13 are personalised and which can becomean individualrsquos health coach This level of support13 will be fine for some people but13 otherswill need incentives so it13 is likely that13 gaming technologies will be introduced perhapsoffering rewards for good compliance There will be a temptation for some people tocheat perhaps allowing others to perform exercise for them or changing theirconsumption details
Many of these opportunities for cheating will be removed through the use of a uniquebiometric identifier a technology that13 will be mature enough to use in place of passwordson smartphones However the biggest13 challenge may be in encouraging older people to usethe technology Many older people have multiple morbidities Indeed a survey of Scottishpatients implied that13 42 of people aged over 80 will suffer from three long termconditions It will be essential for those people to comply with treatment13 regimes if they arenot13 to have the functional deficits that13 follow
33 Finding people who13 donrsquot fit
People who have low social capital are likely to have few relatives and friends with whomthey regularly communicate and are also unlikely to be part13 of community or faithorganisations such as clubs societies and church groups They also die several yearsyounger than most13 of the population often because they donrsquot13 engage with public healthinitiatives such as vaccinations against13 flu regular checks on their blood pressure bloodsugar levels or in the case of women smear tests or mammography The most13 likelyreason for disappearing beneath the radar of such initiatives is their mobility which leadsalmost13 inevitably to them having no fixed abode and no fixed telephone line It thenbecomes very difficult13 for them to be contacted because their mobile telephones are likelyto have Pay-shy‐As-shy‐You-shy‐Go contracts that13 donrsquot13 require validated names addresses and bankaccounts
29
It follows that13 some of the most13 vulnerable people in society including those who live onthe streets are effectively unknown to both the NHS and to social work departments untilthey are referred in a crisis This could be an emergency presentation to a hospital Accident13 and Emergency Department13 where they will come into contact13 with a social worker becausedischarge may be unsafe This often highlights the importance of the prevention agenda13 and the potential for avoiding admissions to hospital by intervening at an earlier stage
The advantages of being able to locate people who are vulnerable to specific diseases willincrease as genetic testing becomes more routine It is already possible to determine whomight13 be most13 at risk of breast13 cancer and prostate cancer as a result13 of family history Addto this the evidence that13 particular diet13 and exposure to environmental factors can furtherincrease risk then it13 is evident13 that13 individuals can be identified and offered treatmentsthat13 could save their lives many years before they become ill In the case of cancersperhaps only the individual is involved but13 for infectious diseases it13 is the whole of societythat13 is at risk if someone contracts one of the new strains of influenza or if someonechooses not13 to be vaccinated against13 rubella In Chinese airports all visitors are screenedfor fever and refused entry if they tested positive in cities the public are monitored in thesame way Similar approaches may be necessary in the UK if potential carriers cannot13 otherwise be identified
34 Volunteering
It is estimated that13 72 per cent13 of people volunteered to perform a charitable act13 at least13 once during 2012 a rise from 65 per cent13 the previous year About13 four out13 of every 10volunteers offer their services formally to one or more organisations The remaindervolunteer informally by helping out13 a friend or a neighbour Around 50 per cent13 volunteered at least13 once a month in the past13 year up from 41 per cent13 on the previous13 year Most13 have retired many of them before the statutory retirement13 age Those whodonrsquot13 feel able to offer time have offered their financial support13 at a time when the fundingavailable from sources such as the National Lottery has been decreasing Despite economicausterity donations to charities have been increasing 74 per cent13 said they had given tocharity at least13 once in the previous month up from 72 per cent13 the previous year
Strikingly 78 per cent13 of people strongly believe that13 they are part13 of their localneighbourhood an increase from 70 per cent13 10 years previously Community cohesion isstronger than ever 87 per cent13 of people believe their local area13 is a place where peoplefrom different13 backgrounds get13 on well together compared to 80 per cent13 in 2003
The role of volunteers in supporting vulnerable people is therefore likely to increase overthe next13 decade perhaps exploiting the success of the army of volunteers that13 was highlysuccessful in London during the Olympic and Paralympic games The greatest13 role for suchvolunteers may be in providing informal care for older people Already the UK has someseven million informal carers whose value in monetary terms has been calculated to be
30
more than the combined budgets of the NHS and social care Maintaining or extending thisprovision will help to support13 services in the future and may be supported by technology
Whilst13 there is ample evidence to suggest13 that13 telecare services support13 informal carers asmuch as (if not13 more than) the people that13 they are caring for it13 is the potential for utilisingthe internet13 and apps to make their role easier to coordinate and hence more effectivethat13 is likely to be most13 successful moving forward
Many of these focus on particular tasks that13 informal carers can help offer to older peoplesuch as organising their medication A pillbox program is just13 one feature of an app calledBalance It also includes sections for caregiving tips notes for the doctor and the patientsappointments plus a lsquolearning sectionrsquo with articles on aspects of Alzheimers and an RSSfeed for news about13 the disease Tyze is another multi-shy‐functional app it13 allows carers to
bull Organise appointmentsbull Plan outingsbull Share storiesbull Send updates to other family members
Another application is Rally Round which helps carers to organise someone to perform littlejobs often on a temporary basis when someone has dementia physical frailty or isrecovering from accident13 or illness Similar applications are MeMaxi and Finerday
35 The High13 Street
The shape and appearance of UK shopping centres have been changing for half a centuryPeople complain that13 centres are losing their identity with one town looking like everyother both in terms of the stores and in terms of the layout But13 there are three trendswhich are having a profound impact13 on many of the most13 vulnerable people in society
bull Centres lock their doors at 6pm or in some cases 10pm -shy‐ thus denying people whosuffer from claustrophobia13 from window shopping at times when other shoppershave left
bull Out13 of town shopping malls -shy‐ these US style centres are ideal for people in carsbecause they offer free parking which is essential for people who want13 to buy largeritems but13 difficult13 for people who have no transport13 and who must13 rely on publictransport13 that13 is often deficient
bull The rise of online shopping -shy‐ which means that13 many potential shoppers only visit13 High Street13 stores to check the prices before returning home to make a purchaseonline
It is the third of these effects that13 has the greatest13 potential for changing the High Street13 forever and it13 is making life for traditional retailers increasingly difficult13 at a time when highrents are crippling stores large and small It is difficult13 to see how this trend is likely tochange because consolidation in banking and estate agencies is already forcing the closure
31
of other High Street13 players while additional pressures on pubs has led to the closure ofthousands of pubs every year
Those figures however demonstrate that13 consumers still value what13 the high street13 canoffer -shy‐ the chance to inspect13 what13 theyrsquore thinking of buying -shy‐ as well as the new opennessof the internet Customer service makes a difference to people especially if there is aproblem and goods need to be returned One of the most13 common reasons for furniture tobe returned for example is that13 when a sofa13 or a wardrobe was delivered it13 couldnrsquot13 fit13 through the front13 door or up the stairs In the future people will be able to benefit from13 visualisation technology they will upload the floor plans of their homes enabling theretailer to inform them of the problem before they try to delivery Augmented reality viewwill similarly allow customers to see what13 a new item of furniture will look like in itsintended place so that13 they can be more informed about13 the effect13 of size and colour
In terms of improving the viability of the High Street stores will have to focus on theimportance of brand which could mean that13 individual independent13 retailers will have topartner with national suppliers to support13 a local tailored offering based on products that13 are designed for a more global market This is a lsquoconnected High Streetrsquo approach whichcould be enabled by the developments in internet13 availability and smart13 phone accessdescribed in the previous section
The overall effect13 of all these changes could mean that13 town centres become smaller but13 more vibrant13 areas They could thrive if people are attracted there in large numbers whichmeans that13 retail must13 be developed alongside restaurants pubs galleries and other leisureopportunities This is possible in new shopping centres which are already being integratedwith transport13 hubs including railway and bus stations but13 may be more of a design13 challenge for older towns and cities with large Victorian buildings To ensure that13 morepeople are welcomed into the new centres they should include attention to green spacesand areas where people can relax without13 feeling that13 they are second class citizensbecause they donrsquot13 have the same buying power
3513 Privacy
To some people privacy is their right13 to live their lives without13 interference they may seethe State as a potential lsquoBig Brotherrsquo spying on their every move and judging their actions13 and activities Other people have fewer concerns about13 the role of the State but13 great13 fearof individuals interfering with and invading their privacy Some embrace the concept13 of lsquomyspacersquo an area13 of a square metre or so into which nobody can enter without13 permissionThis allows them to avoid physical contact13 and to feel safe from any form of threateningbehaviour
Yet13 this idea13 of private space and its potential violation is merely the tip of the iceberg asfar as privacy is concerned more significant13 is the idea13 of personal (and private)information being shared with anyone and everyone This could be related to identityopinion or image for an individual who wants to remain anonymous or even secretive thisis going to become an increasing problem as technology provides the means of taking
32
photographs recording conversations and capturing environment13 with something as smalland ubiquitous as a mobile phone The fact13 that13 this information can then be shared withthe rest13 of the world using e-shy‐mail Twitter and Facebook makes the problem all the moredifficult So the threat13 is no longer solely from the long lenses of the Paparazzi but13 fromanyone (and that13 means everyone) who has even the most13 basic of mobile phones
This relates to the changing views of society on what13 information should remain privateand what13 should be shared with others The success of social media13 has been based on anattitude of lsquosharing everythingrsquo with either your friends or the world This has introduced anaiumlve idea13 in the minds of some younger people (especially those known as Millennials ieaged 18-shy‐30) that13 everyone can be their friends whilst13 perhaps failing to reinforce the bondsof genuine friendship with any form of test13 or restriction Technology could play a role indefining these friendships and allowing individuals to understand what13 makes a goodfriend but13 this approach has yet13 to be developed and may be slow to overcome the needfor some people to measure their own popularity simply as the number of people that13 theycan list13 as friends on their Facebook page
It follows that13 there may be a need for a new definition of privacy that13 is in keeping withthe web and its ability to display images and opinion in an unregulated manner This needsto embrace past13 concerns about13 the ability of an individual to live without13 the threat13 ofothers being able to watch them whilst13 offering some protection from random postingsabout13 them online Perhaps this could include a right13 to be able to edit13 or remove anythingrelating to themselves on the Web including images that13 are not13 news-shy‐worthy Theownership of image rights may be an associated issue that13 needs to be addressedespecially as modern technology can remove an individual from a group (or a background)13 view provide digital touch-shy‐up or air-shy‐brushing and then republish it13 in a different13 contextHowever there is general agreement13 that13 personal information (such as contact13 details andbank codes) should not13 have a place on the web Surprisingly few people take proactivemeasures to prevent13 tracking functions being activated
It follows that13 too much privacy could lead to younger people fearing that13 they maybecome lost13 in a digital world It is not13 surprising then that13 they are prepared to make lots13 of personal information available often with no fear of how it13 might13 be used by othersWhen Google glasses and similar technologies become available during the next13 few yearsthey will have the potential to identify a stranger walking down the street and to find manyof their secrets to present13 to the wearer in a fraction of a second They could know moreabout13 them than their genuine friends know -shy‐ so who will be their friends in the future
36 Data sharing and13 protection
By lsquodata13 sharingrsquo we mean the disclosure of data13 held by one organisation on an individualto a third party organisation(s) or the sharing of data13 between different13 parts of anorganisation Some data13 sharing doesnrsquot13 involve personal data13 because it13 has beenanonymised in such a way that13 the statistics can be used for the collective good without13 theidentification of the individual The Data13 Protection Act13 (DPA) is in place to provide a legal
33
framework that13 ensures that13 organisations that13 hold personal data13 must13 act13 responsibly atall times These principles adequately describe the position of public and government13 bodies especially social services departments who are responsible for the informationconcerning the health and well-shy‐being of individuals -shy‐ and hence by implication thesensitive data13 relating to their vulnerability
The legal framework that13 applies to private and third sector organisations differs from that13 which applies to public sector organisations which may only act13 within the defined limits oftheir statutory powers However all bodies must13 comply fully with the data13 protectionprinciples and this situation is unlikely to change within the next13 10 to 15 years In someprivate sector contexts there are legal constraints on the disclosure of personal dataHowever most13 private and third sector organisations have a general ability to shareinformation provided this does not13 breach the DPA or any other law It is advisable for acompany to check its constitutional documents such as its memorandum and articles13 ofassociation to make sure there are no restrictions that13 would prevent13 it13 from sharingpersonal data13 in a particular context The type of data13 held is therefore a subject13 ofconcern as it13 may be difficult13 for legislation to keep up with the additional layers of data13 created on-shy‐line and through the Internet13 of Things
Private and third sector organisations should have regard to any industry-shy‐specific regulationor guidance about13 handling individualsrsquo information as this may affect13 the organisationrsquosability to share information They should also be aware of the legal issues that13 can arisewhen sharing personal data13 with public sector bodies This becomes more of an issue asprivate and third sector bodies are carrying out13 a wider range of traditionally public sectorfunctions Opportunities for inappropriate sharing of sensitive data13 will therefore inevitablyincrease
Public authorities must13 comply with the Human Rights Act13 (HRA) legislation in theperformance of their functions The HRA also applies to organisations in the private sectorinsofar as they carry out13 functions of a public nature which could include delivering a socialcare activity Where the HRA applies organisations must13 not13 act13 in a way that13 would beincompatible with rights under the European Convention on Human Rights Article 8 of theConvention giving everyone the right13 to respect13 for their private and family life their homeand their correspondence is especially relevant13 to sharing personal data If personal data13 isdisclosed or shared in ways that13 comply with the DPA the sharing or disclosure of that13 information is also likely to comply with the HRA The problem may still be in policing theActs and the rights of an individual if they believe that13 their personal data13 has been sharedor accessed by an inappropriate organisation or individual
A legal industry may be born to deal with such matters but13 this is unlikely to benefit13 peoplewho cannot13 afford the fees involved They would require either legal aid or to employ13 more13 lsquono win no feersquo companies Public attitudes to such costs might13 become negative unlessthey prove successful in preventing breaches of data13 security There may need to belegislation to provide a stronger basis for forcing compliance with privacy laws
34
37 Connecting with13 people
We are social creatures most13 of us rely on our friendships and interactions with friendsand families to share our happiest13 moments and experiences Research suggests that13 thishappiness is infectious at all levels and leads to a 15 increase in the happiness of a closecontact 10 for a second degree contact13 such as the friendrsquos spouse and a 6 increase fora friend of a friend It is hardly surprising that13 the success of social media13 such as Facebookis intimately related to the ability of people to quickly share their happiest13 moments with asmany of their friends and connections as possible
All this has happened during the rise of the Internet13 and the corresponding increase inopportunities for connecting online ie this is a 21st Century phenomenon which has beenfacilitated by Information and Communications Technology But13 the Internet13 remains in itsinfancy and we are only beginning to understand and exploit13 its potential In terms ofaccessing the Internet there are now perhaps two billion people who have access with99 of them having gained this during the past13 decade This number will have doubled bythe period 2020 to 2025 It is likely that13 everyone who wants to be connected in the UK willby then be connected Turning this on its head only those who donrsquot13 want13 to be online willnot13 be on the Internet13 within a decade Connecting with the unconnected will therefore bea case of identifying those people who donrsquot13 want13 to be found unfortunately these mayinclude many people who need the support13 of social care organisations It means that13 theywill be looking for support13 only when they are in crisis unless other ways of finding andormonitoring them are found
While the number of people connected via the Internet13 has exploded this might13 bedwarfed by the number of connected lsquothingsrsquo During 2009 the number of thingsconnected to the Internet13 surpassed the number of connected people at which point13 webegan to experience what13 this report13 has described as the lsquoInternet13 of Thingsrsquo Yet 99 ofall physical objects that13 could join this network are not13 yet13 connected but13 the number couldgrow by 25 every year for the next13 decade so that13 there could be 100 billion connectedobjects by 2025 some of which will be owned or used by everyone in the UK includingthose people who donrsquot13 want13 to be connected themselves We will then have an Internet13 of Everything which will be the smart13 connection of people data events and actions
With each new person object or data13 that13 comes online the connection possibilitiesbetween all these elements grows exponentially The rise of big data mobile networkingcloud storage and data13 mining technologies will all play a critical role in the Internet13 ofEverything The result13 will be new capabilities richer experiences and unprecedentedvalue for individuals businesses communities and countries everywhere The lsquonetworkeffectrsquo of the Internet13 of Everything will be a very powerful thing the true impact13 of whichwe wonrsquot13 fully understand for several years As it13 develops however those who are not13 connected will feel even more digitally and socially excluded There will be a need to reachout13 to vulnerable people unless the process of claiming requires proof of online identityand the payments to be received can only be redeemed using a chipped card or adownloaded app onto a smartphone This is of course the way that13 welfare arrangementsare already developing thus it13 might13 prove impossible to make a successful claim without13
35
already being connected to lsquothe systemrsquo either through an online presence or through theInternet13 of Things
38 Downloading everything
Sixty years ago information was discovered by reading books often in a library wherenotes had to be made because the books or journals couldnrsquot13 be removed Then in theearly 1960s the first13 office photocopying machines were introduced into the UK theyimmediately meant13 that13 pages or articles from books could be copied and taken away to beread and summarised later Within a few years photocopying became a replacement13 forreading as researchers became less adept13 at selecting a few sentences and every deskbecame a depository for reams of printed paper Paper became the means of recordingeverything from bank statements through to music
We now appreciate that13 printing everything is a waste of both the ink (or toner) used tocreate the black print13 and of paper which requires trees to be chopped down and pulpedbefore it13 can be pressed into thin sheets Saving paper is therefore seen as green and goodfor the planet Fortunately we no longer need to print13 everything because computermemory is unlimited thanks to the cloud and we can then view pages and articles onportable or fixed screens
The internet13 has everything and it13 is all available instantly for downloading providing thereis a device available to accept13 it and there is sufficient13 communication bandwidth toperform the transfer of data13 sufficiently quickly Thus we can record all text13 articles that13 are relevant13 to us including digital records of birth certificates qualifications and passportsand the need for original printed versions will decline But13 we can also do this forphotographs Most13 handheld computing devices include at least13 one camera so they cangenerate enormous number of pictures which can be kept13 for posterity without13 having toconsume inks and special papers to print13 them
But13 the materials that13 can be downloaded donrsquot13 stop at pictures software is available that13 can grab TV shows after they air and movies as soon as theyre released In the same wayit13 is possible to schedule music comic books video games and practically anything else asa download with minimal effort People will need enormous hard drives if they want13 theirown digital copies of these files so will more than likely make use of cloud storage that13 willbe available from many organisations The location of the servers may become sensitivedue to border restrictions as will the security of the data13 and the way that13 it13 is backed up sothat13 it13 is resilient13 to failures
It may be evident13 that13 application forms for all types of welfare payment13 will be availableonly for downloading so that once digitised they can be processed by computer andrecords sent13 to various servers for subsequent13 storage and processing Some people maywant13 to keep their data13 on them once it13 has been downloaded Pen drives can already holdseveral GB of data so it13 is likely that13 people will be able to carry their downloaded data13 withthem at all times irrespective of the size and complexities of the information
36
39 Health13 and13 well-shy‐being
The general health of the population is unlikely to deteriorate noticeably within 10 to 20years Indeed expectations of the population are that13 things must13 improve as surgicaltechniques mature and as pharmaceutical interventions become more personalised andpowerful However the rising demand for health services due to an ageing population andthe increasing cost13 of providing sophisticated therapies will make delivering a free anduniversal health service difficult13 without13 substantial increases in taxation This is unlikely tohappen in the UK even though spending on health services will be protected against13 thecuts facing other services
There will have to be changes in how the NHS works For twenty years hospitals have beenclosed and replaced by fewer new facilities so that13 the bed count13 is reduced This has led toa significant13 shift13 in resources to primary care and community care supporting shorter staysin hospital and speedier transfer back home for people after surgery or illness This hasbeen13 successful but13 there remain problems with demand for GP services especially out-shy‐of-shy‐hours and at weekends Indeed despite the introduction of NHS24 and similar help-shy‐linesthe demand for GP appointments continues to increase Delays are inevitable and this willincrease system failures with more unnecessary deaths and a failure for people to access adiagnosis that13 might13 lead to early interventions and ultimately lower delivery costs Over250 more patients are added to waiting lists every day
This will lead to a new model of primary care consistent13 with existing changes which haveseen surgeries move from High Street13 locations to medical centres close to bus routes andwith more parking for patients The process of making an appointment13 is changing from atelephone-shy‐based interview process dominated by a medically-shy‐unqualified receptionist13 to achoose and book approach using an online process linked to electronic patient13 records Thiswill give patients more convenience but13 will allow priority for those who have Internet13 access at the expensive of those who are digitally excluded Making the process of bookingan appointment13 quick and easy may also increase demand from people who do not13 need tobe seen as it13 will fail to identify those in greatest13 need
A greater use of telehealth and telecare technologies will be inevitable beginning with thefirst13 contact13 as an encounter using the telephone e-shy‐mail or video conferencing -shy‐ a visit13 tothe GP surgery should be a last13 resort and should involve a nurse consultation in the first13 instance This would be consistent13 with three quarters of appointments currently involvinga chronic disease or long term condition which relates to improved self-shy‐care The support13 ofthese patients at home should be prioritised through tele-shy‐ and web-shy‐based technologies andshould involve training and coaching through a network of nurse practitioners Home visitsshould generally be unnecessary through the use of these technologies but13 could besupplemented by satellite surgeries manned by nursing in community premises or inpharmacies nurseries and Internet13 cafes
The homes13 of people who13 need13 closer monitoring can then become part13 of virtual wardswith real or electronic visits by health professionals University Hospital Southampton NHSFoundation Trust13 already looks after patients who have undergone surgery such as a hip orknee13 replacements in virtual wards with high levels of satisfaction The Royal Free London
37
NHS Foundation Trust13 offers a similar service but13 plans to add the possibility of videoconsultations between patient13 and consultant
310 Attitudes to public health issues ndash obesity smoking alcohol abuse drugs
As self-shy‐care becomes the focus of the NHS the public will increasingly understand that13 thecosts and availability of services are being harmed by the poor health behaviour ofrelatively small numbers of people The link between public health initiatives today andhealthcare needs and costs in the future will become increasingly evident13 as a result13 of theway that13 information is presented Thus the overweight13 smoker who currently attractsconcern and pity when they are diagnosed with diabetes and COPD is increasingly beingseen as the victim of their own stupidity or lack of self-shy‐discipline If they continue to neglect13 medical advice and continue with an unhealthy lifestyle then the way that13 they receivetreatment13 and consume resources will become a matter for the entire population
Obesity is seen as due to a combination of poor diet13 and a sedentary lifestyle No longer isthe idea13 that13 people are lsquobig bonedrsquo acceptable Governments will respond initially byrequiring manufacturers and food processors to provide nutritional information onpackaging and on menus in restaurants But13 people can choose not13 to read the data13 and toneglect13 both the importance of food quality content13 and quantity This will increasepressure to introduce fat13 or sugar taxes and these are likely to be in force within a decade
Although the high taxes on tobacco products has forced some smokers to reduce theirconsumption or to give up altogether the impact13 has been reduced by the smuggling ofproducts from overseas and by the availability of duty-shy‐free cigarettes for people returningfrom foreign holidays and business meetings Further measures are planned to changepackaging and to include even more graphic images and warnings on cigarette packages tomake smokers aware of the effects of smoking on their health and well-shy‐being There is asyet little evidence of how successful this might13 be More effective has been the banning ofsmoking in public places including trains and aircraft Expensive medical interventions suchas heart13 transplants will be denied to individuals until they change their lifestyle behaviourSmokers might13 therefore be increasingly ostracised leading to a loss of esteem This mayhave a particular impact13 on people who already suffer from mental health problems whoare more likely to smoke
The overuse of alcohol is being recognised as a major factor in hospital admissions withNHS figures showing an increase of over 40 in such admissions over the past13 decadeLinked to this has been a 75 increase in prescriptions to treat13 alcohol dependency Fewpeople have sympathy for those who waste their limited income on booze If they havechildren or other dependents they will be the ones who suffer and who may need thesupport13 of social care
Drug users are already significant13 users of social services as their habit13 is likely to makethem unemployable They receive little sympathy from the general public because they areseen as criminals and people who waste public resources Levels of drug abuse have been
38
slowly increasing over the years but13 this trend is slowly being reversed Indeed the numberof people using drugs during the past13 year has fallen to its lowest13 level for nearly 20 years(below 9) with cannabis being most13 likely often following excessive drinking Aselectronic noses and other technologies can detect13 traces of drugs it13 seems likely that13 success in overcoming addiction can be measured objectively This may become a two-shy‐edged sword rewarding those who can turn around their lives but13 further marginalisingthose who canrsquot13 or wont13 accept13 the lsquocold turkeyrsquo
311 Attitudes to surveillance
Issues associated with privacy confidentiality and data13 security have been discussedpreviously in the context13 of information technology the World Wide Web and the ease ofcollecting recording recalling analysing and displaying data The monitoring of individualsand their methods of using this information can be regarded as surveillance As thequantities of data13 increase along with the number of devices that13 can be used to access itthe surveillance tools will also increase in their sophistication Indeed the Big Data13 approaches described in the previous section will enable the combination of structureddata13 (such as the information held in databases) to be married with unstructured data13 fromimages in such a way that13 it13 can be mined
Whilst13 the lsquodigital surveillancersquo methods described above may cause most13 concern topeople because of its impact13 on anonymity it13 is the collection and analysis of images that13 are the major concern to people as they contemplate the ways that13 lsquoBig Brotherrsquo maydevelop to restrict13 freedom Every major UK city and town centre has an array of CCTVcameras that13 continually record activities from every angle If it13 used to be true that13 nobody in London was more than 10 yards from a rat it13 is certainly the case today that13 nobody can be more than this distance from being in view of a surveillance camera Yetthey receive so much positive publicity from TV programmes where their footage is used todetect13 vehicles close to a crime scene or to monitor the movements of suspects that13 theyare now accepted by the public as a deterrent13 in the same way as lsquobobbies on the beatrsquowere seen 25 years ago There is therefore little public reaction to the expansion in the useof video surveillance except13 for the practical observation of how so many views can beinspected and recorded
Looking to the future the tumbling cost13 of video technology will surely lead to anotherincrease in the number of devices The aerial views taken from towers will besupplemented by more local views taken by devices that13 are embedded in the fabric ofbuildings or carried by individuals either on their person (for example on clothing orspectacles) or in the bags that13 they carry The time and date-shy‐stamped images as Big Datawill be recorded to lsquothe Cloudrsquo where it13 can be added to other data It can then be usedwhen an incident13 has occurred or to provide further detail of night-shy‐time activities
It follows that13 there will be no hiding place for people who simply want13 to disappear Theymay respond by wearing clothing (such as hoodies) that13 hide their faces or which make it13 difficult13 to distinguish gait13 or mannerisms from which they might13 be identified New forms
39
of clothing may be designed to make shapes more difficult13 to analyse and these might13 become the uniforms of a class of person who wants to live in a way that13 they donrsquot13 interact13 with officials from any ministry or local government13 department If they also obstruct13 services then they will be considered to be anarchists of some form sparking protests fromother sectors of society
31213 Attitudes to driving
Motor cars have been a feature of UK roads for over a century but13 it13 is only during the past13 50 years that13 they have become a resource that13 most13 families have had access to enablingthem to travel without13 the restrictions imposed by a limited railway network and non-shy‐integrated bus transport People who have had a car throughout13 their lives often see theircars as an important13 factor in enabling them to remain independent13 and to exercise choicesrelating to where they shop and where they spend their leisure time This extends to theirspouse and to friends and neighbours that13 they might13 take with them on their variousexpeditions
Unfortunately there are incidents involving older drivers who perhaps go down amotorway in the wrong direction who are taken ill at the wheel or who are involved in anaccident13 involving no other vehicles These are small in number but13 often lead to a reactionthat13 they shouldnrsquot13 be allowed to drive lsquoat13 their agersquo Age itself is not13 an indicator ofdriving quality but13 because old age also brings more chance of having limited long termconditions and other illnesses it13 is easy to make a link between driving ability and age Thelicensing system does require continued driving to be linked with medical advice andforbids people with poor eyesight epilepsy and other conditions to hold a licence in oldage
Yet13 statistically older drivers cause far fewer accidents than younger drivers The reasonsfor this may be complex and are likely to include the fact13 that13 they drive less often covershorter distances and donrsquot13 go out13 in the dark or in poor weather However it13 does not13 wholly explain why the UKrsquos drivers aged over 70 and who represent13 some 8 of all driversare involved in only 4 of accidents that13 cause injury This compares favourably with the15 of13 drivers aged between 17 and 29 who are involved in over a third of crashes that13 result13 in injury
By 2020 the number of drivers aged over 70 on UK roads is likely to increase to over 7million This will require a new national strategy perhaps involving support13 for olderdrivers further training raising awareness of issues and making more use of adaptivetechnologies to support13 the driver in avoiding collision or forgetting to check on the statusof their vehicle Poor eyesight13 could be enhanced by camera technologies rather thanforcing people off the road if they are unable to read a licence plate
The International Longevity Centre has found that13 one in four Britons thought13 driversshould be made to switch off the ignition for good somewhere between the ages of 70 and75 The numbers may decrease as the population ages and as cars become safer Forcing
40
older people off the road may be a natural consequence of providing free bus passes andsubsidised rail fares but13 the growth in the pavement13 scooter industry demonstrates that13 older people value their independence and will do almost13 anything to get13 out13 and aboutPerhaps legislation will result13 in more regulation of electric vehicles and where they cantravel
There can be no doubt13 that13 getting out13 will be associated with better quality of life andwell-shy‐being and this is likely to be supported in the future as evidence of improvedoutcomes emerges It is to be hoped that13 positive stories will be publicised so that13 publicattitudes arenrsquot13 hardened This may be supported by more in-shy‐car monitoring of drivers andthe linking of performance with on-shy‐line driving records and licences These could throughremotely monitored ignition systems prevent13 the use of motor vehicles by people without13 a licence or without13 insurance
313 Climate change
There is a general view that13 the emissions of carbon gases are contributing to globalwarming in a manner that13 will change the UK climate in such a way that13 the climate maybecome more Mediterranean However some scientists believe that13 manrsquos impact13 on theenvironment13 may be small compared with natural variations caused for example bycyclical changes in the sunrsquos energy output13 or by the effects of volcanoes and earthquakesRecent13 evidence has suggested that13 we are going through a phase of changing extremesand that13 this is more likely to cause storms periods of excessive rainfall and unusualseasonal trends with snow and frost13 in the spring and warmer winters Considerableuncertainty remains and it13 might13 be necessary to plan for a number of different13 scenariosand for the impact13 on vulnerable people
I Colder winters UK properties are poorly insulated resulting in excess mortalitiesduring cold spells due to an increased number of people suffering from stroke aswell as bronchitis and other pulmonary diseases The cost13 of heating continues toincrease putting more households into a state of fuel poverty Any further coolingduring the winter months will result13 in more people living in unhealthy coldconditions Winter fuel payments are likely to be restricted to the poorest13 peoplebut13 this might13 exclude people who live in larger properties that13 are more difficult13 toheat
II More storms excessive winds and rain can cause flooding at any time of the yearMany UK communities are built13 close to rivers and these can surge during heavyrainfall causing houses to be filled with water and furniture and carpets lostInsurance can be problematic for properties built13 on flood plains which can blight13 properties and prevent13 owners from being able to sell and move on High winds canrip off roofs causing injury and also causing families to be left13 homeless anddependent13 on social services
III Hot13 summers Europe suffered high temperatures during the summers of 2003 and2004 leading to heat13 stroke and hypothermia The UK has not13 previously sufferedfrom such problems but13 might13 be expected to experience days of extreme
41
temperature and humidity at times Older people may not13 be prepared for suchweather Street13 dwellers may be unable to find shade and supplies of drinkingwater
Irrespective of what13 combination of weather scenarios arise it13 must13 be concluded that13 any extremes will have a major negative impact13 on vulnerable people especially if theyare not13 prepared because they havenrsquot13 received the weather warnings and advice that13 can be broadcast13 using the TV radio and online services Once again the digitallyexcluded will suffer and will pay a high cost Society will continue to pick up the bill interms of demands on social care services unless preventive actions are taken in theform of connecting these people to each other and to formal services
42
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
s13 13
13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
n13 13
13 s13
r13 n13
e13 at13
e13 y13 e13 ld13
ly13
13 e13 t13 e13
s13 er13 e13
f13
rt13 13
13 13
13
r13 13
s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
e13 g13 13
e13
13 13 ial13
13
d13
13 d13 h13 r13
d13 13
s13 y13
e13
13
rd13 r13 e13
13
13
13
e13
e13
d13 13
13
13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
on neighbourhoods clubs and pubs and religious groups Meetings became social eventsand absence either signified a rejection of the group or a trigger for other members tobegin to visit But13 what13 happens when a network starts to disintegrate because of death orgeographic dispersal or because the individual loses physical capacity Can web-shy‐basedsocial networks compensate by nullifying geographic separation or by building newnetworks
Skype arguably demonstrates that13 lsquogeography is historyrsquo by making possible free real timevideo communication with family and friends thousands miles and continents apart Thebarrier of course is being able to afford a computer and a broadband connection whichmay limit13 use by lower socio-shy‐economic groups However its potential as a support13 mechanism should not13 be underestimated the technology is simple and it13 works we needonly the social economic and political will to make it13 happen In Scotland older peopleenjoy free bus travel why not13 free broadband
Social networks such as Friends Reunited and more significantly Facebook have emergedas vehicles that13 can not13 only link friends together but13 can also become a means of appealingfor associations and linkages that13 can be supported by the sharing of personal information
The inclusion of a camera13 on smartphones makes it13 easy to share photographs which canenrich communication For example proud parents may announce the arrival of a newbaby with a picture that13 everyone might13 wish to see On the other hand employers might13 also see evidence of why someone who has phoned in sick is unavailable for work on aparticular day Being aware of and able to set13 privacy levels is therefore important13 in orderto control who can see your personal information and news young people and vulnerableadults in particular may admit13 more people as lsquofriendsrsquo (or connections) than might13 beadvisable
The lifetime of major social networks is likely to be limited to a few years as new businessmodels13 emerge and new promotional strategies offer benefits to subscribers This mayoffer an opportunity for new networks to be created to deal specifically with those peoplewho are excluded in any way including those who will be referred to social services forassessment13 and support
27 Entertainment
Many people still remember the coronation of Queen Elizabeth in 1953 being shown live ontelevision This was an important13 milestone in establishing this new medium as acompetitor to radio and the cinema13 as a source of entertainment The arrival of colour TVin the late 1960s contributed to the declining popularity of cinemas and theatres many ofwhich closed
Today many homes have a TV in every room and technology has advanced to deliver highdefinition and 3D pictures on very large screens or lsquohome cinemasrsquo with surround sound
9
Paradoxically perhaps radio is more popular than ever and cinema13 has bounced back fromdecline to once again become an important13 element13 in the social lives of many people
Video images still or moving can be displayed also on laptops tablet13 devices andsmartphones which means that13 people can be entertained or informed on the move Sometrain operators have followed airlines in providing an lsquoat13 seatrsquo entertainment13 experience13 which can be offered with certain choices though many passengers prefer to use their owndevices and content In the future it13 seems likely that13 access to both audio and videoentertainment13 will be possible at any location and in a way that13 doesnrsquot13 interfere with theenvironment13 of other passengers
For those who want13 neither video nor audio (eg music) entertainment reading mayremain the entertainment13 of choice Many older people have struggled to find suitablereading materials as a result13 of the closure of local public and mobile libraries Some peoplecannot13 support13 the weight13 of a book while others lack the dexterity to turn the pagesOthers have sight13 problems which prevent13 them from reading small print All theseproblems can be overcome using either text13 to speech technologies (which are replacingtalking books) or by using e-shy‐reader devices which allow font13 sizes to be increased easily andwhich offer simple interfacing for moving pages backwards or forwards
In the future it13 must13 be assumed that13 all entertainment13 media13 will be held in the lsquocloud2rsquoand will be downloadable to an appropriate device on payment13 of a fee provided that13 acommunications contract13 is in place
The pre-shy‐requisites will bebull A device (eg PC laptop tablet Kindle)bull A contract13 with a telecoms provider (eg BT Virgin Sky) for broadbandbull A contract13 or contracts with media13 provider(s) (eg Netflix iTunes)
Those who lack any of these components may be entertainment13 excluded
28 Cash13 and13 money
Cash has been king since the abolition of the gold standard It is an expensive method oftransferring money between people and organisations and is a considerable overhead forindustry and for individuals travelling between different13 countries The highest13 denominations are lightweight13 and easily lost stolen or destroyed while the smallest13 denominations are heavy dirty and difficult13 to handle It is surprising that13 physical cashcontinues to be used It can only be a matter of time before it13 is digitised and replaced byvirtual cash
2 This means the material (book film or whatever) is stored in a remote computer (thecloud) and downloaded (or lsquostreamedrsquo) to your device on demand and possibly onlytemporarily
10
Large payments were previously made by cheque They are expensive to process by thebanks because people can write them by hand which makes them difficult13 to readelectronically and automatically Consequently they require human intervention and this isnot13 what13 modern banks wish to do so they want13 to promote greater use of debit13 and credit13 cards The latter were used initially as a cheque guarantee but13 are now being used almost13 exclusively as a means of withdrawing cash from ATMs and for making paymentselectronically UK banks wanted to do away with cheques by mid-shy‐2012 but13 they had toperform a u-shy‐turn under pressure from charities representing older people It is apparent13 that13 digital cheques and other cheque-shy‐replacement13 strategies will be introduced soon that13 satisfy the most13 pressing concerns of older people
It was difficult13 to see how cash could be replaced for payments for lower cost13 items such asnewspapers and sweets until the era13 of contactless payments Near field communicationsystems are likely to replace bar-shy‐codes to carry product13 identification information Theycan be read by electronic receivers The same technology can be two-shy‐directional allowinginformation to be passed from a smart13 phone to a reader and back again The smart13 phoneeffectively becomes a wallet13 which can be digitally filled by the owner and then emptiedwhen making purchases For small sums of money this approach is ideal and is likely to berolled out If cash disappears then begging will become difficult13 and welfare paymentsmade on a card Such cards are already used by social services as a means of providingclaimants with a means of receiving self directed care and support By restricting use of thecard to outlets that13 can provide care and support13 services opportunities for spending thecash inappropriately are restricted
It follows that13 many users of social services will need to have a smart13 phone as well as acard that13 can be used to buy services In the future smart13 phones may be provided as aloan item to claimants for social care This could include a digital wallet13 facility as well asthe communications and information ecosystem that13 would allow these people to receive awhole range of other services that13 would prevent13 their social exclusion and which could beused directly to provide them with information and access to entertainment
29 Biometrics and fraud13 prevention
Identity theft13 is used by criminals to pretend to be someone else in order to accessresources or obtain credit13 and other benefits in that13 persons name Although the concept13 has been around for centuries it13 is a growing concern in the digital world as we acquiremultiple online identities for bank accounts social networks and using public services such13 as paying tax electoral registration etc
Passwords are fraught13 with difficulty typically they are hard for humans to remember andeasy for machines to crack Efforts are therefore focused on other forms of provingidentity for example
11
bull Fingerprints have been accepted for over two thousand years to confirm identitymostly in criminal justice The technique has been applied to door-shy‐lock opening insome supported housing schemes There are practical problems associated withregistering lsquoallowedrsquo fingerprints and the useful lifetime of such products is also onlyabout13 three or four years
bull Retinal imaging and DNA analysis have been relatively slow to follow but13 only dueto the sophistication required for measurements and the time taken for testing Acombination of retinal imaging with facial gestures and blinking is possible in the labbut13 currently takes half a minute to achieve a match -shy‐ and this is achieved only withthe use of considerable computer processing power This sort13 of time makesapplications in mass people transfer impossible
Current13 research in this area13 is focusing on the uniqueness of other body parts such as earsand knees as biometric indicators The ears have great13 potential because they are usuallyexposed though hidden sometimes behind hair and other times by hats and other clothingOn the other hand the knees are rarely visible and however unique they may be there willbe cultural and religious obstacles to overcome before scanning could become a regularpart13 of identity confirmation The cameras which are central to such systems used to beexpensive but as the cost13 of high quality cameras continues to fall (there is one in nearlyevery mobile phone) it13 becomes feasible to devise identification devices that13 use multiplecameras to simultaneously recognise the eye and the ear
Movement analysis can be used to identify people by their walk gait13 and other biorhythmsprovide unique signatures It is possible to learn someone elsersquos gait13 though and injury orillness13 can have a temporary effect13 on gait
Over the next13 ten years with more sophisticated databases and image processing facilitiesthe cost13 of implementing advanced biometrics will fall enabling their application acrossmore diverse areas and in more social opportunities Potentially cameras will use cloud-shy‐technologies to provide individuals with instant13 recognition of anyone approaching them inthe street This could prompt13 a name or the occasion when they were last13 seen or spokento as a secondary method of control in much the same way as Internet13 banking seeks toavoid fraud This13 has13 the13 potential to remove13 the13 need for13 passwords13 and might13 then be13 the basis of machine-shy‐based13 communication13 either in front13 of a laptop or tablet13 device orwhen using13 a smart13 phone
There will need to be special measures introduced to support13 people with any form ofdisability as they might13 well have one or more sensory deficits Similarly people maystruggle to communicate following a stroke or a serious accident Nevertheless it13 may bereasonable to conclude that13 such systems will be both available and acceptable within thenext13 10 to 12 years
12
210 Health13 information
Health records in the form of written documents x-shy‐ray images and clinical observations arean important13 means of making all interventions efficient13 and safe Increasingly people havemany different13 conditions (comorbidities) and may be treated by several specialists Asthese physical records are moved inevitably some get13 lost estimates suggest13 that13 one inthree records is lsquolostrsquo at any one time
The best13 resource for information about13 a patient13 is his or her primary care record which isheld by the GP The UK was an early adopter of electronic primary care records and can beproud of the way that13 these have enabled population-shy‐based information to be collectedand analysed Scotland (and to a lesser extent13 Wales) has led the way in ensuring that13 allthese records are accessible through anonymised approaches that13 allow researchers toexamine trends and improve analysis of performance Fundamental to this has been theallocation of a unique identifier At13 the same time individuals can access these recordsboth to check for accuracy and to see what13 their doctor has said about13 them
This13 has13 the potential to make people more responsible for their own conditions andmight lead to better13 self-shy‐care13 and changes in behaviour13 that might reduce13 the13 incidence13 or severity13 of chronic conditions13 that are related13 to lifestyle
In the future we can expect13 the primary electronic health record to be linked with hospitaladministration systems picture archiving systems and other records held by hospitals sothat13 appropriate medical staff can have access to all relevant13 data
When the social care record is added to the mix then this will mean fewer but13 shorter andbetter assessments for social workers and for healthcare staff They will knowcircumstances and factors that13 could influence the choice of approaches This supports theidea13 of there being only one record consisting of several components all of which areaccessible by an appropriate professional at any time and in any place
The13 ambitions13 described above13 are not13 limited by technology most13 of the interoperabilityissues between rival commercial record systems have been resolved and databaseproviders are being compelled to support13 joint13 working The English NHS Mandate requiresTrusts to effectively replicate arrangements already in place in Scotland and in Wales andthis will go a long way towards achieving a genuinely paperless NHS well before 2020 Withnew biometric identification technologies individual records will be available to out-shy‐of-shy‐hours physicians and to those working in an AampE department13 irrespective of theconsciousness state of a patient
New telecare and telehealth technologies will produce significant13 more volumes of data13 which are currently held in different13 places and owned by different13 organisations rarely thepatient These data13 will also need to be shared but13 only in a manner that13 is acceptable toeveryone Patients may not13 want13 all their mental health information published in a formthat13 can be viewed by social workers GPs may not13 want13 to have access to all the data13 that13 might13 suggest13 that13 there is a domestic crisis to which they had neither the wish nor capacity
13
to respond Monitoring systems that13 support13 the lsquoquantified13 selfrsquo may also offer data13 that13 may or may not be added to the full recordThe future of health information might13 therefore be about13 providing individuals with themeans of producing relevant13 information storing it13 somewhere secure and then viewing it13 at a later time but13 in a format13 (or with advice) that13 is acceptable
See also httpmydexorg lsquoMydex gives individuals back control over their personal datarsquo
(see also Digital Scotland 2020 Achieving World-shy‐Class digital infrastructure a final report13 tothe Scottish Government13 httpwwwscotlandgovukPublications2013029054lsquoconnectivity by any device anywhere and anytimersquo)
211 The Future of Healthcare
The strains on our healthcare delivery system are becoming greater as they are in otherdeveloped countries as a result13 of an aging population rising expectations and unhealthylifestyles The necessary changes will require a significant13 shift13 in resources13 fromsecondary13 care13 where unit costs13 are high to community13 carewhere people can generallybe treated at home
The future must13 therefore necessarily involve efficiencies in hospitals and in the way that13 people can be treated in less expensive locations ultimately in their own homes Hospitalswill use more sophisticated diagnostic tools including scanners of all types to non-shy‐invasivelyprobe inside peoplersquos bodies This will result13 in more day cases and hospital stays (alreadyaveraging under a week) to even shorter periods with on-shy‐going support13 provided inintermediate care settings that13 might13 include hotels care homes or the personrsquos own homeif it13 is clean safe secure and has all the necessary amenities (include access to theInternet)
Advances in medical technology will allow more treatments to be delivered in the homeThis will mean fewer visits by clinical staff and fewer opportunities to attend primary carecentres Pharmacists will become suppliers of information as well as drugs so the balanceof care will shift13 significantly away from doctors who will work in different13 ways relying13 increasingly on telemedicine to bring the specialist13 to the patient13 for an online consultation13 For example if a patient13 complains of nausea13 and severe headaches a virtual consultationcan be offered almost13 immediately and without13 having to send a patient13 with a potentiallyserious and acute condition on a potentially long journey to a hospital
In the above example a neurologist13 may ask further questions as well as conduct13 acomplete neurological examination using videoconferencing technology Airedale GeneralHospital consultants have new contracts that13 require them all to be available for virtualconsultations The first13 benefit13 has been in reducing the need for prisoners at local jails tobe brought13 into AampE (which may need to be locked down depending on the circumstancesand the potential for violence of the individuals involved) potentially saving hundreds of
14
pounds in security costs It also avoids the need for healthcare staff to have to go into aprison environment
The principles described above are already saving lives through telestroke services whichlead to more people being thrombolysed appropriately and avoiding long term support13 that13 often follows a stroke incident Teledermatology has been practised for a number of yearsand results in rapid diagnosis and resolution of problems that13 previously required significant13 time for remedy
212 Gadgets and13 DIY13 healthcare
There are at least13 three elements to healthcare
bull Gathering information on symptoms and physiological parametersbull Interpreting the information andbull Responding to the diagnosis with treatment
Many people choose to exercise self-shy‐care because this gives them control whilst13 avoidingthe need to share their concerns and personal details with others A lsquodo It yourselfrsquoapproach might13 even be encouraged by the NHS as a viable way of using scare resources
Medical devices that monitor vital signs are mature and have been miniaturised so that13 they can be used in the home by individuals with little or no medical training Indeed bloodsugar monitors are being produced specifically for use outside the hospital and in such away that13 they can be used reliably by people with advice and training being provided onlinevia13 YouTube
Many medical monitoring devices do no more than produce a single measure which theuser may record or respond to Others link wirelessly to smart13 phones allowing data13 to bestored and entered into a personal health record where trending opportunities existingIndeed individuals can easily enter their data13 into an app running on their laptop tablet13 orsmart13 phone This trending information may be useful13 for self-shy‐care and could be passed onto a physician though the volume of data13 produced in this way and doubts about13 thequality of the data are likely to persuade GPs to discount13 data13 produced in this way
This gap in knowledge can be filled with advice information and diagnosis that13 can beobtained online using a lsquoDoctor Googlersquo approach The quality of such diagnosis may varysignificantly although there are many sources of information that13 are both supported andapproved by the NHS (and by similar sources in other countries) However with a data-shy‐richapproach and a choice of diagnosis people may be empowered to take a greater role inhealthcare
15
The final component13 for the DIY enthusiast13 is the treatment13 option Many people fear longterm use of medication produced by the big pharmaceutical industry and prefer morenatural remedies which are available over the counter More medical treatment13 devicesare available that13 stimulate blood flow and counter pain through the use of electrical andphysical stimulation
The evidence may be weak at present13 but13 might13 grow as more people use them and as theircost13 drops The13 impact13 of13 such technologies13 on vulnerable13 people13 is13 difficult13 to gauge
213 Telecare
Support13 provided at a distance to people in their own homes is known as telecare Thename implies remote monitoring and interaction and includes the monitoring of the homeenvironment13 and of the individual as well as the interaction of the individual with thisenvironment Definitions have become difficult13 due to some US medical devicemanufacturers introducing the term telehealth to describe medical telecare such as remotemeasurement13 and collection of vital signs data
In the UK telecare alarm services have matured quickly using the robust13 platform andinfrastructure of social alarm systems which were originally used by tenants in shelteredhousing schemes to seek help when they didnrsquot13 own a telephone The majority of telecareservice users today live in their own homes and use dispersed alarm units to link with amonitoring centre through the telephone network Improved assessments of needs andrisks to independence have resulted in combinations of sensors being used to support13 theoption of staying put13 rather than moving into residential care or having increasing levels ofdomiciliary support They support13 the policy of bringing care closer to home and ofencouraging people to become partners in their long term support13 arrangements
Telecare services developments over the past13 decade include standalone items such asautomatic lights which have achieved significant13 efficiencies especially for people who arefrail and prone to falling and to those suffering from mild cognitive impairment epilepsyand anxiety People who have long term conditions including chronic conditions such asdiabetes and hypertension can also be managed more effectively through telecare supportThe benefits of telecare services include a relief of stress for family caregivers enablingthem to continue to provide unpaid support13 while holding down a job and maintaining theirquality of life
New developments enable continuous monitoring of behaviour and smart13 devices that13 canfor example remotely control the cooker the water supply and door entry Such13 monitoring may detect13 incidents early and prevent13 emergencies arising Devices arebecoming smaller and easier to embed quickly within the home environment making themmore acceptable and less noticeable Longer battery life means less frequent13 maintenancevisits
16
The13 monitoring13 centre13 becomes13 an information hub13 offering13 both advice13 and a vehicle13 for checking that someone is coping especially following a trigger event such as a stay inhospital or the illness13 of an informal13 carer
New systems utilise web technology that13 allows family members to be more proactive inthe monitoring of their relatives This can lead to greater interaction with them especiallywhen the relatives live a considerable distance away (perhaps in another country) Thesenext13 generation systems might13 include video conferencing and the use of tablets smart13 phones or smart13 TVs but13 when an emergency response is required (perhaps to lift13 someoneup after a non-shy‐injurious fall) there remains a need for human intervention
The13 future13 of13 telecare13 might therefore13 include13 an increasing13 dependence13 on volunteersfrom13 the13 community to provide13 the13 required support Social networking may need to beused13 to support13 telecare technologies
214 Mobile healthcare
While telecare can support13 people effectively in their own homes it13 is now recognised that13 being able to go out13 to enjoy open spaces and to overcome the fear that13 the home is aprison is an important13 part13 of improving well being and supporting a higher quality of lifeExtending telecare technologies to operate outside the home is known as mobile healthcare(or mCare) and is based on mobile telephone networks rather than landlines
The simplest13 form of mCare requires only a basic mobile phone to deliver telephone callsvoice13 messages and SMS (text13 messages) The technology is mature and there are countlessapplications in use both in the UK and in developing countries such as Africa13 and India13 where mobile telephones have already achieved a saturation level and where fixedtelephone infrastructures are not13 likely to be established at any time Such telephones areuniversally available in the UK and are used by the vast13 majority of people including manyolder people especially if they have been introduced to the low cost13 (pound30) devices that13 have large buttons large displays and a separate large button for calling an emergencynumber
Smart13 phones are rapidly replacing basic phones and allow the use of a large range of lsquoappsrsquothat13 are being developed to provide information and for enhanced experiences In thehealthcare space Skype FaceTime Vidyo and GoToMeeting with HD Faces are all current13 examples of video conferencing software available on tablets and smartphones
The specific software will depend on the nature of the communication desired
bull Skype will13 manage a simple video phone callbull Where an AampE physician needs to share a CT scan of head with a Neurologist13 on call
from home GoToMeeting would be more appropriate
17
bull If the physician would rather have a dedicated online meeting room that13 patientsand colleagues can simply drop in for a virtual meeting a Vidyo virtual room may bemore appropriate
This technology can suit13 any form of lifestyle including many people with complex needswhose lifestyle is not13 consistent13 with a fixed address
Social care apps are available already to deal with problems of sensory deficit
bull Guiding a blind person through GPS navigation and reading signs through appslinked to the devicersquos camera13
bull The microphone can be used as a hearing aidbull Speech recognition software can be used either to replay speech at a slower speed
or for translation into a language of choicebull Speech can also be selected for people who have a stammer or who have a problem
with their larynxbull Apps are becoming contextually aware recognising situations and locations and are
thus becoming a personal assistant13 for people with disabilities
By 2020 it is therefore possible that a smartphone may13 be prescribed13 for people who13 need13 social13 care13 together with13 a range of apps that have been13 selected13 to meet13 theirassessed13 needs
Whilst13 smart13 phones tablet13 devices and apps may become an important13 part13 of anindividualrsquos personal support13 armoury the potential of mCare will be limited only by anindividualrsquos ability to make use of all its functions Each device could become a part13 of anindividualrsquos personality supporting them to improve behaviour take exercise avoidtemptation and manage their own health and well-shy‐being Potentially mCare could becomethe most13 important13 element13 of social care and support13 within 10 years
215 Artificial Sensing and Enhancement Devices
bull It is estimated that13 one in seven people has imperfect13 hearingbull The numbers who are born deaf are quite small and many of these people may
have some form of hearing restored through surgery or through technologybull Similarly while there may be nearly a million people registered as blind or having a
severe visual impairment the vast13 majority lose their sight13 during their lives as aresult13 of disease
bull New treatments will deliver sight13 recovery or restoration over the course of the next13 10 to 20 years
Fortunately technology can provide excellent13 sensing capabilities that13 are already providingpeople with external portable devices for enhancing their lives The simple hearing aid is anexcellent13 example of a device which has been improved through both miniaturisation
18
personalisation and enhanced performance Today digital hearing aids use sub-shy‐miniaturemicrophones that13 can be unidirectional or omnidirectional and which can be adjusted insensitivity over an extended range Tomorrowrsquos devices can be switched between modesby the user so that13 they can benefit13 from hearing perfectly in any environment Indeedthey can be used with adaptive filtering technologies (as used by helicopter pilot13 headsets)to eliminate some sounds so that13 the rich speech (or music) components alone remainFuture developments will be on optimising control so that13 the user can switch seamlesslybetween different13 amplification applications without13 appearing to be distracted A smart13 phone or mp3 music player may be used as either a processing unit13 or as a ubiquitousoutput13 device that13 looks cool and natural
These same technologies will also be developed for use within the home environment13 fortimes when a deaf user isnrsquot13 present13 or is asleep Acoustic signatures associated withadverse events and incidents such as the hiss of a gas leak the crackle of a fire the sound ofa smoke detector the drip or a water leak or the sound of breaking glass can be directlyassociated with programmed actions Speech will be recognised interpreted translatedsimplified or displayed so that13 an individual knows what13 is said and can be provided withclear instructions on how to respond
Video cameras have become smaller and cheaper and capable of producing high definitionimages The problem of storing and editing these large image files is being solved by thearrival of cloud computing
Electronic noses are already capable of detecting the quality of wine and fresh fruit Similartechnology will be based in smart13 phones and will be able to analyse the air to warn of13 foodthat is no longer fresh and of other indicators of danger including gases that13 have13 little13 natural13 smell These13 devices13 could support13 people with13 cognitive impairment13 -shy‐ whose13 sense of smell13 tends13 to deteriorate -shy‐ to live independently
Many older and vulnerable people are at risk of hypothermia during the winter Sensordevices can provide warnings of low temperature In the same way heat13 stress can be adanger during the summer months so sensors can alert13 people of the need to openwindows or to operate a fanFinally people who have damaged13 their fingers13 or hands will be able to wear sensorsembedded in artificial skin or in gloves that13 will enable them to identify textures and shapesand be able to dress and undress without13 the assistance of carers
216 Robotics
We may recoil at the idea13 of personal care being delivered by robotic devices but13 it13 is likelythat13 within a decade personal assistants will exist13 to assist13 with household tasks These areunlikely to be humanoid and are more likely to be machines dedicated to helping frailpeople to support13 their own weight13 and to carry trays of food around the home
19
There are four broad classes of robot13 under development13 that13 are likely to mature within 10to 12 years
1 Miniature industrial robots that13 have been programmed to perform specific taskswith precision They are likely to be relatively heavy enabling them to bear weight13 but13 still have the necessary flexibility to carry an individual over short13 distancesplacing them in a chair or on a bed They will have sensors and cameras to provideimmediate feedback and to adjust13 rapidly in response to verbal commands or cues13 from the user Some designs may build on existing assistive devices such as abathroom hoist13 or a bathing aid to become intelligent13 extensions of productsalready on the market A stair lift13 with intelligence is already being designed by a UKcompany and is aimed at providing the user with more control of the journeybetween floors of a house
2 The second group of devices might13 be described as intelligent13 furniture Beds andchairs are already available that13 adjust13 to make the user more comfortable and also13 to help them get13 into or out13 of bed The control units are fairly cumbersome andare suited to operation by a carer Voice activated controls and built-shy‐in intelligencewill give the user more control and independence Other items of furniture to whichintelligence might13 be added would be tables whose height13 can adjust13 and whichhold items of food and medicine securely The table would recognise these objectsand could provide prompts or reminders
3 Mobile robots form the third group These could be goffers that13 can either fetchand carry items such as newspapers drinks or trays or which can accompany theuser when they move between rooms providing them with support13 or prompts Thistype of robot13 could be an intelligent13 walking frame with wheels which13 could13 doubleup as a smart13 wheelchair when necessary
4 Finally there are companion robots These might13 be in the form of an electronicpet typically a cat13 or a dog though the Japanese Paro robot13 is a seal Pets canrespond to stroking and being patted they can also remind their owners that13 theyneed to take exercise and to eat drink and take their medication Various designsare already available which provide feedback but13 future models would includecameras and a screen to provide a mobile means of information and interactionwith other people over the Internet Intelligence within the device could allow themto have a personality of their own and gain knowledge by scraping data13 fromwebsites so that13 they can generate speech and have conversations about13 the newsthe weather or sports results
217 Transport and transfer technologies
Walking is good exercise and is a no-shy‐cost13 form of transport13 that13 is encouraged because of itsimpact13 on well-shy‐being For an individual with a chronic disability or suffering from theeffects of an accident13 or an injury this becomes impractical without13 an assistive technology(AT) A walking stick is the simplest13 example of AT
20
Within the home the stair lift13 has enabled people who live in conventional properties that13 are on two or more floors to continue to use facilities on different13 floors when climbing thestairs has become too difficult This is often the case for people who have arthritis a lowerlimb amputation a long term condition such as Chronic Obstructive Pulmonary Disease orpeople approaching the end of life and who have chosen to die in their own homes
Designs have improved so that13 a curved staircase is no longer an issue and the reliabilityhas reached a level where breakdown is a rare occurrence13 Through-shy‐floor lifts have been analternative proposition but13 they remain too large for most13 properties Alternativeapproaches may emerge using air pressure or water pressure as the driving force ABrazilian design already utilises a plastic tube in which a pod is moved effortlessly up anddown
Electronic wheelchairs are now available that13 allow the individual to become moreindependent13 as they allow the user to control both propulsion and steering Some modelshave the capability of mounting a pavement13 or a step or even a flight13 of stairs Personalmuscle amplification devices have been developed originally with the intention of helpingpeople who are confined to a wheelchair due to a neurological disorder to perform sometasks from a standing position Indeed the Rex walkerrsquos manufacturers claim that13 anyonewho can propel themselves in a wheelchair could walk by using Rex
Other approaches have focused on the rehabilitation of people after major accidents that13 have caused partial paralysis They quickly extend into exoskeleton designs that13 enableanyone to gain a mechanical advantage and thus to tackle physical tasks that13 would not13 otherwise be possible These suits are the focus of major research projects across theworld Some13 products such as the system developed by Honda are being tested inAssisted Living facilities and are likely to become more and more enabling over the next13 decade
Similar benefits are also occurring outside the home with a number of novel carryingsystems appearing over the past13 few years They are generally termed lsquoscootersrsquo but13 thiscovers a wide range of systems and devices ranging from the Segway a device that13 is amobile platform on which the user stands and navigates through to conventional electricvehicles that13 have been developed from golf buggies There remain a number of issuesconcerning their use on roads or on pavements but13 similar problems will need to beresolved for bicycles to play their full part13 in enabling people to get13 more exercise13 Thepotential for hybrid scooters remains
218 Smart domestic appliances and personal hygiene
The bathroom is a dangerous place and one where many older and disabled people slip andsuffer a fall Many older people recall taking a bath in a tin tub in front13 of an open fireToday the options tend to be a level access shower (ie a type of wet13 room) for anyoneunable to get13 into a bath There are various aids to help people get13 into and out13 of thebath most13 involving a seat13 that13 can be raised or lower with some bath-shy‐tubs having a door
21
There has been some research into alternative methods of keeping the body clean Sanyointroduced a machine in 1970 modelled on a clothes or dish washing machines the personsits on a seat13 inside the machine where13 they are cleaned by a set13 of water jets These havenot13 proved popular and furthermore require the individual to be transported to themachine Thus the technology may find application in nursing homes but13 are unlikely to beattractive to people living independently in the community
The washing needs of people change over time Over the past13 20 years body piercingshave appeared which have demanded additional attention to avoid the problemsassociated with poor hygiene and metals Similarly hair may be permed and dyed usingchemicals which are much stronger and which might13 damage the hair Add to this thepainting of finger and toe nails and the washing needs are rather different13 to what13 theymight13 have been even ten years ago Finally tattoos were once popular only with sailorsToday they are likely to be found on the arms backs and legs of both men and womenNew ways of cleaning these tattoos will be needed especially if they become infected orare sites at which pressure sores develop
Even if a personrsquos body is clean if their clothes are dirty they may become socially isolatedBut13 the washing of clothes can be strenuous even if a launderette is used The need toconserve water has driven research into ultrasound techniques to beat13 the dirt13 out13 ofclothing while some companies are experimenting with polymer chips These13 ldquogreenrdquo13 technologies are quickly maturing and are likely to be standard in the next 10 years
Other smart13 household appliances are already appearing on the market13 and may soonbecome common13 in UK homes13
bull Robovac devices have sensors to enable them to detect13 dirt13 on carpets and to adjust13 their operation accordingly
bull Refrigerators can read bar codes or RFID tags to identify their contents and theirldquouse byrdquo13 dates enabling them to inform the owner that13 they should use theproducts before they are out13 of date They can be linked to the Internet13 to reorderitems as they are consumed or to suggest13 menu options for the individual based ontheir preferences or according to the diet13 required to manage a condition
bull Ovens will automatically switch off if they are left13 without13 attention for too longand drying machines will set13 times automatically
Devices may be linked so that13 they are more efficient and report13 maintenance issues sothat13 they can be repaired (perhaps remotely) before they suffer a catastrophic breakdown
219 Personal and home13 security
It might13 appear perverse but13 people with very little personal wealth and property are morelikely to be the victims of crime than those who have expensive items This may be due towhere poorer people tend to live or because people who have valuable assets take greater
22
steps to protect13 them There can be no doubt13 that13 crime has a very negative effect13 onindividuals and on their families creating a fear factor that13 may be difficult13 to remove Theimpact13 on quality of life is therefore very considerable especially if it13 forces people to stayat home behind locked doors effectively isolating themselves from society
Modern policing places increasing reliance on the use of closed circuit13 television (CCTV)Town centres are covered by cameras used increasingly in the fight13 against13 crime by bothdetecting anti-shy‐social incidents and identifying the people involved They are also used tomonitor the movement13 of cars that13 may be involved in incidents of burglary and violenceand are fast13 becoming the primary mechanism of law enforcement13 agencies to solve crime
CCTV has moved into the home to record movement but13 monitoring the footage is timeconsuming and often not13 practical Cameras are now available which provide an instant13 video feed to a smart13 phone when movement13 is detected These may have intercomcapability allowing someone to remotely speak to an intruder sometimes before they havegained access to a building This may serve as a deterrent13 and when fitted alongside simpledevices that13 switch lights on randomly around the home may force burglars to goelsewhere
As the price of cameras continues to fall the option of carrying a camera13 on the body that13 continuously monitors personal space is becoming more useful Using wireless networksthe data13 collected can be sent13 continuously to the cloud for safe storage It cansubsequently be retrieved to provide evidence (video and audio) of confrontations enablingsuccessful prosecutions to be made The smart13 phone itself is becoming a valuable itemthat13 is attractive to criminals These can be tethered to personal attack buttons usingwireless technology allowing the device to be activated by the pressing of a button if theowner is being attacked The phones can then be tracked and located by the police whilebeing rendered useless to the assailant
Bogus callers are a perennial problem for vulnerable people Video door bells can beconfigured to display images and record the words of visitors before they are admittedallowing remote monitoring centres to oversee the situations and use image recognitionsoftware to confirm the bona13 fide of visitors Such13 arrangements may become13 commonplace13 over13 the13 next five13 or13 six years13 significantly13 improving the safety of peopleliving independently
220 Personal safety
The biggest13 risks to personal safety stem from fires and falls Most13 fires are the result13 ofpoor cooking practices resulting in burns or scalds Floods and gas emissions are caused bya failure to remember to close taps
The current13 approach involves detection of an emergency situation as soon as possible but13 always after a problem has already occurred This responsive approach can minimise therisks provided that13 there is a protocol in place for intervening This could increasingly be an
23
automated response such as the switching off of the gas of water or the switching on of asprinkler system or a water mist13 system
In the future monitoring systems will be more sophisticated and will have sensors and localintelligence to identify activities In this way reminders can be issued before an emergencyoccurs13 This lsquosmart kitchenrsquo approach may become13 an integral part of13 homes of13 vulnerable13 people
A prototype system has been developed at the Culture Lab in Newcastle Sensors havebeen embedded into cooking utensils enabling the kitchen to identify what13 the person istrying to cook or prepare It can provide interventions as messages on an instructionscreen
Accidents also occur out13 of doors People with dementia13 might13 become lost13 and may havepoor road safety awareness Location devices based on GPS have advanced from large andheavy receivers that13 were used on ships and boats to small battery-shy‐operated devices that13 can be carried in the hand or in a handbag The current13 generation of locators has limitedbattery life and are rather too large to be secreted about13 a personrsquos clothing while devicesthat13 are integrated into a wrist-shy‐watch are rather clunky and unattractive
Within 10 years the13 technologies13 will have13 matured and will be13 much smaller13 so that theycan be embedded in shoes in walking sticks hats or any other item of clothing Powerrequirements will have reduced so that13 energy harvesting from the movements of theindividual will be sufficient13 to keep these products working for several weeks without13 theneed for recharging The devices will not13 simply indicate to others where the individualhappens to be but13 will provide subtle guidance cues to direct13 them home
Cameras might13 also form part13 of the personal security systems that13 will protect13 people fromaccidents Data13 may be sent13 to the cloud and analysed in real time if the person is in adangerous location and can provide prompts either to the individual or broadcast13 advice toothers to clear the danger These systems may be embedded in items of clothing (such as ahat) or they may be attached to spectacles
221 Energy and13 portable power supplies
The demands of developing economies for more power will inevitably lead to higherdomestic fuel charges in the UK especially as oil and gas reserves dwindle
By 2018 UK homes should be fitted with new smart13 meters The specifications for these13 devices have yet13 to be finalised but13 will include a means of identifying wasteful use ofenergy including TV sets that13 are left13 on and unattended fridges and freezers that13 are set13 attoo low temperatures and dryers that13 are used for too long or when the weather is suitablefor using a washing line They could be an enabling factor that13 supports changes inbehaviour driven by a need to use less power but13 it13 is unlikely that13 they will offer a bigreduction in costs that13 are already a problem for many vulnerable families
24
More generally the need for power conservation will include devices that13 are moreefficient and a significant13 emphasis on heat13 retention in buildings through betterinsulation
The energy crisis may force many people to spend more time in community settingsincluding shops and public buildings where they can benefit13 from the warmth Increasingreliance on mobile communication devices will lead to increasing demand for batterycharging facilities
Greater use may be made of portable devices for generating power based on solar cellswind or hand motion
222 Smart cities and homes
The Digital City initiatives have been based on information and how it13 can be used most13 effectively to make people aware of what13 is going on around them This means bettercoordination of resources more rapid access to advice and a battery of sensors measuringevery conceivable parameter from sound and light13 levels through to air quality andtemperature fluctuations There are several Digital or Smart13 City initiatives currently beingimplemented both in the UK and across the world They may significantly impact13 the livesof the millions of people living in them but13 the timeframe for outcome benefits to influenceplanning and design elsewhere is likely to be at least13 20 years and therefore outside thetimeframe of the current13 project
Housing plays a big role in the lives of most13 people both through their aspirations to moveup in the world (usually to a bigger property with a garden) and as the heart13 of the familylife which is associated with good quality of life UK properties have a life span approaching100 years which is about13 double that13 of their European counterparts (and certainly longerthan the wooden-shy‐frame buildings built13 in North America13 for example) A shortage ofhouses has plagued improvements in social welfare for the past13 30 years There is anargument13 that13 there are enough houses but13 the wrong size and in the wrong places andthis has some basis in fact13 as demography changes lead to more people (and more olderpeople) living alone However if there are two million homes in Scotland each with alifespan of 100 years then the renewal rate needs only to be 20000 per annum to maintainthe status quo However it13 must13 be clear that13 the impact13 of smart13 house development13 willbe small The focus should therefore be on adapting existing properties to render themmore appropriate for vulnerable people
Housing adaptations are a branch of assistive technologies The technologies for providingdifferent13 forms of accessible bath and level access shower are well-shy‐established with littleresearch considering anything other than alternative building materials and methods formaintaining the temperature of the bathwater Different13 technologies for bathing will beconsidered separately
25
Thus housing technologies are not likely to impact on social work13 within the next 20years13 though13 the use of information13 technology13 to ensure that people are aware of what13 is available is likely to be commonplace well before then
26
3 BEHAVIOUR AND ATTITUDE CHANGES DUE TO TECHNOLOGICALADVANCES
Technology is only one factor that13 will affect13 the way society changes in the next13 10 or 15years This chapter will consider the context13 in which the technological developmentsoutlined in the previous chapter will be supported (or held back) by societal factors
When the impact13 of such factors has been considered we can then apply theseassumptions to a number of case studies listed in Appendix13 A13
The headings selected for this chapter are not13 arbitrary as they reflect13 the context13 in whichtechnological changes must13 be considered They must13 include consideration of factors suchas demography and long-shy‐term conditions already addressed in the introduction to thesepapers together with the aspects of workforce and citizenship considered in the parallelpapers The additional elements here focus on trends that13 are already occurring and whichmay leave people struggling with the changes that13 occur
Finally there is a need to consider the attitudes of people to technology generally andespecially to the issues of privacy and social responsibility that13 could be radically changedby technology In some cases public opinion will prevent13 some forms of technology beingdeveloped if not13 commercialised In other cases some technologies will be fast-shy‐trackedeither at the request13 of government13 or because of a clear public demand for theopportunities that13 it13 can bring
Predictions13 about the13 future13 must inevitably be13 subject to considerable13 uncertainty butthat is no reason to stop thinking what might happen
31 The Welfare State
The UK can be rightly proud of the way that13 its welfare state has developed during the past13 100 years to provide a safety net13 of financial support13 to people and to their families whenthey are unemployed destitute homeless or challenged by crises and emergencies Therange of benefits received is considerable some are complex and many people struggle tounderstand their entitlements Some are universal some are discretionary some apply onlyto parents others to anyone
The total cost13 of providing these benefits continues to rise and when the economy isstagnating there is inevitably both political pressure often supported by popular publicopinion to introduce welfare reform so that13 people who do not13 work cannot13 be better offthan they would be if they were in full-shy‐time employment This strategy requires a universalbenefit13 to be introduced so that13 it13 is easier for claimants to access support13 but13 also easierfor agencies to identify the total benefits received The idea13 of a benefits cap then becomes
27
more practical to introduce especially if all the processes involved in making a claim arehandled electronically Indeed this encourages government13 to insist13 on applications forbenefits to be made on-shy‐line Unfortunately this will marginalise those people who haveneither a computer nor access to the internet thus emphasising the digital divide in amanner which works against13 some of the most13 disadvantaged people in society
There are currently few tangible links between digital technology and welfare provisionThe most13 obvious are universal benefits such as a free television licence (worth pound14550)13 for13 everyone aged 75 or older with blind and visually impaired people entitled to a 50discount13 irrespective of their age The significance of this position is that13 6 of revenuesgenerated through licence fees are to fund BBC on-shy‐line services13 such13 as websites and i-shy‐player In Scotland the BBCrsquos Alba Gaelic language television service is predominantlyfunded13 by MG Alba an organisation funded by the Scottish Government It is thereforeconceivable that13 in the future licence fees may be used to directly subsidise access toinformation and advice through the Internet13 for vulnerable people whether it13 is throughbroadband access or through a set-shy‐top box which removes the need for a computer in thehome to access particular websites or to use e-shy‐mail services
A second age-shy‐related benefit13 available in the UK is the winter fuel subsidy People whoreceive certain benefits receive the payments automatically while others must13 make aclaim Those who are not13 eligible for benefit13 due to a lack of an address for example missout13 on these payments and also on Cold Weather payments of pound25 for each seven dayperiod of very cold weather between 1 November and 31 March
The development13 of new warm home initiatives plus the complex of subsidies that13 theelectricity supply industry and government13 offer to people with solar cells further changesthe economic arguments Global warming may lead to greater variations in weatherextremes but13 might13 also increase the amount13 of electricity that13 can be generated byalternative (green) sources such as wind and solar cells It is estimated that13 energyconsumption in the UK increased by 17 between Christmas and Easter 2013 compared toprevious years as a result13 of cold weather but13 the above subsidy scheme did not13 benefit13 older people because two of the seven day cold periods were after 31st March It must13 beassumed that13 there will be more people living in fuel poverty in the future and this will leadto more cases of cold related illness including influenza13 and stroke
32 Management of long term conditions
The management13 of long term conditions will be improved for patients who are compliant13 with their medication regime so it13 is possible that13 there may be compulsion to adhere tothe prescription Such compulsion may be monitored using technology Indeed the remotemonitoring of vital signs using telehealthcare will become commonplace as the old boxesand sensors are replaced by devices that13 can be worn continuously or which can beembedded into the fabric of homes (including furniture and bedding) or can be worn asvests or patches They will wirelessly transmit13 data13 to smartphones or tablets and mobile
28
transmission and cloud technology will enable real-shy‐time data13 collection analysis andfeedback
One of the diseases which is projected to increase most13 significantly over the comingdecade is Type 2 diabetes Whilst13 there is a hereditary susceptibility to this condition formany people including those from the Middle East13 and the Asian sub-shy‐continent it13 is also adisease which tends to affect13 those people who are overweight13 andor have a sedentarylifestyle If untreated diabetes can lead to dizziness and collapse at any time but13 can alsohave more devastating long term consequences which include kidney failure strokeblindness and in extreme cases lower limb amputations Management13 therefore includesdaily monitoring of blood glucose levels and major dietary changes such as a significant13 reduction in the consumption of carbohydrates as well as a rigid exercise regime
Many newly diagnosed diabetics follow this advice closely and can lead normal lives for 40years or more but13 some struggle to accept13 the change in lifestyle required as well asremembering which foods are allowed and how much exercise they need to takeIndividual support13 plans are now forthcoming and over the next13 ten years best13 practicewill emerge in the form of smartphone apps that13 are personalised and which can becomean individualrsquos health coach This level of support13 will be fine for some people but13 otherswill need incentives so it13 is likely that13 gaming technologies will be introduced perhapsoffering rewards for good compliance There will be a temptation for some people tocheat perhaps allowing others to perform exercise for them or changing theirconsumption details
Many of these opportunities for cheating will be removed through the use of a uniquebiometric identifier a technology that13 will be mature enough to use in place of passwordson smartphones However the biggest13 challenge may be in encouraging older people to usethe technology Many older people have multiple morbidities Indeed a survey of Scottishpatients implied that13 42 of people aged over 80 will suffer from three long termconditions It will be essential for those people to comply with treatment13 regimes if they arenot13 to have the functional deficits that13 follow
33 Finding people who13 donrsquot fit
People who have low social capital are likely to have few relatives and friends with whomthey regularly communicate and are also unlikely to be part13 of community or faithorganisations such as clubs societies and church groups They also die several yearsyounger than most13 of the population often because they donrsquot13 engage with public healthinitiatives such as vaccinations against13 flu regular checks on their blood pressure bloodsugar levels or in the case of women smear tests or mammography The most13 likelyreason for disappearing beneath the radar of such initiatives is their mobility which leadsalmost13 inevitably to them having no fixed abode and no fixed telephone line It thenbecomes very difficult13 for them to be contacted because their mobile telephones are likelyto have Pay-shy‐As-shy‐You-shy‐Go contracts that13 donrsquot13 require validated names addresses and bankaccounts
29
It follows that13 some of the most13 vulnerable people in society including those who live onthe streets are effectively unknown to both the NHS and to social work departments untilthey are referred in a crisis This could be an emergency presentation to a hospital Accident13 and Emergency Department13 where they will come into contact13 with a social worker becausedischarge may be unsafe This often highlights the importance of the prevention agenda13 and the potential for avoiding admissions to hospital by intervening at an earlier stage
The advantages of being able to locate people who are vulnerable to specific diseases willincrease as genetic testing becomes more routine It is already possible to determine whomight13 be most13 at risk of breast13 cancer and prostate cancer as a result13 of family history Addto this the evidence that13 particular diet13 and exposure to environmental factors can furtherincrease risk then it13 is evident13 that13 individuals can be identified and offered treatmentsthat13 could save their lives many years before they become ill In the case of cancersperhaps only the individual is involved but13 for infectious diseases it13 is the whole of societythat13 is at risk if someone contracts one of the new strains of influenza or if someonechooses not13 to be vaccinated against13 rubella In Chinese airports all visitors are screenedfor fever and refused entry if they tested positive in cities the public are monitored in thesame way Similar approaches may be necessary in the UK if potential carriers cannot13 otherwise be identified
34 Volunteering
It is estimated that13 72 per cent13 of people volunteered to perform a charitable act13 at least13 once during 2012 a rise from 65 per cent13 the previous year About13 four out13 of every 10volunteers offer their services formally to one or more organisations The remaindervolunteer informally by helping out13 a friend or a neighbour Around 50 per cent13 volunteered at least13 once a month in the past13 year up from 41 per cent13 on the previous13 year Most13 have retired many of them before the statutory retirement13 age Those whodonrsquot13 feel able to offer time have offered their financial support13 at a time when the fundingavailable from sources such as the National Lottery has been decreasing Despite economicausterity donations to charities have been increasing 74 per cent13 said they had given tocharity at least13 once in the previous month up from 72 per cent13 the previous year
Strikingly 78 per cent13 of people strongly believe that13 they are part13 of their localneighbourhood an increase from 70 per cent13 10 years previously Community cohesion isstronger than ever 87 per cent13 of people believe their local area13 is a place where peoplefrom different13 backgrounds get13 on well together compared to 80 per cent13 in 2003
The role of volunteers in supporting vulnerable people is therefore likely to increase overthe next13 decade perhaps exploiting the success of the army of volunteers that13 was highlysuccessful in London during the Olympic and Paralympic games The greatest13 role for suchvolunteers may be in providing informal care for older people Already the UK has someseven million informal carers whose value in monetary terms has been calculated to be
30
more than the combined budgets of the NHS and social care Maintaining or extending thisprovision will help to support13 services in the future and may be supported by technology
Whilst13 there is ample evidence to suggest13 that13 telecare services support13 informal carers asmuch as (if not13 more than) the people that13 they are caring for it13 is the potential for utilisingthe internet13 and apps to make their role easier to coordinate and hence more effectivethat13 is likely to be most13 successful moving forward
Many of these focus on particular tasks that13 informal carers can help offer to older peoplesuch as organising their medication A pillbox program is just13 one feature of an app calledBalance It also includes sections for caregiving tips notes for the doctor and the patientsappointments plus a lsquolearning sectionrsquo with articles on aspects of Alzheimers and an RSSfeed for news about13 the disease Tyze is another multi-shy‐functional app it13 allows carers to
bull Organise appointmentsbull Plan outingsbull Share storiesbull Send updates to other family members
Another application is Rally Round which helps carers to organise someone to perform littlejobs often on a temporary basis when someone has dementia physical frailty or isrecovering from accident13 or illness Similar applications are MeMaxi and Finerday
35 The High13 Street
The shape and appearance of UK shopping centres have been changing for half a centuryPeople complain that13 centres are losing their identity with one town looking like everyother both in terms of the stores and in terms of the layout But13 there are three trendswhich are having a profound impact13 on many of the most13 vulnerable people in society
bull Centres lock their doors at 6pm or in some cases 10pm -shy‐ thus denying people whosuffer from claustrophobia13 from window shopping at times when other shoppershave left
bull Out13 of town shopping malls -shy‐ these US style centres are ideal for people in carsbecause they offer free parking which is essential for people who want13 to buy largeritems but13 difficult13 for people who have no transport13 and who must13 rely on publictransport13 that13 is often deficient
bull The rise of online shopping -shy‐ which means that13 many potential shoppers only visit13 High Street13 stores to check the prices before returning home to make a purchaseonline
It is the third of these effects that13 has the greatest13 potential for changing the High Street13 forever and it13 is making life for traditional retailers increasingly difficult13 at a time when highrents are crippling stores large and small It is difficult13 to see how this trend is likely tochange because consolidation in banking and estate agencies is already forcing the closure
31
of other High Street13 players while additional pressures on pubs has led to the closure ofthousands of pubs every year
Those figures however demonstrate that13 consumers still value what13 the high street13 canoffer -shy‐ the chance to inspect13 what13 theyrsquore thinking of buying -shy‐ as well as the new opennessof the internet Customer service makes a difference to people especially if there is aproblem and goods need to be returned One of the most13 common reasons for furniture tobe returned for example is that13 when a sofa13 or a wardrobe was delivered it13 couldnrsquot13 fit13 through the front13 door or up the stairs In the future people will be able to benefit from13 visualisation technology they will upload the floor plans of their homes enabling theretailer to inform them of the problem before they try to delivery Augmented reality viewwill similarly allow customers to see what13 a new item of furniture will look like in itsintended place so that13 they can be more informed about13 the effect13 of size and colour
In terms of improving the viability of the High Street stores will have to focus on theimportance of brand which could mean that13 individual independent13 retailers will have topartner with national suppliers to support13 a local tailored offering based on products that13 are designed for a more global market This is a lsquoconnected High Streetrsquo approach whichcould be enabled by the developments in internet13 availability and smart13 phone accessdescribed in the previous section
The overall effect13 of all these changes could mean that13 town centres become smaller but13 more vibrant13 areas They could thrive if people are attracted there in large numbers whichmeans that13 retail must13 be developed alongside restaurants pubs galleries and other leisureopportunities This is possible in new shopping centres which are already being integratedwith transport13 hubs including railway and bus stations but13 may be more of a design13 challenge for older towns and cities with large Victorian buildings To ensure that13 morepeople are welcomed into the new centres they should include attention to green spacesand areas where people can relax without13 feeling that13 they are second class citizensbecause they donrsquot13 have the same buying power
3513 Privacy
To some people privacy is their right13 to live their lives without13 interference they may seethe State as a potential lsquoBig Brotherrsquo spying on their every move and judging their actions13 and activities Other people have fewer concerns about13 the role of the State but13 great13 fearof individuals interfering with and invading their privacy Some embrace the concept13 of lsquomyspacersquo an area13 of a square metre or so into which nobody can enter without13 permissionThis allows them to avoid physical contact13 and to feel safe from any form of threateningbehaviour
Yet13 this idea13 of private space and its potential violation is merely the tip of the iceberg asfar as privacy is concerned more significant13 is the idea13 of personal (and private)information being shared with anyone and everyone This could be related to identityopinion or image for an individual who wants to remain anonymous or even secretive thisis going to become an increasing problem as technology provides the means of taking
32
photographs recording conversations and capturing environment13 with something as smalland ubiquitous as a mobile phone The fact13 that13 this information can then be shared withthe rest13 of the world using e-shy‐mail Twitter and Facebook makes the problem all the moredifficult So the threat13 is no longer solely from the long lenses of the Paparazzi but13 fromanyone (and that13 means everyone) who has even the most13 basic of mobile phones
This relates to the changing views of society on what13 information should remain privateand what13 should be shared with others The success of social media13 has been based on anattitude of lsquosharing everythingrsquo with either your friends or the world This has introduced anaiumlve idea13 in the minds of some younger people (especially those known as Millennials ieaged 18-shy‐30) that13 everyone can be their friends whilst13 perhaps failing to reinforce the bondsof genuine friendship with any form of test13 or restriction Technology could play a role indefining these friendships and allowing individuals to understand what13 makes a goodfriend but13 this approach has yet13 to be developed and may be slow to overcome the needfor some people to measure their own popularity simply as the number of people that13 theycan list13 as friends on their Facebook page
It follows that13 there may be a need for a new definition of privacy that13 is in keeping withthe web and its ability to display images and opinion in an unregulated manner This needsto embrace past13 concerns about13 the ability of an individual to live without13 the threat13 ofothers being able to watch them whilst13 offering some protection from random postingsabout13 them online Perhaps this could include a right13 to be able to edit13 or remove anythingrelating to themselves on the Web including images that13 are not13 news-shy‐worthy Theownership of image rights may be an associated issue that13 needs to be addressedespecially as modern technology can remove an individual from a group (or a background)13 view provide digital touch-shy‐up or air-shy‐brushing and then republish it13 in a different13 contextHowever there is general agreement13 that13 personal information (such as contact13 details andbank codes) should not13 have a place on the web Surprisingly few people take proactivemeasures to prevent13 tracking functions being activated
It follows that13 too much privacy could lead to younger people fearing that13 they maybecome lost13 in a digital world It is not13 surprising then that13 they are prepared to make lots13 of personal information available often with no fear of how it13 might13 be used by othersWhen Google glasses and similar technologies become available during the next13 few yearsthey will have the potential to identify a stranger walking down the street and to find manyof their secrets to present13 to the wearer in a fraction of a second They could know moreabout13 them than their genuine friends know -shy‐ so who will be their friends in the future
36 Data sharing and13 protection
By lsquodata13 sharingrsquo we mean the disclosure of data13 held by one organisation on an individualto a third party organisation(s) or the sharing of data13 between different13 parts of anorganisation Some data13 sharing doesnrsquot13 involve personal data13 because it13 has beenanonymised in such a way that13 the statistics can be used for the collective good without13 theidentification of the individual The Data13 Protection Act13 (DPA) is in place to provide a legal
33
framework that13 ensures that13 organisations that13 hold personal data13 must13 act13 responsibly atall times These principles adequately describe the position of public and government13 bodies especially social services departments who are responsible for the informationconcerning the health and well-shy‐being of individuals -shy‐ and hence by implication thesensitive data13 relating to their vulnerability
The legal framework that13 applies to private and third sector organisations differs from that13 which applies to public sector organisations which may only act13 within the defined limits oftheir statutory powers However all bodies must13 comply fully with the data13 protectionprinciples and this situation is unlikely to change within the next13 10 to 15 years In someprivate sector contexts there are legal constraints on the disclosure of personal dataHowever most13 private and third sector organisations have a general ability to shareinformation provided this does not13 breach the DPA or any other law It is advisable for acompany to check its constitutional documents such as its memorandum and articles13 ofassociation to make sure there are no restrictions that13 would prevent13 it13 from sharingpersonal data13 in a particular context The type of data13 held is therefore a subject13 ofconcern as it13 may be difficult13 for legislation to keep up with the additional layers of data13 created on-shy‐line and through the Internet13 of Things
Private and third sector organisations should have regard to any industry-shy‐specific regulationor guidance about13 handling individualsrsquo information as this may affect13 the organisationrsquosability to share information They should also be aware of the legal issues that13 can arisewhen sharing personal data13 with public sector bodies This becomes more of an issue asprivate and third sector bodies are carrying out13 a wider range of traditionally public sectorfunctions Opportunities for inappropriate sharing of sensitive data13 will therefore inevitablyincrease
Public authorities must13 comply with the Human Rights Act13 (HRA) legislation in theperformance of their functions The HRA also applies to organisations in the private sectorinsofar as they carry out13 functions of a public nature which could include delivering a socialcare activity Where the HRA applies organisations must13 not13 act13 in a way that13 would beincompatible with rights under the European Convention on Human Rights Article 8 of theConvention giving everyone the right13 to respect13 for their private and family life their homeand their correspondence is especially relevant13 to sharing personal data If personal data13 isdisclosed or shared in ways that13 comply with the DPA the sharing or disclosure of that13 information is also likely to comply with the HRA The problem may still be in policing theActs and the rights of an individual if they believe that13 their personal data13 has been sharedor accessed by an inappropriate organisation or individual
A legal industry may be born to deal with such matters but13 this is unlikely to benefit13 peoplewho cannot13 afford the fees involved They would require either legal aid or to employ13 more13 lsquono win no feersquo companies Public attitudes to such costs might13 become negative unlessthey prove successful in preventing breaches of data13 security There may need to belegislation to provide a stronger basis for forcing compliance with privacy laws
34
37 Connecting with13 people
We are social creatures most13 of us rely on our friendships and interactions with friendsand families to share our happiest13 moments and experiences Research suggests that13 thishappiness is infectious at all levels and leads to a 15 increase in the happiness of a closecontact 10 for a second degree contact13 such as the friendrsquos spouse and a 6 increase fora friend of a friend It is hardly surprising that13 the success of social media13 such as Facebookis intimately related to the ability of people to quickly share their happiest13 moments with asmany of their friends and connections as possible
All this has happened during the rise of the Internet13 and the corresponding increase inopportunities for connecting online ie this is a 21st Century phenomenon which has beenfacilitated by Information and Communications Technology But13 the Internet13 remains in itsinfancy and we are only beginning to understand and exploit13 its potential In terms ofaccessing the Internet there are now perhaps two billion people who have access with99 of them having gained this during the past13 decade This number will have doubled bythe period 2020 to 2025 It is likely that13 everyone who wants to be connected in the UK willby then be connected Turning this on its head only those who donrsquot13 want13 to be online willnot13 be on the Internet13 within a decade Connecting with the unconnected will therefore bea case of identifying those people who donrsquot13 want13 to be found unfortunately these mayinclude many people who need the support13 of social care organisations It means that13 theywill be looking for support13 only when they are in crisis unless other ways of finding andormonitoring them are found
While the number of people connected via the Internet13 has exploded this might13 bedwarfed by the number of connected lsquothingsrsquo During 2009 the number of thingsconnected to the Internet13 surpassed the number of connected people at which point13 webegan to experience what13 this report13 has described as the lsquoInternet13 of Thingsrsquo Yet 99 ofall physical objects that13 could join this network are not13 yet13 connected but13 the number couldgrow by 25 every year for the next13 decade so that13 there could be 100 billion connectedobjects by 2025 some of which will be owned or used by everyone in the UK includingthose people who donrsquot13 want13 to be connected themselves We will then have an Internet13 of Everything which will be the smart13 connection of people data events and actions
With each new person object or data13 that13 comes online the connection possibilitiesbetween all these elements grows exponentially The rise of big data mobile networkingcloud storage and data13 mining technologies will all play a critical role in the Internet13 ofEverything The result13 will be new capabilities richer experiences and unprecedentedvalue for individuals businesses communities and countries everywhere The lsquonetworkeffectrsquo of the Internet13 of Everything will be a very powerful thing the true impact13 of whichwe wonrsquot13 fully understand for several years As it13 develops however those who are not13 connected will feel even more digitally and socially excluded There will be a need to reachout13 to vulnerable people unless the process of claiming requires proof of online identityand the payments to be received can only be redeemed using a chipped card or adownloaded app onto a smartphone This is of course the way that13 welfare arrangementsare already developing thus it13 might13 prove impossible to make a successful claim without13
35
already being connected to lsquothe systemrsquo either through an online presence or through theInternet13 of Things
38 Downloading everything
Sixty years ago information was discovered by reading books often in a library wherenotes had to be made because the books or journals couldnrsquot13 be removed Then in theearly 1960s the first13 office photocopying machines were introduced into the UK theyimmediately meant13 that13 pages or articles from books could be copied and taken away to beread and summarised later Within a few years photocopying became a replacement13 forreading as researchers became less adept13 at selecting a few sentences and every deskbecame a depository for reams of printed paper Paper became the means of recordingeverything from bank statements through to music
We now appreciate that13 printing everything is a waste of both the ink (or toner) used tocreate the black print13 and of paper which requires trees to be chopped down and pulpedbefore it13 can be pressed into thin sheets Saving paper is therefore seen as green and goodfor the planet Fortunately we no longer need to print13 everything because computermemory is unlimited thanks to the cloud and we can then view pages and articles onportable or fixed screens
The internet13 has everything and it13 is all available instantly for downloading providing thereis a device available to accept13 it and there is sufficient13 communication bandwidth toperform the transfer of data13 sufficiently quickly Thus we can record all text13 articles that13 are relevant13 to us including digital records of birth certificates qualifications and passportsand the need for original printed versions will decline But13 we can also do this forphotographs Most13 handheld computing devices include at least13 one camera so they cangenerate enormous number of pictures which can be kept13 for posterity without13 having toconsume inks and special papers to print13 them
But13 the materials that13 can be downloaded donrsquot13 stop at pictures software is available that13 can grab TV shows after they air and movies as soon as theyre released In the same wayit13 is possible to schedule music comic books video games and practically anything else asa download with minimal effort People will need enormous hard drives if they want13 theirown digital copies of these files so will more than likely make use of cloud storage that13 willbe available from many organisations The location of the servers may become sensitivedue to border restrictions as will the security of the data13 and the way that13 it13 is backed up sothat13 it13 is resilient13 to failures
It may be evident13 that13 application forms for all types of welfare payment13 will be availableonly for downloading so that once digitised they can be processed by computer andrecords sent13 to various servers for subsequent13 storage and processing Some people maywant13 to keep their data13 on them once it13 has been downloaded Pen drives can already holdseveral GB of data so it13 is likely that13 people will be able to carry their downloaded data13 withthem at all times irrespective of the size and complexities of the information
36
39 Health13 and13 well-shy‐being
The general health of the population is unlikely to deteriorate noticeably within 10 to 20years Indeed expectations of the population are that13 things must13 improve as surgicaltechniques mature and as pharmaceutical interventions become more personalised andpowerful However the rising demand for health services due to an ageing population andthe increasing cost13 of providing sophisticated therapies will make delivering a free anduniversal health service difficult13 without13 substantial increases in taxation This is unlikely tohappen in the UK even though spending on health services will be protected against13 thecuts facing other services
There will have to be changes in how the NHS works For twenty years hospitals have beenclosed and replaced by fewer new facilities so that13 the bed count13 is reduced This has led toa significant13 shift13 in resources to primary care and community care supporting shorter staysin hospital and speedier transfer back home for people after surgery or illness This hasbeen13 successful but13 there remain problems with demand for GP services especially out-shy‐of-shy‐hours and at weekends Indeed despite the introduction of NHS24 and similar help-shy‐linesthe demand for GP appointments continues to increase Delays are inevitable and this willincrease system failures with more unnecessary deaths and a failure for people to access adiagnosis that13 might13 lead to early interventions and ultimately lower delivery costs Over250 more patients are added to waiting lists every day
This will lead to a new model of primary care consistent13 with existing changes which haveseen surgeries move from High Street13 locations to medical centres close to bus routes andwith more parking for patients The process of making an appointment13 is changing from atelephone-shy‐based interview process dominated by a medically-shy‐unqualified receptionist13 to achoose and book approach using an online process linked to electronic patient13 records Thiswill give patients more convenience but13 will allow priority for those who have Internet13 access at the expensive of those who are digitally excluded Making the process of bookingan appointment13 quick and easy may also increase demand from people who do not13 need tobe seen as it13 will fail to identify those in greatest13 need
A greater use of telehealth and telecare technologies will be inevitable beginning with thefirst13 contact13 as an encounter using the telephone e-shy‐mail or video conferencing -shy‐ a visit13 tothe GP surgery should be a last13 resort and should involve a nurse consultation in the first13 instance This would be consistent13 with three quarters of appointments currently involvinga chronic disease or long term condition which relates to improved self-shy‐care The support13 ofthese patients at home should be prioritised through tele-shy‐ and web-shy‐based technologies andshould involve training and coaching through a network of nurse practitioners Home visitsshould generally be unnecessary through the use of these technologies but13 could besupplemented by satellite surgeries manned by nursing in community premises or inpharmacies nurseries and Internet13 cafes
The homes13 of people who13 need13 closer monitoring can then become part13 of virtual wardswith real or electronic visits by health professionals University Hospital Southampton NHSFoundation Trust13 already looks after patients who have undergone surgery such as a hip orknee13 replacements in virtual wards with high levels of satisfaction The Royal Free London
37
NHS Foundation Trust13 offers a similar service but13 plans to add the possibility of videoconsultations between patient13 and consultant
310 Attitudes to public health issues ndash obesity smoking alcohol abuse drugs
As self-shy‐care becomes the focus of the NHS the public will increasingly understand that13 thecosts and availability of services are being harmed by the poor health behaviour ofrelatively small numbers of people The link between public health initiatives today andhealthcare needs and costs in the future will become increasingly evident13 as a result13 of theway that13 information is presented Thus the overweight13 smoker who currently attractsconcern and pity when they are diagnosed with diabetes and COPD is increasingly beingseen as the victim of their own stupidity or lack of self-shy‐discipline If they continue to neglect13 medical advice and continue with an unhealthy lifestyle then the way that13 they receivetreatment13 and consume resources will become a matter for the entire population
Obesity is seen as due to a combination of poor diet13 and a sedentary lifestyle No longer isthe idea13 that13 people are lsquobig bonedrsquo acceptable Governments will respond initially byrequiring manufacturers and food processors to provide nutritional information onpackaging and on menus in restaurants But13 people can choose not13 to read the data13 and toneglect13 both the importance of food quality content13 and quantity This will increasepressure to introduce fat13 or sugar taxes and these are likely to be in force within a decade
Although the high taxes on tobacco products has forced some smokers to reduce theirconsumption or to give up altogether the impact13 has been reduced by the smuggling ofproducts from overseas and by the availability of duty-shy‐free cigarettes for people returningfrom foreign holidays and business meetings Further measures are planned to changepackaging and to include even more graphic images and warnings on cigarette packages tomake smokers aware of the effects of smoking on their health and well-shy‐being There is asyet little evidence of how successful this might13 be More effective has been the banning ofsmoking in public places including trains and aircraft Expensive medical interventions suchas heart13 transplants will be denied to individuals until they change their lifestyle behaviourSmokers might13 therefore be increasingly ostracised leading to a loss of esteem This mayhave a particular impact13 on people who already suffer from mental health problems whoare more likely to smoke
The overuse of alcohol is being recognised as a major factor in hospital admissions withNHS figures showing an increase of over 40 in such admissions over the past13 decadeLinked to this has been a 75 increase in prescriptions to treat13 alcohol dependency Fewpeople have sympathy for those who waste their limited income on booze If they havechildren or other dependents they will be the ones who suffer and who may need thesupport13 of social care
Drug users are already significant13 users of social services as their habit13 is likely to makethem unemployable They receive little sympathy from the general public because they areseen as criminals and people who waste public resources Levels of drug abuse have been
38
slowly increasing over the years but13 this trend is slowly being reversed Indeed the numberof people using drugs during the past13 year has fallen to its lowest13 level for nearly 20 years(below 9) with cannabis being most13 likely often following excessive drinking Aselectronic noses and other technologies can detect13 traces of drugs it13 seems likely that13 success in overcoming addiction can be measured objectively This may become a two-shy‐edged sword rewarding those who can turn around their lives but13 further marginalisingthose who canrsquot13 or wont13 accept13 the lsquocold turkeyrsquo
311 Attitudes to surveillance
Issues associated with privacy confidentiality and data13 security have been discussedpreviously in the context13 of information technology the World Wide Web and the ease ofcollecting recording recalling analysing and displaying data The monitoring of individualsand their methods of using this information can be regarded as surveillance As thequantities of data13 increase along with the number of devices that13 can be used to access itthe surveillance tools will also increase in their sophistication Indeed the Big Data13 approaches described in the previous section will enable the combination of structureddata13 (such as the information held in databases) to be married with unstructured data13 fromimages in such a way that13 it13 can be mined
Whilst13 the lsquodigital surveillancersquo methods described above may cause most13 concern topeople because of its impact13 on anonymity it13 is the collection and analysis of images that13 are the major concern to people as they contemplate the ways that13 lsquoBig Brotherrsquo maydevelop to restrict13 freedom Every major UK city and town centre has an array of CCTVcameras that13 continually record activities from every angle If it13 used to be true that13 nobody in London was more than 10 yards from a rat it13 is certainly the case today that13 nobody can be more than this distance from being in view of a surveillance camera Yetthey receive so much positive publicity from TV programmes where their footage is used todetect13 vehicles close to a crime scene or to monitor the movements of suspects that13 theyare now accepted by the public as a deterrent13 in the same way as lsquobobbies on the beatrsquowere seen 25 years ago There is therefore little public reaction to the expansion in the useof video surveillance except13 for the practical observation of how so many views can beinspected and recorded
Looking to the future the tumbling cost13 of video technology will surely lead to anotherincrease in the number of devices The aerial views taken from towers will besupplemented by more local views taken by devices that13 are embedded in the fabric ofbuildings or carried by individuals either on their person (for example on clothing orspectacles) or in the bags that13 they carry The time and date-shy‐stamped images as Big Datawill be recorded to lsquothe Cloudrsquo where it13 can be added to other data It can then be usedwhen an incident13 has occurred or to provide further detail of night-shy‐time activities
It follows that13 there will be no hiding place for people who simply want13 to disappear Theymay respond by wearing clothing (such as hoodies) that13 hide their faces or which make it13 difficult13 to distinguish gait13 or mannerisms from which they might13 be identified New forms
39
of clothing may be designed to make shapes more difficult13 to analyse and these might13 become the uniforms of a class of person who wants to live in a way that13 they donrsquot13 interact13 with officials from any ministry or local government13 department If they also obstruct13 services then they will be considered to be anarchists of some form sparking protests fromother sectors of society
31213 Attitudes to driving
Motor cars have been a feature of UK roads for over a century but13 it13 is only during the past13 50 years that13 they have become a resource that13 most13 families have had access to enablingthem to travel without13 the restrictions imposed by a limited railway network and non-shy‐integrated bus transport People who have had a car throughout13 their lives often see theircars as an important13 factor in enabling them to remain independent13 and to exercise choicesrelating to where they shop and where they spend their leisure time This extends to theirspouse and to friends and neighbours that13 they might13 take with them on their variousexpeditions
Unfortunately there are incidents involving older drivers who perhaps go down amotorway in the wrong direction who are taken ill at the wheel or who are involved in anaccident13 involving no other vehicles These are small in number but13 often lead to a reactionthat13 they shouldnrsquot13 be allowed to drive lsquoat13 their agersquo Age itself is not13 an indicator ofdriving quality but13 because old age also brings more chance of having limited long termconditions and other illnesses it13 is easy to make a link between driving ability and age Thelicensing system does require continued driving to be linked with medical advice andforbids people with poor eyesight epilepsy and other conditions to hold a licence in oldage
Yet13 statistically older drivers cause far fewer accidents than younger drivers The reasonsfor this may be complex and are likely to include the fact13 that13 they drive less often covershorter distances and donrsquot13 go out13 in the dark or in poor weather However it13 does not13 wholly explain why the UKrsquos drivers aged over 70 and who represent13 some 8 of all driversare involved in only 4 of accidents that13 cause injury This compares favourably with the15 of13 drivers aged between 17 and 29 who are involved in over a third of crashes that13 result13 in injury
By 2020 the number of drivers aged over 70 on UK roads is likely to increase to over 7million This will require a new national strategy perhaps involving support13 for olderdrivers further training raising awareness of issues and making more use of adaptivetechnologies to support13 the driver in avoiding collision or forgetting to check on the statusof their vehicle Poor eyesight13 could be enhanced by camera technologies rather thanforcing people off the road if they are unable to read a licence plate
The International Longevity Centre has found that13 one in four Britons thought13 driversshould be made to switch off the ignition for good somewhere between the ages of 70 and75 The numbers may decrease as the population ages and as cars become safer Forcing
40
older people off the road may be a natural consequence of providing free bus passes andsubsidised rail fares but13 the growth in the pavement13 scooter industry demonstrates that13 older people value their independence and will do almost13 anything to get13 out13 and aboutPerhaps legislation will result13 in more regulation of electric vehicles and where they cantravel
There can be no doubt13 that13 getting out13 will be associated with better quality of life andwell-shy‐being and this is likely to be supported in the future as evidence of improvedoutcomes emerges It is to be hoped that13 positive stories will be publicised so that13 publicattitudes arenrsquot13 hardened This may be supported by more in-shy‐car monitoring of drivers andthe linking of performance with on-shy‐line driving records and licences These could throughremotely monitored ignition systems prevent13 the use of motor vehicles by people without13 a licence or without13 insurance
313 Climate change
There is a general view that13 the emissions of carbon gases are contributing to globalwarming in a manner that13 will change the UK climate in such a way that13 the climate maybecome more Mediterranean However some scientists believe that13 manrsquos impact13 on theenvironment13 may be small compared with natural variations caused for example bycyclical changes in the sunrsquos energy output13 or by the effects of volcanoes and earthquakesRecent13 evidence has suggested that13 we are going through a phase of changing extremesand that13 this is more likely to cause storms periods of excessive rainfall and unusualseasonal trends with snow and frost13 in the spring and warmer winters Considerableuncertainty remains and it13 might13 be necessary to plan for a number of different13 scenariosand for the impact13 on vulnerable people
I Colder winters UK properties are poorly insulated resulting in excess mortalitiesduring cold spells due to an increased number of people suffering from stroke aswell as bronchitis and other pulmonary diseases The cost13 of heating continues toincrease putting more households into a state of fuel poverty Any further coolingduring the winter months will result13 in more people living in unhealthy coldconditions Winter fuel payments are likely to be restricted to the poorest13 peoplebut13 this might13 exclude people who live in larger properties that13 are more difficult13 toheat
II More storms excessive winds and rain can cause flooding at any time of the yearMany UK communities are built13 close to rivers and these can surge during heavyrainfall causing houses to be filled with water and furniture and carpets lostInsurance can be problematic for properties built13 on flood plains which can blight13 properties and prevent13 owners from being able to sell and move on High winds canrip off roofs causing injury and also causing families to be left13 homeless anddependent13 on social services
III Hot13 summers Europe suffered high temperatures during the summers of 2003 and2004 leading to heat13 stroke and hypothermia The UK has not13 previously sufferedfrom such problems but13 might13 be expected to experience days of extreme
41
temperature and humidity at times Older people may not13 be prepared for suchweather Street13 dwellers may be unable to find shade and supplies of drinkingwater
Irrespective of what13 combination of weather scenarios arise it13 must13 be concluded that13 any extremes will have a major negative impact13 on vulnerable people especially if theyare not13 prepared because they havenrsquot13 received the weather warnings and advice that13 can be broadcast13 using the TV radio and online services Once again the digitallyexcluded will suffer and will pay a high cost Society will continue to pick up the bill interms of demands on social care services unless preventive actions are taken in theform of connecting these people to each other and to formal services
42
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
s13 13
13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
n13 13
13 s13
r13 n13
e13 at13
e13 y13 e13 ld13
ly13
13 e13 t13 e13
s13 er13 e13
f13
rt13 13
13 13
13
r13 13
s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
e13 g13 13
e13
13 13 ial13
13
d13
13 d13 h13 r13
d13 13
s13 y13
e13
13
rd13 r13 e13
13
13
13
e13
e13
d13 13
13
13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
Paradoxically perhaps radio is more popular than ever and cinema13 has bounced back fromdecline to once again become an important13 element13 in the social lives of many people
Video images still or moving can be displayed also on laptops tablet13 devices andsmartphones which means that13 people can be entertained or informed on the move Sometrain operators have followed airlines in providing an lsquoat13 seatrsquo entertainment13 experience13 which can be offered with certain choices though many passengers prefer to use their owndevices and content In the future it13 seems likely that13 access to both audio and videoentertainment13 will be possible at any location and in a way that13 doesnrsquot13 interfere with theenvironment13 of other passengers
For those who want13 neither video nor audio (eg music) entertainment reading mayremain the entertainment13 of choice Many older people have struggled to find suitablereading materials as a result13 of the closure of local public and mobile libraries Some peoplecannot13 support13 the weight13 of a book while others lack the dexterity to turn the pagesOthers have sight13 problems which prevent13 them from reading small print All theseproblems can be overcome using either text13 to speech technologies (which are replacingtalking books) or by using e-shy‐reader devices which allow font13 sizes to be increased easily andwhich offer simple interfacing for moving pages backwards or forwards
In the future it13 must13 be assumed that13 all entertainment13 media13 will be held in the lsquocloud2rsquoand will be downloadable to an appropriate device on payment13 of a fee provided that13 acommunications contract13 is in place
The pre-shy‐requisites will bebull A device (eg PC laptop tablet Kindle)bull A contract13 with a telecoms provider (eg BT Virgin Sky) for broadbandbull A contract13 or contracts with media13 provider(s) (eg Netflix iTunes)
Those who lack any of these components may be entertainment13 excluded
28 Cash13 and13 money
Cash has been king since the abolition of the gold standard It is an expensive method oftransferring money between people and organisations and is a considerable overhead forindustry and for individuals travelling between different13 countries The highest13 denominations are lightweight13 and easily lost stolen or destroyed while the smallest13 denominations are heavy dirty and difficult13 to handle It is surprising that13 physical cashcontinues to be used It can only be a matter of time before it13 is digitised and replaced byvirtual cash
2 This means the material (book film or whatever) is stored in a remote computer (thecloud) and downloaded (or lsquostreamedrsquo) to your device on demand and possibly onlytemporarily
10
Large payments were previously made by cheque They are expensive to process by thebanks because people can write them by hand which makes them difficult13 to readelectronically and automatically Consequently they require human intervention and this isnot13 what13 modern banks wish to do so they want13 to promote greater use of debit13 and credit13 cards The latter were used initially as a cheque guarantee but13 are now being used almost13 exclusively as a means of withdrawing cash from ATMs and for making paymentselectronically UK banks wanted to do away with cheques by mid-shy‐2012 but13 they had toperform a u-shy‐turn under pressure from charities representing older people It is apparent13 that13 digital cheques and other cheque-shy‐replacement13 strategies will be introduced soon that13 satisfy the most13 pressing concerns of older people
It was difficult13 to see how cash could be replaced for payments for lower cost13 items such asnewspapers and sweets until the era13 of contactless payments Near field communicationsystems are likely to replace bar-shy‐codes to carry product13 identification information Theycan be read by electronic receivers The same technology can be two-shy‐directional allowinginformation to be passed from a smart13 phone to a reader and back again The smart13 phoneeffectively becomes a wallet13 which can be digitally filled by the owner and then emptiedwhen making purchases For small sums of money this approach is ideal and is likely to berolled out If cash disappears then begging will become difficult13 and welfare paymentsmade on a card Such cards are already used by social services as a means of providingclaimants with a means of receiving self directed care and support By restricting use of thecard to outlets that13 can provide care and support13 services opportunities for spending thecash inappropriately are restricted
It follows that13 many users of social services will need to have a smart13 phone as well as acard that13 can be used to buy services In the future smart13 phones may be provided as aloan item to claimants for social care This could include a digital wallet13 facility as well asthe communications and information ecosystem that13 would allow these people to receive awhole range of other services that13 would prevent13 their social exclusion and which could beused directly to provide them with information and access to entertainment
29 Biometrics and fraud13 prevention
Identity theft13 is used by criminals to pretend to be someone else in order to accessresources or obtain credit13 and other benefits in that13 persons name Although the concept13 has been around for centuries it13 is a growing concern in the digital world as we acquiremultiple online identities for bank accounts social networks and using public services such13 as paying tax electoral registration etc
Passwords are fraught13 with difficulty typically they are hard for humans to remember andeasy for machines to crack Efforts are therefore focused on other forms of provingidentity for example
11
bull Fingerprints have been accepted for over two thousand years to confirm identitymostly in criminal justice The technique has been applied to door-shy‐lock opening insome supported housing schemes There are practical problems associated withregistering lsquoallowedrsquo fingerprints and the useful lifetime of such products is also onlyabout13 three or four years
bull Retinal imaging and DNA analysis have been relatively slow to follow but13 only dueto the sophistication required for measurements and the time taken for testing Acombination of retinal imaging with facial gestures and blinking is possible in the labbut13 currently takes half a minute to achieve a match -shy‐ and this is achieved only withthe use of considerable computer processing power This sort13 of time makesapplications in mass people transfer impossible
Current13 research in this area13 is focusing on the uniqueness of other body parts such as earsand knees as biometric indicators The ears have great13 potential because they are usuallyexposed though hidden sometimes behind hair and other times by hats and other clothingOn the other hand the knees are rarely visible and however unique they may be there willbe cultural and religious obstacles to overcome before scanning could become a regularpart13 of identity confirmation The cameras which are central to such systems used to beexpensive but as the cost13 of high quality cameras continues to fall (there is one in nearlyevery mobile phone) it13 becomes feasible to devise identification devices that13 use multiplecameras to simultaneously recognise the eye and the ear
Movement analysis can be used to identify people by their walk gait13 and other biorhythmsprovide unique signatures It is possible to learn someone elsersquos gait13 though and injury orillness13 can have a temporary effect13 on gait
Over the next13 ten years with more sophisticated databases and image processing facilitiesthe cost13 of implementing advanced biometrics will fall enabling their application acrossmore diverse areas and in more social opportunities Potentially cameras will use cloud-shy‐technologies to provide individuals with instant13 recognition of anyone approaching them inthe street This could prompt13 a name or the occasion when they were last13 seen or spokento as a secondary method of control in much the same way as Internet13 banking seeks toavoid fraud This13 has13 the13 potential to remove13 the13 need for13 passwords13 and might13 then be13 the basis of machine-shy‐based13 communication13 either in front13 of a laptop or tablet13 device orwhen using13 a smart13 phone
There will need to be special measures introduced to support13 people with any form ofdisability as they might13 well have one or more sensory deficits Similarly people maystruggle to communicate following a stroke or a serious accident Nevertheless it13 may bereasonable to conclude that13 such systems will be both available and acceptable within thenext13 10 to 12 years
12
210 Health13 information
Health records in the form of written documents x-shy‐ray images and clinical observations arean important13 means of making all interventions efficient13 and safe Increasingly people havemany different13 conditions (comorbidities) and may be treated by several specialists Asthese physical records are moved inevitably some get13 lost estimates suggest13 that13 one inthree records is lsquolostrsquo at any one time
The best13 resource for information about13 a patient13 is his or her primary care record which isheld by the GP The UK was an early adopter of electronic primary care records and can beproud of the way that13 these have enabled population-shy‐based information to be collectedand analysed Scotland (and to a lesser extent13 Wales) has led the way in ensuring that13 allthese records are accessible through anonymised approaches that13 allow researchers toexamine trends and improve analysis of performance Fundamental to this has been theallocation of a unique identifier At13 the same time individuals can access these recordsboth to check for accuracy and to see what13 their doctor has said about13 them
This13 has13 the potential to make people more responsible for their own conditions andmight lead to better13 self-shy‐care13 and changes in behaviour13 that might reduce13 the13 incidence13 or severity13 of chronic conditions13 that are related13 to lifestyle
In the future we can expect13 the primary electronic health record to be linked with hospitaladministration systems picture archiving systems and other records held by hospitals sothat13 appropriate medical staff can have access to all relevant13 data
When the social care record is added to the mix then this will mean fewer but13 shorter andbetter assessments for social workers and for healthcare staff They will knowcircumstances and factors that13 could influence the choice of approaches This supports theidea13 of there being only one record consisting of several components all of which areaccessible by an appropriate professional at any time and in any place
The13 ambitions13 described above13 are not13 limited by technology most13 of the interoperabilityissues between rival commercial record systems have been resolved and databaseproviders are being compelled to support13 joint13 working The English NHS Mandate requiresTrusts to effectively replicate arrangements already in place in Scotland and in Wales andthis will go a long way towards achieving a genuinely paperless NHS well before 2020 Withnew biometric identification technologies individual records will be available to out-shy‐of-shy‐hours physicians and to those working in an AampE department13 irrespective of theconsciousness state of a patient
New telecare and telehealth technologies will produce significant13 more volumes of data13 which are currently held in different13 places and owned by different13 organisations rarely thepatient These data13 will also need to be shared but13 only in a manner that13 is acceptable toeveryone Patients may not13 want13 all their mental health information published in a formthat13 can be viewed by social workers GPs may not13 want13 to have access to all the data13 that13 might13 suggest13 that13 there is a domestic crisis to which they had neither the wish nor capacity
13
to respond Monitoring systems that13 support13 the lsquoquantified13 selfrsquo may also offer data13 that13 may or may not be added to the full recordThe future of health information might13 therefore be about13 providing individuals with themeans of producing relevant13 information storing it13 somewhere secure and then viewing it13 at a later time but13 in a format13 (or with advice) that13 is acceptable
See also httpmydexorg lsquoMydex gives individuals back control over their personal datarsquo
(see also Digital Scotland 2020 Achieving World-shy‐Class digital infrastructure a final report13 tothe Scottish Government13 httpwwwscotlandgovukPublications2013029054lsquoconnectivity by any device anywhere and anytimersquo)
211 The Future of Healthcare
The strains on our healthcare delivery system are becoming greater as they are in otherdeveloped countries as a result13 of an aging population rising expectations and unhealthylifestyles The necessary changes will require a significant13 shift13 in resources13 fromsecondary13 care13 where unit costs13 are high to community13 carewhere people can generallybe treated at home
The future must13 therefore necessarily involve efficiencies in hospitals and in the way that13 people can be treated in less expensive locations ultimately in their own homes Hospitalswill use more sophisticated diagnostic tools including scanners of all types to non-shy‐invasivelyprobe inside peoplersquos bodies This will result13 in more day cases and hospital stays (alreadyaveraging under a week) to even shorter periods with on-shy‐going support13 provided inintermediate care settings that13 might13 include hotels care homes or the personrsquos own homeif it13 is clean safe secure and has all the necessary amenities (include access to theInternet)
Advances in medical technology will allow more treatments to be delivered in the homeThis will mean fewer visits by clinical staff and fewer opportunities to attend primary carecentres Pharmacists will become suppliers of information as well as drugs so the balanceof care will shift13 significantly away from doctors who will work in different13 ways relying13 increasingly on telemedicine to bring the specialist13 to the patient13 for an online consultation13 For example if a patient13 complains of nausea13 and severe headaches a virtual consultationcan be offered almost13 immediately and without13 having to send a patient13 with a potentiallyserious and acute condition on a potentially long journey to a hospital
In the above example a neurologist13 may ask further questions as well as conduct13 acomplete neurological examination using videoconferencing technology Airedale GeneralHospital consultants have new contracts that13 require them all to be available for virtualconsultations The first13 benefit13 has been in reducing the need for prisoners at local jails tobe brought13 into AampE (which may need to be locked down depending on the circumstancesand the potential for violence of the individuals involved) potentially saving hundreds of
14
pounds in security costs It also avoids the need for healthcare staff to have to go into aprison environment
The principles described above are already saving lives through telestroke services whichlead to more people being thrombolysed appropriately and avoiding long term support13 that13 often follows a stroke incident Teledermatology has been practised for a number of yearsand results in rapid diagnosis and resolution of problems that13 previously required significant13 time for remedy
212 Gadgets and13 DIY13 healthcare
There are at least13 three elements to healthcare
bull Gathering information on symptoms and physiological parametersbull Interpreting the information andbull Responding to the diagnosis with treatment
Many people choose to exercise self-shy‐care because this gives them control whilst13 avoidingthe need to share their concerns and personal details with others A lsquodo It yourselfrsquoapproach might13 even be encouraged by the NHS as a viable way of using scare resources
Medical devices that monitor vital signs are mature and have been miniaturised so that13 they can be used in the home by individuals with little or no medical training Indeed bloodsugar monitors are being produced specifically for use outside the hospital and in such away that13 they can be used reliably by people with advice and training being provided onlinevia13 YouTube
Many medical monitoring devices do no more than produce a single measure which theuser may record or respond to Others link wirelessly to smart13 phones allowing data13 to bestored and entered into a personal health record where trending opportunities existingIndeed individuals can easily enter their data13 into an app running on their laptop tablet13 orsmart13 phone This trending information may be useful13 for self-shy‐care and could be passed onto a physician though the volume of data13 produced in this way and doubts about13 thequality of the data are likely to persuade GPs to discount13 data13 produced in this way
This gap in knowledge can be filled with advice information and diagnosis that13 can beobtained online using a lsquoDoctor Googlersquo approach The quality of such diagnosis may varysignificantly although there are many sources of information that13 are both supported andapproved by the NHS (and by similar sources in other countries) However with a data-shy‐richapproach and a choice of diagnosis people may be empowered to take a greater role inhealthcare
15
The final component13 for the DIY enthusiast13 is the treatment13 option Many people fear longterm use of medication produced by the big pharmaceutical industry and prefer morenatural remedies which are available over the counter More medical treatment13 devicesare available that13 stimulate blood flow and counter pain through the use of electrical andphysical stimulation
The evidence may be weak at present13 but13 might13 grow as more people use them and as theircost13 drops The13 impact13 of13 such technologies13 on vulnerable13 people13 is13 difficult13 to gauge
213 Telecare
Support13 provided at a distance to people in their own homes is known as telecare Thename implies remote monitoring and interaction and includes the monitoring of the homeenvironment13 and of the individual as well as the interaction of the individual with thisenvironment Definitions have become difficult13 due to some US medical devicemanufacturers introducing the term telehealth to describe medical telecare such as remotemeasurement13 and collection of vital signs data
In the UK telecare alarm services have matured quickly using the robust13 platform andinfrastructure of social alarm systems which were originally used by tenants in shelteredhousing schemes to seek help when they didnrsquot13 own a telephone The majority of telecareservice users today live in their own homes and use dispersed alarm units to link with amonitoring centre through the telephone network Improved assessments of needs andrisks to independence have resulted in combinations of sensors being used to support13 theoption of staying put13 rather than moving into residential care or having increasing levels ofdomiciliary support They support13 the policy of bringing care closer to home and ofencouraging people to become partners in their long term support13 arrangements
Telecare services developments over the past13 decade include standalone items such asautomatic lights which have achieved significant13 efficiencies especially for people who arefrail and prone to falling and to those suffering from mild cognitive impairment epilepsyand anxiety People who have long term conditions including chronic conditions such asdiabetes and hypertension can also be managed more effectively through telecare supportThe benefits of telecare services include a relief of stress for family caregivers enablingthem to continue to provide unpaid support13 while holding down a job and maintaining theirquality of life
New developments enable continuous monitoring of behaviour and smart13 devices that13 canfor example remotely control the cooker the water supply and door entry Such13 monitoring may detect13 incidents early and prevent13 emergencies arising Devices arebecoming smaller and easier to embed quickly within the home environment making themmore acceptable and less noticeable Longer battery life means less frequent13 maintenancevisits
16
The13 monitoring13 centre13 becomes13 an information hub13 offering13 both advice13 and a vehicle13 for checking that someone is coping especially following a trigger event such as a stay inhospital or the illness13 of an informal13 carer
New systems utilise web technology that13 allows family members to be more proactive inthe monitoring of their relatives This can lead to greater interaction with them especiallywhen the relatives live a considerable distance away (perhaps in another country) Thesenext13 generation systems might13 include video conferencing and the use of tablets smart13 phones or smart13 TVs but13 when an emergency response is required (perhaps to lift13 someoneup after a non-shy‐injurious fall) there remains a need for human intervention
The13 future13 of13 telecare13 might therefore13 include13 an increasing13 dependence13 on volunteersfrom13 the13 community to provide13 the13 required support Social networking may need to beused13 to support13 telecare technologies
214 Mobile healthcare
While telecare can support13 people effectively in their own homes it13 is now recognised that13 being able to go out13 to enjoy open spaces and to overcome the fear that13 the home is aprison is an important13 part13 of improving well being and supporting a higher quality of lifeExtending telecare technologies to operate outside the home is known as mobile healthcare(or mCare) and is based on mobile telephone networks rather than landlines
The simplest13 form of mCare requires only a basic mobile phone to deliver telephone callsvoice13 messages and SMS (text13 messages) The technology is mature and there are countlessapplications in use both in the UK and in developing countries such as Africa13 and India13 where mobile telephones have already achieved a saturation level and where fixedtelephone infrastructures are not13 likely to be established at any time Such telephones areuniversally available in the UK and are used by the vast13 majority of people including manyolder people especially if they have been introduced to the low cost13 (pound30) devices that13 have large buttons large displays and a separate large button for calling an emergencynumber
Smart13 phones are rapidly replacing basic phones and allow the use of a large range of lsquoappsrsquothat13 are being developed to provide information and for enhanced experiences In thehealthcare space Skype FaceTime Vidyo and GoToMeeting with HD Faces are all current13 examples of video conferencing software available on tablets and smartphones
The specific software will depend on the nature of the communication desired
bull Skype will13 manage a simple video phone callbull Where an AampE physician needs to share a CT scan of head with a Neurologist13 on call
from home GoToMeeting would be more appropriate
17
bull If the physician would rather have a dedicated online meeting room that13 patientsand colleagues can simply drop in for a virtual meeting a Vidyo virtual room may bemore appropriate
This technology can suit13 any form of lifestyle including many people with complex needswhose lifestyle is not13 consistent13 with a fixed address
Social care apps are available already to deal with problems of sensory deficit
bull Guiding a blind person through GPS navigation and reading signs through appslinked to the devicersquos camera13
bull The microphone can be used as a hearing aidbull Speech recognition software can be used either to replay speech at a slower speed
or for translation into a language of choicebull Speech can also be selected for people who have a stammer or who have a problem
with their larynxbull Apps are becoming contextually aware recognising situations and locations and are
thus becoming a personal assistant13 for people with disabilities
By 2020 it is therefore possible that a smartphone may13 be prescribed13 for people who13 need13 social13 care13 together with13 a range of apps that have been13 selected13 to meet13 theirassessed13 needs
Whilst13 smart13 phones tablet13 devices and apps may become an important13 part13 of anindividualrsquos personal support13 armoury the potential of mCare will be limited only by anindividualrsquos ability to make use of all its functions Each device could become a part13 of anindividualrsquos personality supporting them to improve behaviour take exercise avoidtemptation and manage their own health and well-shy‐being Potentially mCare could becomethe most13 important13 element13 of social care and support13 within 10 years
215 Artificial Sensing and Enhancement Devices
bull It is estimated that13 one in seven people has imperfect13 hearingbull The numbers who are born deaf are quite small and many of these people may
have some form of hearing restored through surgery or through technologybull Similarly while there may be nearly a million people registered as blind or having a
severe visual impairment the vast13 majority lose their sight13 during their lives as aresult13 of disease
bull New treatments will deliver sight13 recovery or restoration over the course of the next13 10 to 20 years
Fortunately technology can provide excellent13 sensing capabilities that13 are already providingpeople with external portable devices for enhancing their lives The simple hearing aid is anexcellent13 example of a device which has been improved through both miniaturisation
18
personalisation and enhanced performance Today digital hearing aids use sub-shy‐miniaturemicrophones that13 can be unidirectional or omnidirectional and which can be adjusted insensitivity over an extended range Tomorrowrsquos devices can be switched between modesby the user so that13 they can benefit13 from hearing perfectly in any environment Indeedthey can be used with adaptive filtering technologies (as used by helicopter pilot13 headsets)to eliminate some sounds so that13 the rich speech (or music) components alone remainFuture developments will be on optimising control so that13 the user can switch seamlesslybetween different13 amplification applications without13 appearing to be distracted A smart13 phone or mp3 music player may be used as either a processing unit13 or as a ubiquitousoutput13 device that13 looks cool and natural
These same technologies will also be developed for use within the home environment13 fortimes when a deaf user isnrsquot13 present13 or is asleep Acoustic signatures associated withadverse events and incidents such as the hiss of a gas leak the crackle of a fire the sound ofa smoke detector the drip or a water leak or the sound of breaking glass can be directlyassociated with programmed actions Speech will be recognised interpreted translatedsimplified or displayed so that13 an individual knows what13 is said and can be provided withclear instructions on how to respond
Video cameras have become smaller and cheaper and capable of producing high definitionimages The problem of storing and editing these large image files is being solved by thearrival of cloud computing
Electronic noses are already capable of detecting the quality of wine and fresh fruit Similartechnology will be based in smart13 phones and will be able to analyse the air to warn of13 foodthat is no longer fresh and of other indicators of danger including gases that13 have13 little13 natural13 smell These13 devices13 could support13 people with13 cognitive impairment13 -shy‐ whose13 sense of smell13 tends13 to deteriorate -shy‐ to live independently
Many older and vulnerable people are at risk of hypothermia during the winter Sensordevices can provide warnings of low temperature In the same way heat13 stress can be adanger during the summer months so sensors can alert13 people of the need to openwindows or to operate a fanFinally people who have damaged13 their fingers13 or hands will be able to wear sensorsembedded in artificial skin or in gloves that13 will enable them to identify textures and shapesand be able to dress and undress without13 the assistance of carers
216 Robotics
We may recoil at the idea13 of personal care being delivered by robotic devices but13 it13 is likelythat13 within a decade personal assistants will exist13 to assist13 with household tasks These areunlikely to be humanoid and are more likely to be machines dedicated to helping frailpeople to support13 their own weight13 and to carry trays of food around the home
19
There are four broad classes of robot13 under development13 that13 are likely to mature within 10to 12 years
1 Miniature industrial robots that13 have been programmed to perform specific taskswith precision They are likely to be relatively heavy enabling them to bear weight13 but13 still have the necessary flexibility to carry an individual over short13 distancesplacing them in a chair or on a bed They will have sensors and cameras to provideimmediate feedback and to adjust13 rapidly in response to verbal commands or cues13 from the user Some designs may build on existing assistive devices such as abathroom hoist13 or a bathing aid to become intelligent13 extensions of productsalready on the market A stair lift13 with intelligence is already being designed by a UKcompany and is aimed at providing the user with more control of the journeybetween floors of a house
2 The second group of devices might13 be described as intelligent13 furniture Beds andchairs are already available that13 adjust13 to make the user more comfortable and also13 to help them get13 into or out13 of bed The control units are fairly cumbersome andare suited to operation by a carer Voice activated controls and built-shy‐in intelligencewill give the user more control and independence Other items of furniture to whichintelligence might13 be added would be tables whose height13 can adjust13 and whichhold items of food and medicine securely The table would recognise these objectsand could provide prompts or reminders
3 Mobile robots form the third group These could be goffers that13 can either fetchand carry items such as newspapers drinks or trays or which can accompany theuser when they move between rooms providing them with support13 or prompts Thistype of robot13 could be an intelligent13 walking frame with wheels which13 could13 doubleup as a smart13 wheelchair when necessary
4 Finally there are companion robots These might13 be in the form of an electronicpet typically a cat13 or a dog though the Japanese Paro robot13 is a seal Pets canrespond to stroking and being patted they can also remind their owners that13 theyneed to take exercise and to eat drink and take their medication Various designsare already available which provide feedback but13 future models would includecameras and a screen to provide a mobile means of information and interactionwith other people over the Internet Intelligence within the device could allow themto have a personality of their own and gain knowledge by scraping data13 fromwebsites so that13 they can generate speech and have conversations about13 the newsthe weather or sports results
217 Transport and transfer technologies
Walking is good exercise and is a no-shy‐cost13 form of transport13 that13 is encouraged because of itsimpact13 on well-shy‐being For an individual with a chronic disability or suffering from theeffects of an accident13 or an injury this becomes impractical without13 an assistive technology(AT) A walking stick is the simplest13 example of AT
20
Within the home the stair lift13 has enabled people who live in conventional properties that13 are on two or more floors to continue to use facilities on different13 floors when climbing thestairs has become too difficult This is often the case for people who have arthritis a lowerlimb amputation a long term condition such as Chronic Obstructive Pulmonary Disease orpeople approaching the end of life and who have chosen to die in their own homes
Designs have improved so that13 a curved staircase is no longer an issue and the reliabilityhas reached a level where breakdown is a rare occurrence13 Through-shy‐floor lifts have been analternative proposition but13 they remain too large for most13 properties Alternativeapproaches may emerge using air pressure or water pressure as the driving force ABrazilian design already utilises a plastic tube in which a pod is moved effortlessly up anddown
Electronic wheelchairs are now available that13 allow the individual to become moreindependent13 as they allow the user to control both propulsion and steering Some modelshave the capability of mounting a pavement13 or a step or even a flight13 of stairs Personalmuscle amplification devices have been developed originally with the intention of helpingpeople who are confined to a wheelchair due to a neurological disorder to perform sometasks from a standing position Indeed the Rex walkerrsquos manufacturers claim that13 anyonewho can propel themselves in a wheelchair could walk by using Rex
Other approaches have focused on the rehabilitation of people after major accidents that13 have caused partial paralysis They quickly extend into exoskeleton designs that13 enableanyone to gain a mechanical advantage and thus to tackle physical tasks that13 would not13 otherwise be possible These suits are the focus of major research projects across theworld Some13 products such as the system developed by Honda are being tested inAssisted Living facilities and are likely to become more and more enabling over the next13 decade
Similar benefits are also occurring outside the home with a number of novel carryingsystems appearing over the past13 few years They are generally termed lsquoscootersrsquo but13 thiscovers a wide range of systems and devices ranging from the Segway a device that13 is amobile platform on which the user stands and navigates through to conventional electricvehicles that13 have been developed from golf buggies There remain a number of issuesconcerning their use on roads or on pavements but13 similar problems will need to beresolved for bicycles to play their full part13 in enabling people to get13 more exercise13 Thepotential for hybrid scooters remains
218 Smart domestic appliances and personal hygiene
The bathroom is a dangerous place and one where many older and disabled people slip andsuffer a fall Many older people recall taking a bath in a tin tub in front13 of an open fireToday the options tend to be a level access shower (ie a type of wet13 room) for anyoneunable to get13 into a bath There are various aids to help people get13 into and out13 of thebath most13 involving a seat13 that13 can be raised or lower with some bath-shy‐tubs having a door
21
There has been some research into alternative methods of keeping the body clean Sanyointroduced a machine in 1970 modelled on a clothes or dish washing machines the personsits on a seat13 inside the machine where13 they are cleaned by a set13 of water jets These havenot13 proved popular and furthermore require the individual to be transported to themachine Thus the technology may find application in nursing homes but13 are unlikely to beattractive to people living independently in the community
The washing needs of people change over time Over the past13 20 years body piercingshave appeared which have demanded additional attention to avoid the problemsassociated with poor hygiene and metals Similarly hair may be permed and dyed usingchemicals which are much stronger and which might13 damage the hair Add to this thepainting of finger and toe nails and the washing needs are rather different13 to what13 theymight13 have been even ten years ago Finally tattoos were once popular only with sailorsToday they are likely to be found on the arms backs and legs of both men and womenNew ways of cleaning these tattoos will be needed especially if they become infected orare sites at which pressure sores develop
Even if a personrsquos body is clean if their clothes are dirty they may become socially isolatedBut13 the washing of clothes can be strenuous even if a launderette is used The need toconserve water has driven research into ultrasound techniques to beat13 the dirt13 out13 ofclothing while some companies are experimenting with polymer chips These13 ldquogreenrdquo13 technologies are quickly maturing and are likely to be standard in the next 10 years
Other smart13 household appliances are already appearing on the market13 and may soonbecome common13 in UK homes13
bull Robovac devices have sensors to enable them to detect13 dirt13 on carpets and to adjust13 their operation accordingly
bull Refrigerators can read bar codes or RFID tags to identify their contents and theirldquouse byrdquo13 dates enabling them to inform the owner that13 they should use theproducts before they are out13 of date They can be linked to the Internet13 to reorderitems as they are consumed or to suggest13 menu options for the individual based ontheir preferences or according to the diet13 required to manage a condition
bull Ovens will automatically switch off if they are left13 without13 attention for too longand drying machines will set13 times automatically
Devices may be linked so that13 they are more efficient and report13 maintenance issues sothat13 they can be repaired (perhaps remotely) before they suffer a catastrophic breakdown
219 Personal and home13 security
It might13 appear perverse but13 people with very little personal wealth and property are morelikely to be the victims of crime than those who have expensive items This may be due towhere poorer people tend to live or because people who have valuable assets take greater
22
steps to protect13 them There can be no doubt13 that13 crime has a very negative effect13 onindividuals and on their families creating a fear factor that13 may be difficult13 to remove Theimpact13 on quality of life is therefore very considerable especially if it13 forces people to stayat home behind locked doors effectively isolating themselves from society
Modern policing places increasing reliance on the use of closed circuit13 television (CCTV)Town centres are covered by cameras used increasingly in the fight13 against13 crime by bothdetecting anti-shy‐social incidents and identifying the people involved They are also used tomonitor the movement13 of cars that13 may be involved in incidents of burglary and violenceand are fast13 becoming the primary mechanism of law enforcement13 agencies to solve crime
CCTV has moved into the home to record movement but13 monitoring the footage is timeconsuming and often not13 practical Cameras are now available which provide an instant13 video feed to a smart13 phone when movement13 is detected These may have intercomcapability allowing someone to remotely speak to an intruder sometimes before they havegained access to a building This may serve as a deterrent13 and when fitted alongside simpledevices that13 switch lights on randomly around the home may force burglars to goelsewhere
As the price of cameras continues to fall the option of carrying a camera13 on the body that13 continuously monitors personal space is becoming more useful Using wireless networksthe data13 collected can be sent13 continuously to the cloud for safe storage It cansubsequently be retrieved to provide evidence (video and audio) of confrontations enablingsuccessful prosecutions to be made The smart13 phone itself is becoming a valuable itemthat13 is attractive to criminals These can be tethered to personal attack buttons usingwireless technology allowing the device to be activated by the pressing of a button if theowner is being attacked The phones can then be tracked and located by the police whilebeing rendered useless to the assailant
Bogus callers are a perennial problem for vulnerable people Video door bells can beconfigured to display images and record the words of visitors before they are admittedallowing remote monitoring centres to oversee the situations and use image recognitionsoftware to confirm the bona13 fide of visitors Such13 arrangements may become13 commonplace13 over13 the13 next five13 or13 six years13 significantly13 improving the safety of peopleliving independently
220 Personal safety
The biggest13 risks to personal safety stem from fires and falls Most13 fires are the result13 ofpoor cooking practices resulting in burns or scalds Floods and gas emissions are caused bya failure to remember to close taps
The current13 approach involves detection of an emergency situation as soon as possible but13 always after a problem has already occurred This responsive approach can minimise therisks provided that13 there is a protocol in place for intervening This could increasingly be an
23
automated response such as the switching off of the gas of water or the switching on of asprinkler system or a water mist13 system
In the future monitoring systems will be more sophisticated and will have sensors and localintelligence to identify activities In this way reminders can be issued before an emergencyoccurs13 This lsquosmart kitchenrsquo approach may become13 an integral part of13 homes of13 vulnerable13 people
A prototype system has been developed at the Culture Lab in Newcastle Sensors havebeen embedded into cooking utensils enabling the kitchen to identify what13 the person istrying to cook or prepare It can provide interventions as messages on an instructionscreen
Accidents also occur out13 of doors People with dementia13 might13 become lost13 and may havepoor road safety awareness Location devices based on GPS have advanced from large andheavy receivers that13 were used on ships and boats to small battery-shy‐operated devices that13 can be carried in the hand or in a handbag The current13 generation of locators has limitedbattery life and are rather too large to be secreted about13 a personrsquos clothing while devicesthat13 are integrated into a wrist-shy‐watch are rather clunky and unattractive
Within 10 years the13 technologies13 will have13 matured and will be13 much smaller13 so that theycan be embedded in shoes in walking sticks hats or any other item of clothing Powerrequirements will have reduced so that13 energy harvesting from the movements of theindividual will be sufficient13 to keep these products working for several weeks without13 theneed for recharging The devices will not13 simply indicate to others where the individualhappens to be but13 will provide subtle guidance cues to direct13 them home
Cameras might13 also form part13 of the personal security systems that13 will protect13 people fromaccidents Data13 may be sent13 to the cloud and analysed in real time if the person is in adangerous location and can provide prompts either to the individual or broadcast13 advice toothers to clear the danger These systems may be embedded in items of clothing (such as ahat) or they may be attached to spectacles
221 Energy and13 portable power supplies
The demands of developing economies for more power will inevitably lead to higherdomestic fuel charges in the UK especially as oil and gas reserves dwindle
By 2018 UK homes should be fitted with new smart13 meters The specifications for these13 devices have yet13 to be finalised but13 will include a means of identifying wasteful use ofenergy including TV sets that13 are left13 on and unattended fridges and freezers that13 are set13 attoo low temperatures and dryers that13 are used for too long or when the weather is suitablefor using a washing line They could be an enabling factor that13 supports changes inbehaviour driven by a need to use less power but13 it13 is unlikely that13 they will offer a bigreduction in costs that13 are already a problem for many vulnerable families
24
More generally the need for power conservation will include devices that13 are moreefficient and a significant13 emphasis on heat13 retention in buildings through betterinsulation
The energy crisis may force many people to spend more time in community settingsincluding shops and public buildings where they can benefit13 from the warmth Increasingreliance on mobile communication devices will lead to increasing demand for batterycharging facilities
Greater use may be made of portable devices for generating power based on solar cellswind or hand motion
222 Smart cities and homes
The Digital City initiatives have been based on information and how it13 can be used most13 effectively to make people aware of what13 is going on around them This means bettercoordination of resources more rapid access to advice and a battery of sensors measuringevery conceivable parameter from sound and light13 levels through to air quality andtemperature fluctuations There are several Digital or Smart13 City initiatives currently beingimplemented both in the UK and across the world They may significantly impact13 the livesof the millions of people living in them but13 the timeframe for outcome benefits to influenceplanning and design elsewhere is likely to be at least13 20 years and therefore outside thetimeframe of the current13 project
Housing plays a big role in the lives of most13 people both through their aspirations to moveup in the world (usually to a bigger property with a garden) and as the heart13 of the familylife which is associated with good quality of life UK properties have a life span approaching100 years which is about13 double that13 of their European counterparts (and certainly longerthan the wooden-shy‐frame buildings built13 in North America13 for example) A shortage ofhouses has plagued improvements in social welfare for the past13 30 years There is anargument13 that13 there are enough houses but13 the wrong size and in the wrong places andthis has some basis in fact13 as demography changes lead to more people (and more olderpeople) living alone However if there are two million homes in Scotland each with alifespan of 100 years then the renewal rate needs only to be 20000 per annum to maintainthe status quo However it13 must13 be clear that13 the impact13 of smart13 house development13 willbe small The focus should therefore be on adapting existing properties to render themmore appropriate for vulnerable people
Housing adaptations are a branch of assistive technologies The technologies for providingdifferent13 forms of accessible bath and level access shower are well-shy‐established with littleresearch considering anything other than alternative building materials and methods formaintaining the temperature of the bathwater Different13 technologies for bathing will beconsidered separately
25
Thus housing technologies are not likely to impact on social work13 within the next 20years13 though13 the use of information13 technology13 to ensure that people are aware of what13 is available is likely to be commonplace well before then
26
3 BEHAVIOUR AND ATTITUDE CHANGES DUE TO TECHNOLOGICALADVANCES
Technology is only one factor that13 will affect13 the way society changes in the next13 10 or 15years This chapter will consider the context13 in which the technological developmentsoutlined in the previous chapter will be supported (or held back) by societal factors
When the impact13 of such factors has been considered we can then apply theseassumptions to a number of case studies listed in Appendix13 A13
The headings selected for this chapter are not13 arbitrary as they reflect13 the context13 in whichtechnological changes must13 be considered They must13 include consideration of factors suchas demography and long-shy‐term conditions already addressed in the introduction to thesepapers together with the aspects of workforce and citizenship considered in the parallelpapers The additional elements here focus on trends that13 are already occurring and whichmay leave people struggling with the changes that13 occur
Finally there is a need to consider the attitudes of people to technology generally andespecially to the issues of privacy and social responsibility that13 could be radically changedby technology In some cases public opinion will prevent13 some forms of technology beingdeveloped if not13 commercialised In other cases some technologies will be fast-shy‐trackedeither at the request13 of government13 or because of a clear public demand for theopportunities that13 it13 can bring
Predictions13 about the13 future13 must inevitably be13 subject to considerable13 uncertainty butthat is no reason to stop thinking what might happen
31 The Welfare State
The UK can be rightly proud of the way that13 its welfare state has developed during the past13 100 years to provide a safety net13 of financial support13 to people and to their families whenthey are unemployed destitute homeless or challenged by crises and emergencies Therange of benefits received is considerable some are complex and many people struggle tounderstand their entitlements Some are universal some are discretionary some apply onlyto parents others to anyone
The total cost13 of providing these benefits continues to rise and when the economy isstagnating there is inevitably both political pressure often supported by popular publicopinion to introduce welfare reform so that13 people who do not13 work cannot13 be better offthan they would be if they were in full-shy‐time employment This strategy requires a universalbenefit13 to be introduced so that13 it13 is easier for claimants to access support13 but13 also easierfor agencies to identify the total benefits received The idea13 of a benefits cap then becomes
27
more practical to introduce especially if all the processes involved in making a claim arehandled electronically Indeed this encourages government13 to insist13 on applications forbenefits to be made on-shy‐line Unfortunately this will marginalise those people who haveneither a computer nor access to the internet thus emphasising the digital divide in amanner which works against13 some of the most13 disadvantaged people in society
There are currently few tangible links between digital technology and welfare provisionThe most13 obvious are universal benefits such as a free television licence (worth pound14550)13 for13 everyone aged 75 or older with blind and visually impaired people entitled to a 50discount13 irrespective of their age The significance of this position is that13 6 of revenuesgenerated through licence fees are to fund BBC on-shy‐line services13 such13 as websites and i-shy‐player In Scotland the BBCrsquos Alba Gaelic language television service is predominantlyfunded13 by MG Alba an organisation funded by the Scottish Government It is thereforeconceivable that13 in the future licence fees may be used to directly subsidise access toinformation and advice through the Internet13 for vulnerable people whether it13 is throughbroadband access or through a set-shy‐top box which removes the need for a computer in thehome to access particular websites or to use e-shy‐mail services
A second age-shy‐related benefit13 available in the UK is the winter fuel subsidy People whoreceive certain benefits receive the payments automatically while others must13 make aclaim Those who are not13 eligible for benefit13 due to a lack of an address for example missout13 on these payments and also on Cold Weather payments of pound25 for each seven dayperiod of very cold weather between 1 November and 31 March
The development13 of new warm home initiatives plus the complex of subsidies that13 theelectricity supply industry and government13 offer to people with solar cells further changesthe economic arguments Global warming may lead to greater variations in weatherextremes but13 might13 also increase the amount13 of electricity that13 can be generated byalternative (green) sources such as wind and solar cells It is estimated that13 energyconsumption in the UK increased by 17 between Christmas and Easter 2013 compared toprevious years as a result13 of cold weather but13 the above subsidy scheme did not13 benefit13 older people because two of the seven day cold periods were after 31st March It must13 beassumed that13 there will be more people living in fuel poverty in the future and this will leadto more cases of cold related illness including influenza13 and stroke
32 Management of long term conditions
The management13 of long term conditions will be improved for patients who are compliant13 with their medication regime so it13 is possible that13 there may be compulsion to adhere tothe prescription Such compulsion may be monitored using technology Indeed the remotemonitoring of vital signs using telehealthcare will become commonplace as the old boxesand sensors are replaced by devices that13 can be worn continuously or which can beembedded into the fabric of homes (including furniture and bedding) or can be worn asvests or patches They will wirelessly transmit13 data13 to smartphones or tablets and mobile
28
transmission and cloud technology will enable real-shy‐time data13 collection analysis andfeedback
One of the diseases which is projected to increase most13 significantly over the comingdecade is Type 2 diabetes Whilst13 there is a hereditary susceptibility to this condition formany people including those from the Middle East13 and the Asian sub-shy‐continent it13 is also adisease which tends to affect13 those people who are overweight13 andor have a sedentarylifestyle If untreated diabetes can lead to dizziness and collapse at any time but13 can alsohave more devastating long term consequences which include kidney failure strokeblindness and in extreme cases lower limb amputations Management13 therefore includesdaily monitoring of blood glucose levels and major dietary changes such as a significant13 reduction in the consumption of carbohydrates as well as a rigid exercise regime
Many newly diagnosed diabetics follow this advice closely and can lead normal lives for 40years or more but13 some struggle to accept13 the change in lifestyle required as well asremembering which foods are allowed and how much exercise they need to takeIndividual support13 plans are now forthcoming and over the next13 ten years best13 practicewill emerge in the form of smartphone apps that13 are personalised and which can becomean individualrsquos health coach This level of support13 will be fine for some people but13 otherswill need incentives so it13 is likely that13 gaming technologies will be introduced perhapsoffering rewards for good compliance There will be a temptation for some people tocheat perhaps allowing others to perform exercise for them or changing theirconsumption details
Many of these opportunities for cheating will be removed through the use of a uniquebiometric identifier a technology that13 will be mature enough to use in place of passwordson smartphones However the biggest13 challenge may be in encouraging older people to usethe technology Many older people have multiple morbidities Indeed a survey of Scottishpatients implied that13 42 of people aged over 80 will suffer from three long termconditions It will be essential for those people to comply with treatment13 regimes if they arenot13 to have the functional deficits that13 follow
33 Finding people who13 donrsquot fit
People who have low social capital are likely to have few relatives and friends with whomthey regularly communicate and are also unlikely to be part13 of community or faithorganisations such as clubs societies and church groups They also die several yearsyounger than most13 of the population often because they donrsquot13 engage with public healthinitiatives such as vaccinations against13 flu regular checks on their blood pressure bloodsugar levels or in the case of women smear tests or mammography The most13 likelyreason for disappearing beneath the radar of such initiatives is their mobility which leadsalmost13 inevitably to them having no fixed abode and no fixed telephone line It thenbecomes very difficult13 for them to be contacted because their mobile telephones are likelyto have Pay-shy‐As-shy‐You-shy‐Go contracts that13 donrsquot13 require validated names addresses and bankaccounts
29
It follows that13 some of the most13 vulnerable people in society including those who live onthe streets are effectively unknown to both the NHS and to social work departments untilthey are referred in a crisis This could be an emergency presentation to a hospital Accident13 and Emergency Department13 where they will come into contact13 with a social worker becausedischarge may be unsafe This often highlights the importance of the prevention agenda13 and the potential for avoiding admissions to hospital by intervening at an earlier stage
The advantages of being able to locate people who are vulnerable to specific diseases willincrease as genetic testing becomes more routine It is already possible to determine whomight13 be most13 at risk of breast13 cancer and prostate cancer as a result13 of family history Addto this the evidence that13 particular diet13 and exposure to environmental factors can furtherincrease risk then it13 is evident13 that13 individuals can be identified and offered treatmentsthat13 could save their lives many years before they become ill In the case of cancersperhaps only the individual is involved but13 for infectious diseases it13 is the whole of societythat13 is at risk if someone contracts one of the new strains of influenza or if someonechooses not13 to be vaccinated against13 rubella In Chinese airports all visitors are screenedfor fever and refused entry if they tested positive in cities the public are monitored in thesame way Similar approaches may be necessary in the UK if potential carriers cannot13 otherwise be identified
34 Volunteering
It is estimated that13 72 per cent13 of people volunteered to perform a charitable act13 at least13 once during 2012 a rise from 65 per cent13 the previous year About13 four out13 of every 10volunteers offer their services formally to one or more organisations The remaindervolunteer informally by helping out13 a friend or a neighbour Around 50 per cent13 volunteered at least13 once a month in the past13 year up from 41 per cent13 on the previous13 year Most13 have retired many of them before the statutory retirement13 age Those whodonrsquot13 feel able to offer time have offered their financial support13 at a time when the fundingavailable from sources such as the National Lottery has been decreasing Despite economicausterity donations to charities have been increasing 74 per cent13 said they had given tocharity at least13 once in the previous month up from 72 per cent13 the previous year
Strikingly 78 per cent13 of people strongly believe that13 they are part13 of their localneighbourhood an increase from 70 per cent13 10 years previously Community cohesion isstronger than ever 87 per cent13 of people believe their local area13 is a place where peoplefrom different13 backgrounds get13 on well together compared to 80 per cent13 in 2003
The role of volunteers in supporting vulnerable people is therefore likely to increase overthe next13 decade perhaps exploiting the success of the army of volunteers that13 was highlysuccessful in London during the Olympic and Paralympic games The greatest13 role for suchvolunteers may be in providing informal care for older people Already the UK has someseven million informal carers whose value in monetary terms has been calculated to be
30
more than the combined budgets of the NHS and social care Maintaining or extending thisprovision will help to support13 services in the future and may be supported by technology
Whilst13 there is ample evidence to suggest13 that13 telecare services support13 informal carers asmuch as (if not13 more than) the people that13 they are caring for it13 is the potential for utilisingthe internet13 and apps to make their role easier to coordinate and hence more effectivethat13 is likely to be most13 successful moving forward
Many of these focus on particular tasks that13 informal carers can help offer to older peoplesuch as organising their medication A pillbox program is just13 one feature of an app calledBalance It also includes sections for caregiving tips notes for the doctor and the patientsappointments plus a lsquolearning sectionrsquo with articles on aspects of Alzheimers and an RSSfeed for news about13 the disease Tyze is another multi-shy‐functional app it13 allows carers to
bull Organise appointmentsbull Plan outingsbull Share storiesbull Send updates to other family members
Another application is Rally Round which helps carers to organise someone to perform littlejobs often on a temporary basis when someone has dementia physical frailty or isrecovering from accident13 or illness Similar applications are MeMaxi and Finerday
35 The High13 Street
The shape and appearance of UK shopping centres have been changing for half a centuryPeople complain that13 centres are losing their identity with one town looking like everyother both in terms of the stores and in terms of the layout But13 there are three trendswhich are having a profound impact13 on many of the most13 vulnerable people in society
bull Centres lock their doors at 6pm or in some cases 10pm -shy‐ thus denying people whosuffer from claustrophobia13 from window shopping at times when other shoppershave left
bull Out13 of town shopping malls -shy‐ these US style centres are ideal for people in carsbecause they offer free parking which is essential for people who want13 to buy largeritems but13 difficult13 for people who have no transport13 and who must13 rely on publictransport13 that13 is often deficient
bull The rise of online shopping -shy‐ which means that13 many potential shoppers only visit13 High Street13 stores to check the prices before returning home to make a purchaseonline
It is the third of these effects that13 has the greatest13 potential for changing the High Street13 forever and it13 is making life for traditional retailers increasingly difficult13 at a time when highrents are crippling stores large and small It is difficult13 to see how this trend is likely tochange because consolidation in banking and estate agencies is already forcing the closure
31
of other High Street13 players while additional pressures on pubs has led to the closure ofthousands of pubs every year
Those figures however demonstrate that13 consumers still value what13 the high street13 canoffer -shy‐ the chance to inspect13 what13 theyrsquore thinking of buying -shy‐ as well as the new opennessof the internet Customer service makes a difference to people especially if there is aproblem and goods need to be returned One of the most13 common reasons for furniture tobe returned for example is that13 when a sofa13 or a wardrobe was delivered it13 couldnrsquot13 fit13 through the front13 door or up the stairs In the future people will be able to benefit from13 visualisation technology they will upload the floor plans of their homes enabling theretailer to inform them of the problem before they try to delivery Augmented reality viewwill similarly allow customers to see what13 a new item of furniture will look like in itsintended place so that13 they can be more informed about13 the effect13 of size and colour
In terms of improving the viability of the High Street stores will have to focus on theimportance of brand which could mean that13 individual independent13 retailers will have topartner with national suppliers to support13 a local tailored offering based on products that13 are designed for a more global market This is a lsquoconnected High Streetrsquo approach whichcould be enabled by the developments in internet13 availability and smart13 phone accessdescribed in the previous section
The overall effect13 of all these changes could mean that13 town centres become smaller but13 more vibrant13 areas They could thrive if people are attracted there in large numbers whichmeans that13 retail must13 be developed alongside restaurants pubs galleries and other leisureopportunities This is possible in new shopping centres which are already being integratedwith transport13 hubs including railway and bus stations but13 may be more of a design13 challenge for older towns and cities with large Victorian buildings To ensure that13 morepeople are welcomed into the new centres they should include attention to green spacesand areas where people can relax without13 feeling that13 they are second class citizensbecause they donrsquot13 have the same buying power
3513 Privacy
To some people privacy is their right13 to live their lives without13 interference they may seethe State as a potential lsquoBig Brotherrsquo spying on their every move and judging their actions13 and activities Other people have fewer concerns about13 the role of the State but13 great13 fearof individuals interfering with and invading their privacy Some embrace the concept13 of lsquomyspacersquo an area13 of a square metre or so into which nobody can enter without13 permissionThis allows them to avoid physical contact13 and to feel safe from any form of threateningbehaviour
Yet13 this idea13 of private space and its potential violation is merely the tip of the iceberg asfar as privacy is concerned more significant13 is the idea13 of personal (and private)information being shared with anyone and everyone This could be related to identityopinion or image for an individual who wants to remain anonymous or even secretive thisis going to become an increasing problem as technology provides the means of taking
32
photographs recording conversations and capturing environment13 with something as smalland ubiquitous as a mobile phone The fact13 that13 this information can then be shared withthe rest13 of the world using e-shy‐mail Twitter and Facebook makes the problem all the moredifficult So the threat13 is no longer solely from the long lenses of the Paparazzi but13 fromanyone (and that13 means everyone) who has even the most13 basic of mobile phones
This relates to the changing views of society on what13 information should remain privateand what13 should be shared with others The success of social media13 has been based on anattitude of lsquosharing everythingrsquo with either your friends or the world This has introduced anaiumlve idea13 in the minds of some younger people (especially those known as Millennials ieaged 18-shy‐30) that13 everyone can be their friends whilst13 perhaps failing to reinforce the bondsof genuine friendship with any form of test13 or restriction Technology could play a role indefining these friendships and allowing individuals to understand what13 makes a goodfriend but13 this approach has yet13 to be developed and may be slow to overcome the needfor some people to measure their own popularity simply as the number of people that13 theycan list13 as friends on their Facebook page
It follows that13 there may be a need for a new definition of privacy that13 is in keeping withthe web and its ability to display images and opinion in an unregulated manner This needsto embrace past13 concerns about13 the ability of an individual to live without13 the threat13 ofothers being able to watch them whilst13 offering some protection from random postingsabout13 them online Perhaps this could include a right13 to be able to edit13 or remove anythingrelating to themselves on the Web including images that13 are not13 news-shy‐worthy Theownership of image rights may be an associated issue that13 needs to be addressedespecially as modern technology can remove an individual from a group (or a background)13 view provide digital touch-shy‐up or air-shy‐brushing and then republish it13 in a different13 contextHowever there is general agreement13 that13 personal information (such as contact13 details andbank codes) should not13 have a place on the web Surprisingly few people take proactivemeasures to prevent13 tracking functions being activated
It follows that13 too much privacy could lead to younger people fearing that13 they maybecome lost13 in a digital world It is not13 surprising then that13 they are prepared to make lots13 of personal information available often with no fear of how it13 might13 be used by othersWhen Google glasses and similar technologies become available during the next13 few yearsthey will have the potential to identify a stranger walking down the street and to find manyof their secrets to present13 to the wearer in a fraction of a second They could know moreabout13 them than their genuine friends know -shy‐ so who will be their friends in the future
36 Data sharing and13 protection
By lsquodata13 sharingrsquo we mean the disclosure of data13 held by one organisation on an individualto a third party organisation(s) or the sharing of data13 between different13 parts of anorganisation Some data13 sharing doesnrsquot13 involve personal data13 because it13 has beenanonymised in such a way that13 the statistics can be used for the collective good without13 theidentification of the individual The Data13 Protection Act13 (DPA) is in place to provide a legal
33
framework that13 ensures that13 organisations that13 hold personal data13 must13 act13 responsibly atall times These principles adequately describe the position of public and government13 bodies especially social services departments who are responsible for the informationconcerning the health and well-shy‐being of individuals -shy‐ and hence by implication thesensitive data13 relating to their vulnerability
The legal framework that13 applies to private and third sector organisations differs from that13 which applies to public sector organisations which may only act13 within the defined limits oftheir statutory powers However all bodies must13 comply fully with the data13 protectionprinciples and this situation is unlikely to change within the next13 10 to 15 years In someprivate sector contexts there are legal constraints on the disclosure of personal dataHowever most13 private and third sector organisations have a general ability to shareinformation provided this does not13 breach the DPA or any other law It is advisable for acompany to check its constitutional documents such as its memorandum and articles13 ofassociation to make sure there are no restrictions that13 would prevent13 it13 from sharingpersonal data13 in a particular context The type of data13 held is therefore a subject13 ofconcern as it13 may be difficult13 for legislation to keep up with the additional layers of data13 created on-shy‐line and through the Internet13 of Things
Private and third sector organisations should have regard to any industry-shy‐specific regulationor guidance about13 handling individualsrsquo information as this may affect13 the organisationrsquosability to share information They should also be aware of the legal issues that13 can arisewhen sharing personal data13 with public sector bodies This becomes more of an issue asprivate and third sector bodies are carrying out13 a wider range of traditionally public sectorfunctions Opportunities for inappropriate sharing of sensitive data13 will therefore inevitablyincrease
Public authorities must13 comply with the Human Rights Act13 (HRA) legislation in theperformance of their functions The HRA also applies to organisations in the private sectorinsofar as they carry out13 functions of a public nature which could include delivering a socialcare activity Where the HRA applies organisations must13 not13 act13 in a way that13 would beincompatible with rights under the European Convention on Human Rights Article 8 of theConvention giving everyone the right13 to respect13 for their private and family life their homeand their correspondence is especially relevant13 to sharing personal data If personal data13 isdisclosed or shared in ways that13 comply with the DPA the sharing or disclosure of that13 information is also likely to comply with the HRA The problem may still be in policing theActs and the rights of an individual if they believe that13 their personal data13 has been sharedor accessed by an inappropriate organisation or individual
A legal industry may be born to deal with such matters but13 this is unlikely to benefit13 peoplewho cannot13 afford the fees involved They would require either legal aid or to employ13 more13 lsquono win no feersquo companies Public attitudes to such costs might13 become negative unlessthey prove successful in preventing breaches of data13 security There may need to belegislation to provide a stronger basis for forcing compliance with privacy laws
34
37 Connecting with13 people
We are social creatures most13 of us rely on our friendships and interactions with friendsand families to share our happiest13 moments and experiences Research suggests that13 thishappiness is infectious at all levels and leads to a 15 increase in the happiness of a closecontact 10 for a second degree contact13 such as the friendrsquos spouse and a 6 increase fora friend of a friend It is hardly surprising that13 the success of social media13 such as Facebookis intimately related to the ability of people to quickly share their happiest13 moments with asmany of their friends and connections as possible
All this has happened during the rise of the Internet13 and the corresponding increase inopportunities for connecting online ie this is a 21st Century phenomenon which has beenfacilitated by Information and Communications Technology But13 the Internet13 remains in itsinfancy and we are only beginning to understand and exploit13 its potential In terms ofaccessing the Internet there are now perhaps two billion people who have access with99 of them having gained this during the past13 decade This number will have doubled bythe period 2020 to 2025 It is likely that13 everyone who wants to be connected in the UK willby then be connected Turning this on its head only those who donrsquot13 want13 to be online willnot13 be on the Internet13 within a decade Connecting with the unconnected will therefore bea case of identifying those people who donrsquot13 want13 to be found unfortunately these mayinclude many people who need the support13 of social care organisations It means that13 theywill be looking for support13 only when they are in crisis unless other ways of finding andormonitoring them are found
While the number of people connected via the Internet13 has exploded this might13 bedwarfed by the number of connected lsquothingsrsquo During 2009 the number of thingsconnected to the Internet13 surpassed the number of connected people at which point13 webegan to experience what13 this report13 has described as the lsquoInternet13 of Thingsrsquo Yet 99 ofall physical objects that13 could join this network are not13 yet13 connected but13 the number couldgrow by 25 every year for the next13 decade so that13 there could be 100 billion connectedobjects by 2025 some of which will be owned or used by everyone in the UK includingthose people who donrsquot13 want13 to be connected themselves We will then have an Internet13 of Everything which will be the smart13 connection of people data events and actions
With each new person object or data13 that13 comes online the connection possibilitiesbetween all these elements grows exponentially The rise of big data mobile networkingcloud storage and data13 mining technologies will all play a critical role in the Internet13 ofEverything The result13 will be new capabilities richer experiences and unprecedentedvalue for individuals businesses communities and countries everywhere The lsquonetworkeffectrsquo of the Internet13 of Everything will be a very powerful thing the true impact13 of whichwe wonrsquot13 fully understand for several years As it13 develops however those who are not13 connected will feel even more digitally and socially excluded There will be a need to reachout13 to vulnerable people unless the process of claiming requires proof of online identityand the payments to be received can only be redeemed using a chipped card or adownloaded app onto a smartphone This is of course the way that13 welfare arrangementsare already developing thus it13 might13 prove impossible to make a successful claim without13
35
already being connected to lsquothe systemrsquo either through an online presence or through theInternet13 of Things
38 Downloading everything
Sixty years ago information was discovered by reading books often in a library wherenotes had to be made because the books or journals couldnrsquot13 be removed Then in theearly 1960s the first13 office photocopying machines were introduced into the UK theyimmediately meant13 that13 pages or articles from books could be copied and taken away to beread and summarised later Within a few years photocopying became a replacement13 forreading as researchers became less adept13 at selecting a few sentences and every deskbecame a depository for reams of printed paper Paper became the means of recordingeverything from bank statements through to music
We now appreciate that13 printing everything is a waste of both the ink (or toner) used tocreate the black print13 and of paper which requires trees to be chopped down and pulpedbefore it13 can be pressed into thin sheets Saving paper is therefore seen as green and goodfor the planet Fortunately we no longer need to print13 everything because computermemory is unlimited thanks to the cloud and we can then view pages and articles onportable or fixed screens
The internet13 has everything and it13 is all available instantly for downloading providing thereis a device available to accept13 it and there is sufficient13 communication bandwidth toperform the transfer of data13 sufficiently quickly Thus we can record all text13 articles that13 are relevant13 to us including digital records of birth certificates qualifications and passportsand the need for original printed versions will decline But13 we can also do this forphotographs Most13 handheld computing devices include at least13 one camera so they cangenerate enormous number of pictures which can be kept13 for posterity without13 having toconsume inks and special papers to print13 them
But13 the materials that13 can be downloaded donrsquot13 stop at pictures software is available that13 can grab TV shows after they air and movies as soon as theyre released In the same wayit13 is possible to schedule music comic books video games and practically anything else asa download with minimal effort People will need enormous hard drives if they want13 theirown digital copies of these files so will more than likely make use of cloud storage that13 willbe available from many organisations The location of the servers may become sensitivedue to border restrictions as will the security of the data13 and the way that13 it13 is backed up sothat13 it13 is resilient13 to failures
It may be evident13 that13 application forms for all types of welfare payment13 will be availableonly for downloading so that once digitised they can be processed by computer andrecords sent13 to various servers for subsequent13 storage and processing Some people maywant13 to keep their data13 on them once it13 has been downloaded Pen drives can already holdseveral GB of data so it13 is likely that13 people will be able to carry their downloaded data13 withthem at all times irrespective of the size and complexities of the information
36
39 Health13 and13 well-shy‐being
The general health of the population is unlikely to deteriorate noticeably within 10 to 20years Indeed expectations of the population are that13 things must13 improve as surgicaltechniques mature and as pharmaceutical interventions become more personalised andpowerful However the rising demand for health services due to an ageing population andthe increasing cost13 of providing sophisticated therapies will make delivering a free anduniversal health service difficult13 without13 substantial increases in taxation This is unlikely tohappen in the UK even though spending on health services will be protected against13 thecuts facing other services
There will have to be changes in how the NHS works For twenty years hospitals have beenclosed and replaced by fewer new facilities so that13 the bed count13 is reduced This has led toa significant13 shift13 in resources to primary care and community care supporting shorter staysin hospital and speedier transfer back home for people after surgery or illness This hasbeen13 successful but13 there remain problems with demand for GP services especially out-shy‐of-shy‐hours and at weekends Indeed despite the introduction of NHS24 and similar help-shy‐linesthe demand for GP appointments continues to increase Delays are inevitable and this willincrease system failures with more unnecessary deaths and a failure for people to access adiagnosis that13 might13 lead to early interventions and ultimately lower delivery costs Over250 more patients are added to waiting lists every day
This will lead to a new model of primary care consistent13 with existing changes which haveseen surgeries move from High Street13 locations to medical centres close to bus routes andwith more parking for patients The process of making an appointment13 is changing from atelephone-shy‐based interview process dominated by a medically-shy‐unqualified receptionist13 to achoose and book approach using an online process linked to electronic patient13 records Thiswill give patients more convenience but13 will allow priority for those who have Internet13 access at the expensive of those who are digitally excluded Making the process of bookingan appointment13 quick and easy may also increase demand from people who do not13 need tobe seen as it13 will fail to identify those in greatest13 need
A greater use of telehealth and telecare technologies will be inevitable beginning with thefirst13 contact13 as an encounter using the telephone e-shy‐mail or video conferencing -shy‐ a visit13 tothe GP surgery should be a last13 resort and should involve a nurse consultation in the first13 instance This would be consistent13 with three quarters of appointments currently involvinga chronic disease or long term condition which relates to improved self-shy‐care The support13 ofthese patients at home should be prioritised through tele-shy‐ and web-shy‐based technologies andshould involve training and coaching through a network of nurse practitioners Home visitsshould generally be unnecessary through the use of these technologies but13 could besupplemented by satellite surgeries manned by nursing in community premises or inpharmacies nurseries and Internet13 cafes
The homes13 of people who13 need13 closer monitoring can then become part13 of virtual wardswith real or electronic visits by health professionals University Hospital Southampton NHSFoundation Trust13 already looks after patients who have undergone surgery such as a hip orknee13 replacements in virtual wards with high levels of satisfaction The Royal Free London
37
NHS Foundation Trust13 offers a similar service but13 plans to add the possibility of videoconsultations between patient13 and consultant
310 Attitudes to public health issues ndash obesity smoking alcohol abuse drugs
As self-shy‐care becomes the focus of the NHS the public will increasingly understand that13 thecosts and availability of services are being harmed by the poor health behaviour ofrelatively small numbers of people The link between public health initiatives today andhealthcare needs and costs in the future will become increasingly evident13 as a result13 of theway that13 information is presented Thus the overweight13 smoker who currently attractsconcern and pity when they are diagnosed with diabetes and COPD is increasingly beingseen as the victim of their own stupidity or lack of self-shy‐discipline If they continue to neglect13 medical advice and continue with an unhealthy lifestyle then the way that13 they receivetreatment13 and consume resources will become a matter for the entire population
Obesity is seen as due to a combination of poor diet13 and a sedentary lifestyle No longer isthe idea13 that13 people are lsquobig bonedrsquo acceptable Governments will respond initially byrequiring manufacturers and food processors to provide nutritional information onpackaging and on menus in restaurants But13 people can choose not13 to read the data13 and toneglect13 both the importance of food quality content13 and quantity This will increasepressure to introduce fat13 or sugar taxes and these are likely to be in force within a decade
Although the high taxes on tobacco products has forced some smokers to reduce theirconsumption or to give up altogether the impact13 has been reduced by the smuggling ofproducts from overseas and by the availability of duty-shy‐free cigarettes for people returningfrom foreign holidays and business meetings Further measures are planned to changepackaging and to include even more graphic images and warnings on cigarette packages tomake smokers aware of the effects of smoking on their health and well-shy‐being There is asyet little evidence of how successful this might13 be More effective has been the banning ofsmoking in public places including trains and aircraft Expensive medical interventions suchas heart13 transplants will be denied to individuals until they change their lifestyle behaviourSmokers might13 therefore be increasingly ostracised leading to a loss of esteem This mayhave a particular impact13 on people who already suffer from mental health problems whoare more likely to smoke
The overuse of alcohol is being recognised as a major factor in hospital admissions withNHS figures showing an increase of over 40 in such admissions over the past13 decadeLinked to this has been a 75 increase in prescriptions to treat13 alcohol dependency Fewpeople have sympathy for those who waste their limited income on booze If they havechildren or other dependents they will be the ones who suffer and who may need thesupport13 of social care
Drug users are already significant13 users of social services as their habit13 is likely to makethem unemployable They receive little sympathy from the general public because they areseen as criminals and people who waste public resources Levels of drug abuse have been
38
slowly increasing over the years but13 this trend is slowly being reversed Indeed the numberof people using drugs during the past13 year has fallen to its lowest13 level for nearly 20 years(below 9) with cannabis being most13 likely often following excessive drinking Aselectronic noses and other technologies can detect13 traces of drugs it13 seems likely that13 success in overcoming addiction can be measured objectively This may become a two-shy‐edged sword rewarding those who can turn around their lives but13 further marginalisingthose who canrsquot13 or wont13 accept13 the lsquocold turkeyrsquo
311 Attitudes to surveillance
Issues associated with privacy confidentiality and data13 security have been discussedpreviously in the context13 of information technology the World Wide Web and the ease ofcollecting recording recalling analysing and displaying data The monitoring of individualsand their methods of using this information can be regarded as surveillance As thequantities of data13 increase along with the number of devices that13 can be used to access itthe surveillance tools will also increase in their sophistication Indeed the Big Data13 approaches described in the previous section will enable the combination of structureddata13 (such as the information held in databases) to be married with unstructured data13 fromimages in such a way that13 it13 can be mined
Whilst13 the lsquodigital surveillancersquo methods described above may cause most13 concern topeople because of its impact13 on anonymity it13 is the collection and analysis of images that13 are the major concern to people as they contemplate the ways that13 lsquoBig Brotherrsquo maydevelop to restrict13 freedom Every major UK city and town centre has an array of CCTVcameras that13 continually record activities from every angle If it13 used to be true that13 nobody in London was more than 10 yards from a rat it13 is certainly the case today that13 nobody can be more than this distance from being in view of a surveillance camera Yetthey receive so much positive publicity from TV programmes where their footage is used todetect13 vehicles close to a crime scene or to monitor the movements of suspects that13 theyare now accepted by the public as a deterrent13 in the same way as lsquobobbies on the beatrsquowere seen 25 years ago There is therefore little public reaction to the expansion in the useof video surveillance except13 for the practical observation of how so many views can beinspected and recorded
Looking to the future the tumbling cost13 of video technology will surely lead to anotherincrease in the number of devices The aerial views taken from towers will besupplemented by more local views taken by devices that13 are embedded in the fabric ofbuildings or carried by individuals either on their person (for example on clothing orspectacles) or in the bags that13 they carry The time and date-shy‐stamped images as Big Datawill be recorded to lsquothe Cloudrsquo where it13 can be added to other data It can then be usedwhen an incident13 has occurred or to provide further detail of night-shy‐time activities
It follows that13 there will be no hiding place for people who simply want13 to disappear Theymay respond by wearing clothing (such as hoodies) that13 hide their faces or which make it13 difficult13 to distinguish gait13 or mannerisms from which they might13 be identified New forms
39
of clothing may be designed to make shapes more difficult13 to analyse and these might13 become the uniforms of a class of person who wants to live in a way that13 they donrsquot13 interact13 with officials from any ministry or local government13 department If they also obstruct13 services then they will be considered to be anarchists of some form sparking protests fromother sectors of society
31213 Attitudes to driving
Motor cars have been a feature of UK roads for over a century but13 it13 is only during the past13 50 years that13 they have become a resource that13 most13 families have had access to enablingthem to travel without13 the restrictions imposed by a limited railway network and non-shy‐integrated bus transport People who have had a car throughout13 their lives often see theircars as an important13 factor in enabling them to remain independent13 and to exercise choicesrelating to where they shop and where they spend their leisure time This extends to theirspouse and to friends and neighbours that13 they might13 take with them on their variousexpeditions
Unfortunately there are incidents involving older drivers who perhaps go down amotorway in the wrong direction who are taken ill at the wheel or who are involved in anaccident13 involving no other vehicles These are small in number but13 often lead to a reactionthat13 they shouldnrsquot13 be allowed to drive lsquoat13 their agersquo Age itself is not13 an indicator ofdriving quality but13 because old age also brings more chance of having limited long termconditions and other illnesses it13 is easy to make a link between driving ability and age Thelicensing system does require continued driving to be linked with medical advice andforbids people with poor eyesight epilepsy and other conditions to hold a licence in oldage
Yet13 statistically older drivers cause far fewer accidents than younger drivers The reasonsfor this may be complex and are likely to include the fact13 that13 they drive less often covershorter distances and donrsquot13 go out13 in the dark or in poor weather However it13 does not13 wholly explain why the UKrsquos drivers aged over 70 and who represent13 some 8 of all driversare involved in only 4 of accidents that13 cause injury This compares favourably with the15 of13 drivers aged between 17 and 29 who are involved in over a third of crashes that13 result13 in injury
By 2020 the number of drivers aged over 70 on UK roads is likely to increase to over 7million This will require a new national strategy perhaps involving support13 for olderdrivers further training raising awareness of issues and making more use of adaptivetechnologies to support13 the driver in avoiding collision or forgetting to check on the statusof their vehicle Poor eyesight13 could be enhanced by camera technologies rather thanforcing people off the road if they are unable to read a licence plate
The International Longevity Centre has found that13 one in four Britons thought13 driversshould be made to switch off the ignition for good somewhere between the ages of 70 and75 The numbers may decrease as the population ages and as cars become safer Forcing
40
older people off the road may be a natural consequence of providing free bus passes andsubsidised rail fares but13 the growth in the pavement13 scooter industry demonstrates that13 older people value their independence and will do almost13 anything to get13 out13 and aboutPerhaps legislation will result13 in more regulation of electric vehicles and where they cantravel
There can be no doubt13 that13 getting out13 will be associated with better quality of life andwell-shy‐being and this is likely to be supported in the future as evidence of improvedoutcomes emerges It is to be hoped that13 positive stories will be publicised so that13 publicattitudes arenrsquot13 hardened This may be supported by more in-shy‐car monitoring of drivers andthe linking of performance with on-shy‐line driving records and licences These could throughremotely monitored ignition systems prevent13 the use of motor vehicles by people without13 a licence or without13 insurance
313 Climate change
There is a general view that13 the emissions of carbon gases are contributing to globalwarming in a manner that13 will change the UK climate in such a way that13 the climate maybecome more Mediterranean However some scientists believe that13 manrsquos impact13 on theenvironment13 may be small compared with natural variations caused for example bycyclical changes in the sunrsquos energy output13 or by the effects of volcanoes and earthquakesRecent13 evidence has suggested that13 we are going through a phase of changing extremesand that13 this is more likely to cause storms periods of excessive rainfall and unusualseasonal trends with snow and frost13 in the spring and warmer winters Considerableuncertainty remains and it13 might13 be necessary to plan for a number of different13 scenariosand for the impact13 on vulnerable people
I Colder winters UK properties are poorly insulated resulting in excess mortalitiesduring cold spells due to an increased number of people suffering from stroke aswell as bronchitis and other pulmonary diseases The cost13 of heating continues toincrease putting more households into a state of fuel poverty Any further coolingduring the winter months will result13 in more people living in unhealthy coldconditions Winter fuel payments are likely to be restricted to the poorest13 peoplebut13 this might13 exclude people who live in larger properties that13 are more difficult13 toheat
II More storms excessive winds and rain can cause flooding at any time of the yearMany UK communities are built13 close to rivers and these can surge during heavyrainfall causing houses to be filled with water and furniture and carpets lostInsurance can be problematic for properties built13 on flood plains which can blight13 properties and prevent13 owners from being able to sell and move on High winds canrip off roofs causing injury and also causing families to be left13 homeless anddependent13 on social services
III Hot13 summers Europe suffered high temperatures during the summers of 2003 and2004 leading to heat13 stroke and hypothermia The UK has not13 previously sufferedfrom such problems but13 might13 be expected to experience days of extreme
41
temperature and humidity at times Older people may not13 be prepared for suchweather Street13 dwellers may be unable to find shade and supplies of drinkingwater
Irrespective of what13 combination of weather scenarios arise it13 must13 be concluded that13 any extremes will have a major negative impact13 on vulnerable people especially if theyare not13 prepared because they havenrsquot13 received the weather warnings and advice that13 can be broadcast13 using the TV radio and online services Once again the digitallyexcluded will suffer and will pay a high cost Society will continue to pick up the bill interms of demands on social care services unless preventive actions are taken in theform of connecting these people to each other and to formal services
42
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
s13 13
13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
n13 13
13 s13
r13 n13
e13 at13
e13 y13 e13 ld13
ly13
13 e13 t13 e13
s13 er13 e13
f13
rt13 13
13 13
13
r13 13
s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
e13 g13 13
e13
13 13 ial13
13
d13
13 d13 h13 r13
d13 13
s13 y13
e13
13
rd13 r13 e13
13
13
13
e13
e13
d13 13
13
13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
Large payments were previously made by cheque They are expensive to process by thebanks because people can write them by hand which makes them difficult13 to readelectronically and automatically Consequently they require human intervention and this isnot13 what13 modern banks wish to do so they want13 to promote greater use of debit13 and credit13 cards The latter were used initially as a cheque guarantee but13 are now being used almost13 exclusively as a means of withdrawing cash from ATMs and for making paymentselectronically UK banks wanted to do away with cheques by mid-shy‐2012 but13 they had toperform a u-shy‐turn under pressure from charities representing older people It is apparent13 that13 digital cheques and other cheque-shy‐replacement13 strategies will be introduced soon that13 satisfy the most13 pressing concerns of older people
It was difficult13 to see how cash could be replaced for payments for lower cost13 items such asnewspapers and sweets until the era13 of contactless payments Near field communicationsystems are likely to replace bar-shy‐codes to carry product13 identification information Theycan be read by electronic receivers The same technology can be two-shy‐directional allowinginformation to be passed from a smart13 phone to a reader and back again The smart13 phoneeffectively becomes a wallet13 which can be digitally filled by the owner and then emptiedwhen making purchases For small sums of money this approach is ideal and is likely to berolled out If cash disappears then begging will become difficult13 and welfare paymentsmade on a card Such cards are already used by social services as a means of providingclaimants with a means of receiving self directed care and support By restricting use of thecard to outlets that13 can provide care and support13 services opportunities for spending thecash inappropriately are restricted
It follows that13 many users of social services will need to have a smart13 phone as well as acard that13 can be used to buy services In the future smart13 phones may be provided as aloan item to claimants for social care This could include a digital wallet13 facility as well asthe communications and information ecosystem that13 would allow these people to receive awhole range of other services that13 would prevent13 their social exclusion and which could beused directly to provide them with information and access to entertainment
29 Biometrics and fraud13 prevention
Identity theft13 is used by criminals to pretend to be someone else in order to accessresources or obtain credit13 and other benefits in that13 persons name Although the concept13 has been around for centuries it13 is a growing concern in the digital world as we acquiremultiple online identities for bank accounts social networks and using public services such13 as paying tax electoral registration etc
Passwords are fraught13 with difficulty typically they are hard for humans to remember andeasy for machines to crack Efforts are therefore focused on other forms of provingidentity for example
11
bull Fingerprints have been accepted for over two thousand years to confirm identitymostly in criminal justice The technique has been applied to door-shy‐lock opening insome supported housing schemes There are practical problems associated withregistering lsquoallowedrsquo fingerprints and the useful lifetime of such products is also onlyabout13 three or four years
bull Retinal imaging and DNA analysis have been relatively slow to follow but13 only dueto the sophistication required for measurements and the time taken for testing Acombination of retinal imaging with facial gestures and blinking is possible in the labbut13 currently takes half a minute to achieve a match -shy‐ and this is achieved only withthe use of considerable computer processing power This sort13 of time makesapplications in mass people transfer impossible
Current13 research in this area13 is focusing on the uniqueness of other body parts such as earsand knees as biometric indicators The ears have great13 potential because they are usuallyexposed though hidden sometimes behind hair and other times by hats and other clothingOn the other hand the knees are rarely visible and however unique they may be there willbe cultural and religious obstacles to overcome before scanning could become a regularpart13 of identity confirmation The cameras which are central to such systems used to beexpensive but as the cost13 of high quality cameras continues to fall (there is one in nearlyevery mobile phone) it13 becomes feasible to devise identification devices that13 use multiplecameras to simultaneously recognise the eye and the ear
Movement analysis can be used to identify people by their walk gait13 and other biorhythmsprovide unique signatures It is possible to learn someone elsersquos gait13 though and injury orillness13 can have a temporary effect13 on gait
Over the next13 ten years with more sophisticated databases and image processing facilitiesthe cost13 of implementing advanced biometrics will fall enabling their application acrossmore diverse areas and in more social opportunities Potentially cameras will use cloud-shy‐technologies to provide individuals with instant13 recognition of anyone approaching them inthe street This could prompt13 a name or the occasion when they were last13 seen or spokento as a secondary method of control in much the same way as Internet13 banking seeks toavoid fraud This13 has13 the13 potential to remove13 the13 need for13 passwords13 and might13 then be13 the basis of machine-shy‐based13 communication13 either in front13 of a laptop or tablet13 device orwhen using13 a smart13 phone
There will need to be special measures introduced to support13 people with any form ofdisability as they might13 well have one or more sensory deficits Similarly people maystruggle to communicate following a stroke or a serious accident Nevertheless it13 may bereasonable to conclude that13 such systems will be both available and acceptable within thenext13 10 to 12 years
12
210 Health13 information
Health records in the form of written documents x-shy‐ray images and clinical observations arean important13 means of making all interventions efficient13 and safe Increasingly people havemany different13 conditions (comorbidities) and may be treated by several specialists Asthese physical records are moved inevitably some get13 lost estimates suggest13 that13 one inthree records is lsquolostrsquo at any one time
The best13 resource for information about13 a patient13 is his or her primary care record which isheld by the GP The UK was an early adopter of electronic primary care records and can beproud of the way that13 these have enabled population-shy‐based information to be collectedand analysed Scotland (and to a lesser extent13 Wales) has led the way in ensuring that13 allthese records are accessible through anonymised approaches that13 allow researchers toexamine trends and improve analysis of performance Fundamental to this has been theallocation of a unique identifier At13 the same time individuals can access these recordsboth to check for accuracy and to see what13 their doctor has said about13 them
This13 has13 the potential to make people more responsible for their own conditions andmight lead to better13 self-shy‐care13 and changes in behaviour13 that might reduce13 the13 incidence13 or severity13 of chronic conditions13 that are related13 to lifestyle
In the future we can expect13 the primary electronic health record to be linked with hospitaladministration systems picture archiving systems and other records held by hospitals sothat13 appropriate medical staff can have access to all relevant13 data
When the social care record is added to the mix then this will mean fewer but13 shorter andbetter assessments for social workers and for healthcare staff They will knowcircumstances and factors that13 could influence the choice of approaches This supports theidea13 of there being only one record consisting of several components all of which areaccessible by an appropriate professional at any time and in any place
The13 ambitions13 described above13 are not13 limited by technology most13 of the interoperabilityissues between rival commercial record systems have been resolved and databaseproviders are being compelled to support13 joint13 working The English NHS Mandate requiresTrusts to effectively replicate arrangements already in place in Scotland and in Wales andthis will go a long way towards achieving a genuinely paperless NHS well before 2020 Withnew biometric identification technologies individual records will be available to out-shy‐of-shy‐hours physicians and to those working in an AampE department13 irrespective of theconsciousness state of a patient
New telecare and telehealth technologies will produce significant13 more volumes of data13 which are currently held in different13 places and owned by different13 organisations rarely thepatient These data13 will also need to be shared but13 only in a manner that13 is acceptable toeveryone Patients may not13 want13 all their mental health information published in a formthat13 can be viewed by social workers GPs may not13 want13 to have access to all the data13 that13 might13 suggest13 that13 there is a domestic crisis to which they had neither the wish nor capacity
13
to respond Monitoring systems that13 support13 the lsquoquantified13 selfrsquo may also offer data13 that13 may or may not be added to the full recordThe future of health information might13 therefore be about13 providing individuals with themeans of producing relevant13 information storing it13 somewhere secure and then viewing it13 at a later time but13 in a format13 (or with advice) that13 is acceptable
See also httpmydexorg lsquoMydex gives individuals back control over their personal datarsquo
(see also Digital Scotland 2020 Achieving World-shy‐Class digital infrastructure a final report13 tothe Scottish Government13 httpwwwscotlandgovukPublications2013029054lsquoconnectivity by any device anywhere and anytimersquo)
211 The Future of Healthcare
The strains on our healthcare delivery system are becoming greater as they are in otherdeveloped countries as a result13 of an aging population rising expectations and unhealthylifestyles The necessary changes will require a significant13 shift13 in resources13 fromsecondary13 care13 where unit costs13 are high to community13 carewhere people can generallybe treated at home
The future must13 therefore necessarily involve efficiencies in hospitals and in the way that13 people can be treated in less expensive locations ultimately in their own homes Hospitalswill use more sophisticated diagnostic tools including scanners of all types to non-shy‐invasivelyprobe inside peoplersquos bodies This will result13 in more day cases and hospital stays (alreadyaveraging under a week) to even shorter periods with on-shy‐going support13 provided inintermediate care settings that13 might13 include hotels care homes or the personrsquos own homeif it13 is clean safe secure and has all the necessary amenities (include access to theInternet)
Advances in medical technology will allow more treatments to be delivered in the homeThis will mean fewer visits by clinical staff and fewer opportunities to attend primary carecentres Pharmacists will become suppliers of information as well as drugs so the balanceof care will shift13 significantly away from doctors who will work in different13 ways relying13 increasingly on telemedicine to bring the specialist13 to the patient13 for an online consultation13 For example if a patient13 complains of nausea13 and severe headaches a virtual consultationcan be offered almost13 immediately and without13 having to send a patient13 with a potentiallyserious and acute condition on a potentially long journey to a hospital
In the above example a neurologist13 may ask further questions as well as conduct13 acomplete neurological examination using videoconferencing technology Airedale GeneralHospital consultants have new contracts that13 require them all to be available for virtualconsultations The first13 benefit13 has been in reducing the need for prisoners at local jails tobe brought13 into AampE (which may need to be locked down depending on the circumstancesand the potential for violence of the individuals involved) potentially saving hundreds of
14
pounds in security costs It also avoids the need for healthcare staff to have to go into aprison environment
The principles described above are already saving lives through telestroke services whichlead to more people being thrombolysed appropriately and avoiding long term support13 that13 often follows a stroke incident Teledermatology has been practised for a number of yearsand results in rapid diagnosis and resolution of problems that13 previously required significant13 time for remedy
212 Gadgets and13 DIY13 healthcare
There are at least13 three elements to healthcare
bull Gathering information on symptoms and physiological parametersbull Interpreting the information andbull Responding to the diagnosis with treatment
Many people choose to exercise self-shy‐care because this gives them control whilst13 avoidingthe need to share their concerns and personal details with others A lsquodo It yourselfrsquoapproach might13 even be encouraged by the NHS as a viable way of using scare resources
Medical devices that monitor vital signs are mature and have been miniaturised so that13 they can be used in the home by individuals with little or no medical training Indeed bloodsugar monitors are being produced specifically for use outside the hospital and in such away that13 they can be used reliably by people with advice and training being provided onlinevia13 YouTube
Many medical monitoring devices do no more than produce a single measure which theuser may record or respond to Others link wirelessly to smart13 phones allowing data13 to bestored and entered into a personal health record where trending opportunities existingIndeed individuals can easily enter their data13 into an app running on their laptop tablet13 orsmart13 phone This trending information may be useful13 for self-shy‐care and could be passed onto a physician though the volume of data13 produced in this way and doubts about13 thequality of the data are likely to persuade GPs to discount13 data13 produced in this way
This gap in knowledge can be filled with advice information and diagnosis that13 can beobtained online using a lsquoDoctor Googlersquo approach The quality of such diagnosis may varysignificantly although there are many sources of information that13 are both supported andapproved by the NHS (and by similar sources in other countries) However with a data-shy‐richapproach and a choice of diagnosis people may be empowered to take a greater role inhealthcare
15
The final component13 for the DIY enthusiast13 is the treatment13 option Many people fear longterm use of medication produced by the big pharmaceutical industry and prefer morenatural remedies which are available over the counter More medical treatment13 devicesare available that13 stimulate blood flow and counter pain through the use of electrical andphysical stimulation
The evidence may be weak at present13 but13 might13 grow as more people use them and as theircost13 drops The13 impact13 of13 such technologies13 on vulnerable13 people13 is13 difficult13 to gauge
213 Telecare
Support13 provided at a distance to people in their own homes is known as telecare Thename implies remote monitoring and interaction and includes the monitoring of the homeenvironment13 and of the individual as well as the interaction of the individual with thisenvironment Definitions have become difficult13 due to some US medical devicemanufacturers introducing the term telehealth to describe medical telecare such as remotemeasurement13 and collection of vital signs data
In the UK telecare alarm services have matured quickly using the robust13 platform andinfrastructure of social alarm systems which were originally used by tenants in shelteredhousing schemes to seek help when they didnrsquot13 own a telephone The majority of telecareservice users today live in their own homes and use dispersed alarm units to link with amonitoring centre through the telephone network Improved assessments of needs andrisks to independence have resulted in combinations of sensors being used to support13 theoption of staying put13 rather than moving into residential care or having increasing levels ofdomiciliary support They support13 the policy of bringing care closer to home and ofencouraging people to become partners in their long term support13 arrangements
Telecare services developments over the past13 decade include standalone items such asautomatic lights which have achieved significant13 efficiencies especially for people who arefrail and prone to falling and to those suffering from mild cognitive impairment epilepsyand anxiety People who have long term conditions including chronic conditions such asdiabetes and hypertension can also be managed more effectively through telecare supportThe benefits of telecare services include a relief of stress for family caregivers enablingthem to continue to provide unpaid support13 while holding down a job and maintaining theirquality of life
New developments enable continuous monitoring of behaviour and smart13 devices that13 canfor example remotely control the cooker the water supply and door entry Such13 monitoring may detect13 incidents early and prevent13 emergencies arising Devices arebecoming smaller and easier to embed quickly within the home environment making themmore acceptable and less noticeable Longer battery life means less frequent13 maintenancevisits
16
The13 monitoring13 centre13 becomes13 an information hub13 offering13 both advice13 and a vehicle13 for checking that someone is coping especially following a trigger event such as a stay inhospital or the illness13 of an informal13 carer
New systems utilise web technology that13 allows family members to be more proactive inthe monitoring of their relatives This can lead to greater interaction with them especiallywhen the relatives live a considerable distance away (perhaps in another country) Thesenext13 generation systems might13 include video conferencing and the use of tablets smart13 phones or smart13 TVs but13 when an emergency response is required (perhaps to lift13 someoneup after a non-shy‐injurious fall) there remains a need for human intervention
The13 future13 of13 telecare13 might therefore13 include13 an increasing13 dependence13 on volunteersfrom13 the13 community to provide13 the13 required support Social networking may need to beused13 to support13 telecare technologies
214 Mobile healthcare
While telecare can support13 people effectively in their own homes it13 is now recognised that13 being able to go out13 to enjoy open spaces and to overcome the fear that13 the home is aprison is an important13 part13 of improving well being and supporting a higher quality of lifeExtending telecare technologies to operate outside the home is known as mobile healthcare(or mCare) and is based on mobile telephone networks rather than landlines
The simplest13 form of mCare requires only a basic mobile phone to deliver telephone callsvoice13 messages and SMS (text13 messages) The technology is mature and there are countlessapplications in use both in the UK and in developing countries such as Africa13 and India13 where mobile telephones have already achieved a saturation level and where fixedtelephone infrastructures are not13 likely to be established at any time Such telephones areuniversally available in the UK and are used by the vast13 majority of people including manyolder people especially if they have been introduced to the low cost13 (pound30) devices that13 have large buttons large displays and a separate large button for calling an emergencynumber
Smart13 phones are rapidly replacing basic phones and allow the use of a large range of lsquoappsrsquothat13 are being developed to provide information and for enhanced experiences In thehealthcare space Skype FaceTime Vidyo and GoToMeeting with HD Faces are all current13 examples of video conferencing software available on tablets and smartphones
The specific software will depend on the nature of the communication desired
bull Skype will13 manage a simple video phone callbull Where an AampE physician needs to share a CT scan of head with a Neurologist13 on call
from home GoToMeeting would be more appropriate
17
bull If the physician would rather have a dedicated online meeting room that13 patientsand colleagues can simply drop in for a virtual meeting a Vidyo virtual room may bemore appropriate
This technology can suit13 any form of lifestyle including many people with complex needswhose lifestyle is not13 consistent13 with a fixed address
Social care apps are available already to deal with problems of sensory deficit
bull Guiding a blind person through GPS navigation and reading signs through appslinked to the devicersquos camera13
bull The microphone can be used as a hearing aidbull Speech recognition software can be used either to replay speech at a slower speed
or for translation into a language of choicebull Speech can also be selected for people who have a stammer or who have a problem
with their larynxbull Apps are becoming contextually aware recognising situations and locations and are
thus becoming a personal assistant13 for people with disabilities
By 2020 it is therefore possible that a smartphone may13 be prescribed13 for people who13 need13 social13 care13 together with13 a range of apps that have been13 selected13 to meet13 theirassessed13 needs
Whilst13 smart13 phones tablet13 devices and apps may become an important13 part13 of anindividualrsquos personal support13 armoury the potential of mCare will be limited only by anindividualrsquos ability to make use of all its functions Each device could become a part13 of anindividualrsquos personality supporting them to improve behaviour take exercise avoidtemptation and manage their own health and well-shy‐being Potentially mCare could becomethe most13 important13 element13 of social care and support13 within 10 years
215 Artificial Sensing and Enhancement Devices
bull It is estimated that13 one in seven people has imperfect13 hearingbull The numbers who are born deaf are quite small and many of these people may
have some form of hearing restored through surgery or through technologybull Similarly while there may be nearly a million people registered as blind or having a
severe visual impairment the vast13 majority lose their sight13 during their lives as aresult13 of disease
bull New treatments will deliver sight13 recovery or restoration over the course of the next13 10 to 20 years
Fortunately technology can provide excellent13 sensing capabilities that13 are already providingpeople with external portable devices for enhancing their lives The simple hearing aid is anexcellent13 example of a device which has been improved through both miniaturisation
18
personalisation and enhanced performance Today digital hearing aids use sub-shy‐miniaturemicrophones that13 can be unidirectional or omnidirectional and which can be adjusted insensitivity over an extended range Tomorrowrsquos devices can be switched between modesby the user so that13 they can benefit13 from hearing perfectly in any environment Indeedthey can be used with adaptive filtering technologies (as used by helicopter pilot13 headsets)to eliminate some sounds so that13 the rich speech (or music) components alone remainFuture developments will be on optimising control so that13 the user can switch seamlesslybetween different13 amplification applications without13 appearing to be distracted A smart13 phone or mp3 music player may be used as either a processing unit13 or as a ubiquitousoutput13 device that13 looks cool and natural
These same technologies will also be developed for use within the home environment13 fortimes when a deaf user isnrsquot13 present13 or is asleep Acoustic signatures associated withadverse events and incidents such as the hiss of a gas leak the crackle of a fire the sound ofa smoke detector the drip or a water leak or the sound of breaking glass can be directlyassociated with programmed actions Speech will be recognised interpreted translatedsimplified or displayed so that13 an individual knows what13 is said and can be provided withclear instructions on how to respond
Video cameras have become smaller and cheaper and capable of producing high definitionimages The problem of storing and editing these large image files is being solved by thearrival of cloud computing
Electronic noses are already capable of detecting the quality of wine and fresh fruit Similartechnology will be based in smart13 phones and will be able to analyse the air to warn of13 foodthat is no longer fresh and of other indicators of danger including gases that13 have13 little13 natural13 smell These13 devices13 could support13 people with13 cognitive impairment13 -shy‐ whose13 sense of smell13 tends13 to deteriorate -shy‐ to live independently
Many older and vulnerable people are at risk of hypothermia during the winter Sensordevices can provide warnings of low temperature In the same way heat13 stress can be adanger during the summer months so sensors can alert13 people of the need to openwindows or to operate a fanFinally people who have damaged13 their fingers13 or hands will be able to wear sensorsembedded in artificial skin or in gloves that13 will enable them to identify textures and shapesand be able to dress and undress without13 the assistance of carers
216 Robotics
We may recoil at the idea13 of personal care being delivered by robotic devices but13 it13 is likelythat13 within a decade personal assistants will exist13 to assist13 with household tasks These areunlikely to be humanoid and are more likely to be machines dedicated to helping frailpeople to support13 their own weight13 and to carry trays of food around the home
19
There are four broad classes of robot13 under development13 that13 are likely to mature within 10to 12 years
1 Miniature industrial robots that13 have been programmed to perform specific taskswith precision They are likely to be relatively heavy enabling them to bear weight13 but13 still have the necessary flexibility to carry an individual over short13 distancesplacing them in a chair or on a bed They will have sensors and cameras to provideimmediate feedback and to adjust13 rapidly in response to verbal commands or cues13 from the user Some designs may build on existing assistive devices such as abathroom hoist13 or a bathing aid to become intelligent13 extensions of productsalready on the market A stair lift13 with intelligence is already being designed by a UKcompany and is aimed at providing the user with more control of the journeybetween floors of a house
2 The second group of devices might13 be described as intelligent13 furniture Beds andchairs are already available that13 adjust13 to make the user more comfortable and also13 to help them get13 into or out13 of bed The control units are fairly cumbersome andare suited to operation by a carer Voice activated controls and built-shy‐in intelligencewill give the user more control and independence Other items of furniture to whichintelligence might13 be added would be tables whose height13 can adjust13 and whichhold items of food and medicine securely The table would recognise these objectsand could provide prompts or reminders
3 Mobile robots form the third group These could be goffers that13 can either fetchand carry items such as newspapers drinks or trays or which can accompany theuser when they move between rooms providing them with support13 or prompts Thistype of robot13 could be an intelligent13 walking frame with wheels which13 could13 doubleup as a smart13 wheelchair when necessary
4 Finally there are companion robots These might13 be in the form of an electronicpet typically a cat13 or a dog though the Japanese Paro robot13 is a seal Pets canrespond to stroking and being patted they can also remind their owners that13 theyneed to take exercise and to eat drink and take their medication Various designsare already available which provide feedback but13 future models would includecameras and a screen to provide a mobile means of information and interactionwith other people over the Internet Intelligence within the device could allow themto have a personality of their own and gain knowledge by scraping data13 fromwebsites so that13 they can generate speech and have conversations about13 the newsthe weather or sports results
217 Transport and transfer technologies
Walking is good exercise and is a no-shy‐cost13 form of transport13 that13 is encouraged because of itsimpact13 on well-shy‐being For an individual with a chronic disability or suffering from theeffects of an accident13 or an injury this becomes impractical without13 an assistive technology(AT) A walking stick is the simplest13 example of AT
20
Within the home the stair lift13 has enabled people who live in conventional properties that13 are on two or more floors to continue to use facilities on different13 floors when climbing thestairs has become too difficult This is often the case for people who have arthritis a lowerlimb amputation a long term condition such as Chronic Obstructive Pulmonary Disease orpeople approaching the end of life and who have chosen to die in their own homes
Designs have improved so that13 a curved staircase is no longer an issue and the reliabilityhas reached a level where breakdown is a rare occurrence13 Through-shy‐floor lifts have been analternative proposition but13 they remain too large for most13 properties Alternativeapproaches may emerge using air pressure or water pressure as the driving force ABrazilian design already utilises a plastic tube in which a pod is moved effortlessly up anddown
Electronic wheelchairs are now available that13 allow the individual to become moreindependent13 as they allow the user to control both propulsion and steering Some modelshave the capability of mounting a pavement13 or a step or even a flight13 of stairs Personalmuscle amplification devices have been developed originally with the intention of helpingpeople who are confined to a wheelchair due to a neurological disorder to perform sometasks from a standing position Indeed the Rex walkerrsquos manufacturers claim that13 anyonewho can propel themselves in a wheelchair could walk by using Rex
Other approaches have focused on the rehabilitation of people after major accidents that13 have caused partial paralysis They quickly extend into exoskeleton designs that13 enableanyone to gain a mechanical advantage and thus to tackle physical tasks that13 would not13 otherwise be possible These suits are the focus of major research projects across theworld Some13 products such as the system developed by Honda are being tested inAssisted Living facilities and are likely to become more and more enabling over the next13 decade
Similar benefits are also occurring outside the home with a number of novel carryingsystems appearing over the past13 few years They are generally termed lsquoscootersrsquo but13 thiscovers a wide range of systems and devices ranging from the Segway a device that13 is amobile platform on which the user stands and navigates through to conventional electricvehicles that13 have been developed from golf buggies There remain a number of issuesconcerning their use on roads or on pavements but13 similar problems will need to beresolved for bicycles to play their full part13 in enabling people to get13 more exercise13 Thepotential for hybrid scooters remains
218 Smart domestic appliances and personal hygiene
The bathroom is a dangerous place and one where many older and disabled people slip andsuffer a fall Many older people recall taking a bath in a tin tub in front13 of an open fireToday the options tend to be a level access shower (ie a type of wet13 room) for anyoneunable to get13 into a bath There are various aids to help people get13 into and out13 of thebath most13 involving a seat13 that13 can be raised or lower with some bath-shy‐tubs having a door
21
There has been some research into alternative methods of keeping the body clean Sanyointroduced a machine in 1970 modelled on a clothes or dish washing machines the personsits on a seat13 inside the machine where13 they are cleaned by a set13 of water jets These havenot13 proved popular and furthermore require the individual to be transported to themachine Thus the technology may find application in nursing homes but13 are unlikely to beattractive to people living independently in the community
The washing needs of people change over time Over the past13 20 years body piercingshave appeared which have demanded additional attention to avoid the problemsassociated with poor hygiene and metals Similarly hair may be permed and dyed usingchemicals which are much stronger and which might13 damage the hair Add to this thepainting of finger and toe nails and the washing needs are rather different13 to what13 theymight13 have been even ten years ago Finally tattoos were once popular only with sailorsToday they are likely to be found on the arms backs and legs of both men and womenNew ways of cleaning these tattoos will be needed especially if they become infected orare sites at which pressure sores develop
Even if a personrsquos body is clean if their clothes are dirty they may become socially isolatedBut13 the washing of clothes can be strenuous even if a launderette is used The need toconserve water has driven research into ultrasound techniques to beat13 the dirt13 out13 ofclothing while some companies are experimenting with polymer chips These13 ldquogreenrdquo13 technologies are quickly maturing and are likely to be standard in the next 10 years
Other smart13 household appliances are already appearing on the market13 and may soonbecome common13 in UK homes13
bull Robovac devices have sensors to enable them to detect13 dirt13 on carpets and to adjust13 their operation accordingly
bull Refrigerators can read bar codes or RFID tags to identify their contents and theirldquouse byrdquo13 dates enabling them to inform the owner that13 they should use theproducts before they are out13 of date They can be linked to the Internet13 to reorderitems as they are consumed or to suggest13 menu options for the individual based ontheir preferences or according to the diet13 required to manage a condition
bull Ovens will automatically switch off if they are left13 without13 attention for too longand drying machines will set13 times automatically
Devices may be linked so that13 they are more efficient and report13 maintenance issues sothat13 they can be repaired (perhaps remotely) before they suffer a catastrophic breakdown
219 Personal and home13 security
It might13 appear perverse but13 people with very little personal wealth and property are morelikely to be the victims of crime than those who have expensive items This may be due towhere poorer people tend to live or because people who have valuable assets take greater
22
steps to protect13 them There can be no doubt13 that13 crime has a very negative effect13 onindividuals and on their families creating a fear factor that13 may be difficult13 to remove Theimpact13 on quality of life is therefore very considerable especially if it13 forces people to stayat home behind locked doors effectively isolating themselves from society
Modern policing places increasing reliance on the use of closed circuit13 television (CCTV)Town centres are covered by cameras used increasingly in the fight13 against13 crime by bothdetecting anti-shy‐social incidents and identifying the people involved They are also used tomonitor the movement13 of cars that13 may be involved in incidents of burglary and violenceand are fast13 becoming the primary mechanism of law enforcement13 agencies to solve crime
CCTV has moved into the home to record movement but13 monitoring the footage is timeconsuming and often not13 practical Cameras are now available which provide an instant13 video feed to a smart13 phone when movement13 is detected These may have intercomcapability allowing someone to remotely speak to an intruder sometimes before they havegained access to a building This may serve as a deterrent13 and when fitted alongside simpledevices that13 switch lights on randomly around the home may force burglars to goelsewhere
As the price of cameras continues to fall the option of carrying a camera13 on the body that13 continuously monitors personal space is becoming more useful Using wireless networksthe data13 collected can be sent13 continuously to the cloud for safe storage It cansubsequently be retrieved to provide evidence (video and audio) of confrontations enablingsuccessful prosecutions to be made The smart13 phone itself is becoming a valuable itemthat13 is attractive to criminals These can be tethered to personal attack buttons usingwireless technology allowing the device to be activated by the pressing of a button if theowner is being attacked The phones can then be tracked and located by the police whilebeing rendered useless to the assailant
Bogus callers are a perennial problem for vulnerable people Video door bells can beconfigured to display images and record the words of visitors before they are admittedallowing remote monitoring centres to oversee the situations and use image recognitionsoftware to confirm the bona13 fide of visitors Such13 arrangements may become13 commonplace13 over13 the13 next five13 or13 six years13 significantly13 improving the safety of peopleliving independently
220 Personal safety
The biggest13 risks to personal safety stem from fires and falls Most13 fires are the result13 ofpoor cooking practices resulting in burns or scalds Floods and gas emissions are caused bya failure to remember to close taps
The current13 approach involves detection of an emergency situation as soon as possible but13 always after a problem has already occurred This responsive approach can minimise therisks provided that13 there is a protocol in place for intervening This could increasingly be an
23
automated response such as the switching off of the gas of water or the switching on of asprinkler system or a water mist13 system
In the future monitoring systems will be more sophisticated and will have sensors and localintelligence to identify activities In this way reminders can be issued before an emergencyoccurs13 This lsquosmart kitchenrsquo approach may become13 an integral part of13 homes of13 vulnerable13 people
A prototype system has been developed at the Culture Lab in Newcastle Sensors havebeen embedded into cooking utensils enabling the kitchen to identify what13 the person istrying to cook or prepare It can provide interventions as messages on an instructionscreen
Accidents also occur out13 of doors People with dementia13 might13 become lost13 and may havepoor road safety awareness Location devices based on GPS have advanced from large andheavy receivers that13 were used on ships and boats to small battery-shy‐operated devices that13 can be carried in the hand or in a handbag The current13 generation of locators has limitedbattery life and are rather too large to be secreted about13 a personrsquos clothing while devicesthat13 are integrated into a wrist-shy‐watch are rather clunky and unattractive
Within 10 years the13 technologies13 will have13 matured and will be13 much smaller13 so that theycan be embedded in shoes in walking sticks hats or any other item of clothing Powerrequirements will have reduced so that13 energy harvesting from the movements of theindividual will be sufficient13 to keep these products working for several weeks without13 theneed for recharging The devices will not13 simply indicate to others where the individualhappens to be but13 will provide subtle guidance cues to direct13 them home
Cameras might13 also form part13 of the personal security systems that13 will protect13 people fromaccidents Data13 may be sent13 to the cloud and analysed in real time if the person is in adangerous location and can provide prompts either to the individual or broadcast13 advice toothers to clear the danger These systems may be embedded in items of clothing (such as ahat) or they may be attached to spectacles
221 Energy and13 portable power supplies
The demands of developing economies for more power will inevitably lead to higherdomestic fuel charges in the UK especially as oil and gas reserves dwindle
By 2018 UK homes should be fitted with new smart13 meters The specifications for these13 devices have yet13 to be finalised but13 will include a means of identifying wasteful use ofenergy including TV sets that13 are left13 on and unattended fridges and freezers that13 are set13 attoo low temperatures and dryers that13 are used for too long or when the weather is suitablefor using a washing line They could be an enabling factor that13 supports changes inbehaviour driven by a need to use less power but13 it13 is unlikely that13 they will offer a bigreduction in costs that13 are already a problem for many vulnerable families
24
More generally the need for power conservation will include devices that13 are moreefficient and a significant13 emphasis on heat13 retention in buildings through betterinsulation
The energy crisis may force many people to spend more time in community settingsincluding shops and public buildings where they can benefit13 from the warmth Increasingreliance on mobile communication devices will lead to increasing demand for batterycharging facilities
Greater use may be made of portable devices for generating power based on solar cellswind or hand motion
222 Smart cities and homes
The Digital City initiatives have been based on information and how it13 can be used most13 effectively to make people aware of what13 is going on around them This means bettercoordination of resources more rapid access to advice and a battery of sensors measuringevery conceivable parameter from sound and light13 levels through to air quality andtemperature fluctuations There are several Digital or Smart13 City initiatives currently beingimplemented both in the UK and across the world They may significantly impact13 the livesof the millions of people living in them but13 the timeframe for outcome benefits to influenceplanning and design elsewhere is likely to be at least13 20 years and therefore outside thetimeframe of the current13 project
Housing plays a big role in the lives of most13 people both through their aspirations to moveup in the world (usually to a bigger property with a garden) and as the heart13 of the familylife which is associated with good quality of life UK properties have a life span approaching100 years which is about13 double that13 of their European counterparts (and certainly longerthan the wooden-shy‐frame buildings built13 in North America13 for example) A shortage ofhouses has plagued improvements in social welfare for the past13 30 years There is anargument13 that13 there are enough houses but13 the wrong size and in the wrong places andthis has some basis in fact13 as demography changes lead to more people (and more olderpeople) living alone However if there are two million homes in Scotland each with alifespan of 100 years then the renewal rate needs only to be 20000 per annum to maintainthe status quo However it13 must13 be clear that13 the impact13 of smart13 house development13 willbe small The focus should therefore be on adapting existing properties to render themmore appropriate for vulnerable people
Housing adaptations are a branch of assistive technologies The technologies for providingdifferent13 forms of accessible bath and level access shower are well-shy‐established with littleresearch considering anything other than alternative building materials and methods formaintaining the temperature of the bathwater Different13 technologies for bathing will beconsidered separately
25
Thus housing technologies are not likely to impact on social work13 within the next 20years13 though13 the use of information13 technology13 to ensure that people are aware of what13 is available is likely to be commonplace well before then
26
3 BEHAVIOUR AND ATTITUDE CHANGES DUE TO TECHNOLOGICALADVANCES
Technology is only one factor that13 will affect13 the way society changes in the next13 10 or 15years This chapter will consider the context13 in which the technological developmentsoutlined in the previous chapter will be supported (or held back) by societal factors
When the impact13 of such factors has been considered we can then apply theseassumptions to a number of case studies listed in Appendix13 A13
The headings selected for this chapter are not13 arbitrary as they reflect13 the context13 in whichtechnological changes must13 be considered They must13 include consideration of factors suchas demography and long-shy‐term conditions already addressed in the introduction to thesepapers together with the aspects of workforce and citizenship considered in the parallelpapers The additional elements here focus on trends that13 are already occurring and whichmay leave people struggling with the changes that13 occur
Finally there is a need to consider the attitudes of people to technology generally andespecially to the issues of privacy and social responsibility that13 could be radically changedby technology In some cases public opinion will prevent13 some forms of technology beingdeveloped if not13 commercialised In other cases some technologies will be fast-shy‐trackedeither at the request13 of government13 or because of a clear public demand for theopportunities that13 it13 can bring
Predictions13 about the13 future13 must inevitably be13 subject to considerable13 uncertainty butthat is no reason to stop thinking what might happen
31 The Welfare State
The UK can be rightly proud of the way that13 its welfare state has developed during the past13 100 years to provide a safety net13 of financial support13 to people and to their families whenthey are unemployed destitute homeless or challenged by crises and emergencies Therange of benefits received is considerable some are complex and many people struggle tounderstand their entitlements Some are universal some are discretionary some apply onlyto parents others to anyone
The total cost13 of providing these benefits continues to rise and when the economy isstagnating there is inevitably both political pressure often supported by popular publicopinion to introduce welfare reform so that13 people who do not13 work cannot13 be better offthan they would be if they were in full-shy‐time employment This strategy requires a universalbenefit13 to be introduced so that13 it13 is easier for claimants to access support13 but13 also easierfor agencies to identify the total benefits received The idea13 of a benefits cap then becomes
27
more practical to introduce especially if all the processes involved in making a claim arehandled electronically Indeed this encourages government13 to insist13 on applications forbenefits to be made on-shy‐line Unfortunately this will marginalise those people who haveneither a computer nor access to the internet thus emphasising the digital divide in amanner which works against13 some of the most13 disadvantaged people in society
There are currently few tangible links between digital technology and welfare provisionThe most13 obvious are universal benefits such as a free television licence (worth pound14550)13 for13 everyone aged 75 or older with blind and visually impaired people entitled to a 50discount13 irrespective of their age The significance of this position is that13 6 of revenuesgenerated through licence fees are to fund BBC on-shy‐line services13 such13 as websites and i-shy‐player In Scotland the BBCrsquos Alba Gaelic language television service is predominantlyfunded13 by MG Alba an organisation funded by the Scottish Government It is thereforeconceivable that13 in the future licence fees may be used to directly subsidise access toinformation and advice through the Internet13 for vulnerable people whether it13 is throughbroadband access or through a set-shy‐top box which removes the need for a computer in thehome to access particular websites or to use e-shy‐mail services
A second age-shy‐related benefit13 available in the UK is the winter fuel subsidy People whoreceive certain benefits receive the payments automatically while others must13 make aclaim Those who are not13 eligible for benefit13 due to a lack of an address for example missout13 on these payments and also on Cold Weather payments of pound25 for each seven dayperiod of very cold weather between 1 November and 31 March
The development13 of new warm home initiatives plus the complex of subsidies that13 theelectricity supply industry and government13 offer to people with solar cells further changesthe economic arguments Global warming may lead to greater variations in weatherextremes but13 might13 also increase the amount13 of electricity that13 can be generated byalternative (green) sources such as wind and solar cells It is estimated that13 energyconsumption in the UK increased by 17 between Christmas and Easter 2013 compared toprevious years as a result13 of cold weather but13 the above subsidy scheme did not13 benefit13 older people because two of the seven day cold periods were after 31st March It must13 beassumed that13 there will be more people living in fuel poverty in the future and this will leadto more cases of cold related illness including influenza13 and stroke
32 Management of long term conditions
The management13 of long term conditions will be improved for patients who are compliant13 with their medication regime so it13 is possible that13 there may be compulsion to adhere tothe prescription Such compulsion may be monitored using technology Indeed the remotemonitoring of vital signs using telehealthcare will become commonplace as the old boxesand sensors are replaced by devices that13 can be worn continuously or which can beembedded into the fabric of homes (including furniture and bedding) or can be worn asvests or patches They will wirelessly transmit13 data13 to smartphones or tablets and mobile
28
transmission and cloud technology will enable real-shy‐time data13 collection analysis andfeedback
One of the diseases which is projected to increase most13 significantly over the comingdecade is Type 2 diabetes Whilst13 there is a hereditary susceptibility to this condition formany people including those from the Middle East13 and the Asian sub-shy‐continent it13 is also adisease which tends to affect13 those people who are overweight13 andor have a sedentarylifestyle If untreated diabetes can lead to dizziness and collapse at any time but13 can alsohave more devastating long term consequences which include kidney failure strokeblindness and in extreme cases lower limb amputations Management13 therefore includesdaily monitoring of blood glucose levels and major dietary changes such as a significant13 reduction in the consumption of carbohydrates as well as a rigid exercise regime
Many newly diagnosed diabetics follow this advice closely and can lead normal lives for 40years or more but13 some struggle to accept13 the change in lifestyle required as well asremembering which foods are allowed and how much exercise they need to takeIndividual support13 plans are now forthcoming and over the next13 ten years best13 practicewill emerge in the form of smartphone apps that13 are personalised and which can becomean individualrsquos health coach This level of support13 will be fine for some people but13 otherswill need incentives so it13 is likely that13 gaming technologies will be introduced perhapsoffering rewards for good compliance There will be a temptation for some people tocheat perhaps allowing others to perform exercise for them or changing theirconsumption details
Many of these opportunities for cheating will be removed through the use of a uniquebiometric identifier a technology that13 will be mature enough to use in place of passwordson smartphones However the biggest13 challenge may be in encouraging older people to usethe technology Many older people have multiple morbidities Indeed a survey of Scottishpatients implied that13 42 of people aged over 80 will suffer from three long termconditions It will be essential for those people to comply with treatment13 regimes if they arenot13 to have the functional deficits that13 follow
33 Finding people who13 donrsquot fit
People who have low social capital are likely to have few relatives and friends with whomthey regularly communicate and are also unlikely to be part13 of community or faithorganisations such as clubs societies and church groups They also die several yearsyounger than most13 of the population often because they donrsquot13 engage with public healthinitiatives such as vaccinations against13 flu regular checks on their blood pressure bloodsugar levels or in the case of women smear tests or mammography The most13 likelyreason for disappearing beneath the radar of such initiatives is their mobility which leadsalmost13 inevitably to them having no fixed abode and no fixed telephone line It thenbecomes very difficult13 for them to be contacted because their mobile telephones are likelyto have Pay-shy‐As-shy‐You-shy‐Go contracts that13 donrsquot13 require validated names addresses and bankaccounts
29
It follows that13 some of the most13 vulnerable people in society including those who live onthe streets are effectively unknown to both the NHS and to social work departments untilthey are referred in a crisis This could be an emergency presentation to a hospital Accident13 and Emergency Department13 where they will come into contact13 with a social worker becausedischarge may be unsafe This often highlights the importance of the prevention agenda13 and the potential for avoiding admissions to hospital by intervening at an earlier stage
The advantages of being able to locate people who are vulnerable to specific diseases willincrease as genetic testing becomes more routine It is already possible to determine whomight13 be most13 at risk of breast13 cancer and prostate cancer as a result13 of family history Addto this the evidence that13 particular diet13 and exposure to environmental factors can furtherincrease risk then it13 is evident13 that13 individuals can be identified and offered treatmentsthat13 could save their lives many years before they become ill In the case of cancersperhaps only the individual is involved but13 for infectious diseases it13 is the whole of societythat13 is at risk if someone contracts one of the new strains of influenza or if someonechooses not13 to be vaccinated against13 rubella In Chinese airports all visitors are screenedfor fever and refused entry if they tested positive in cities the public are monitored in thesame way Similar approaches may be necessary in the UK if potential carriers cannot13 otherwise be identified
34 Volunteering
It is estimated that13 72 per cent13 of people volunteered to perform a charitable act13 at least13 once during 2012 a rise from 65 per cent13 the previous year About13 four out13 of every 10volunteers offer their services formally to one or more organisations The remaindervolunteer informally by helping out13 a friend or a neighbour Around 50 per cent13 volunteered at least13 once a month in the past13 year up from 41 per cent13 on the previous13 year Most13 have retired many of them before the statutory retirement13 age Those whodonrsquot13 feel able to offer time have offered their financial support13 at a time when the fundingavailable from sources such as the National Lottery has been decreasing Despite economicausterity donations to charities have been increasing 74 per cent13 said they had given tocharity at least13 once in the previous month up from 72 per cent13 the previous year
Strikingly 78 per cent13 of people strongly believe that13 they are part13 of their localneighbourhood an increase from 70 per cent13 10 years previously Community cohesion isstronger than ever 87 per cent13 of people believe their local area13 is a place where peoplefrom different13 backgrounds get13 on well together compared to 80 per cent13 in 2003
The role of volunteers in supporting vulnerable people is therefore likely to increase overthe next13 decade perhaps exploiting the success of the army of volunteers that13 was highlysuccessful in London during the Olympic and Paralympic games The greatest13 role for suchvolunteers may be in providing informal care for older people Already the UK has someseven million informal carers whose value in monetary terms has been calculated to be
30
more than the combined budgets of the NHS and social care Maintaining or extending thisprovision will help to support13 services in the future and may be supported by technology
Whilst13 there is ample evidence to suggest13 that13 telecare services support13 informal carers asmuch as (if not13 more than) the people that13 they are caring for it13 is the potential for utilisingthe internet13 and apps to make their role easier to coordinate and hence more effectivethat13 is likely to be most13 successful moving forward
Many of these focus on particular tasks that13 informal carers can help offer to older peoplesuch as organising their medication A pillbox program is just13 one feature of an app calledBalance It also includes sections for caregiving tips notes for the doctor and the patientsappointments plus a lsquolearning sectionrsquo with articles on aspects of Alzheimers and an RSSfeed for news about13 the disease Tyze is another multi-shy‐functional app it13 allows carers to
bull Organise appointmentsbull Plan outingsbull Share storiesbull Send updates to other family members
Another application is Rally Round which helps carers to organise someone to perform littlejobs often on a temporary basis when someone has dementia physical frailty or isrecovering from accident13 or illness Similar applications are MeMaxi and Finerday
35 The High13 Street
The shape and appearance of UK shopping centres have been changing for half a centuryPeople complain that13 centres are losing their identity with one town looking like everyother both in terms of the stores and in terms of the layout But13 there are three trendswhich are having a profound impact13 on many of the most13 vulnerable people in society
bull Centres lock their doors at 6pm or in some cases 10pm -shy‐ thus denying people whosuffer from claustrophobia13 from window shopping at times when other shoppershave left
bull Out13 of town shopping malls -shy‐ these US style centres are ideal for people in carsbecause they offer free parking which is essential for people who want13 to buy largeritems but13 difficult13 for people who have no transport13 and who must13 rely on publictransport13 that13 is often deficient
bull The rise of online shopping -shy‐ which means that13 many potential shoppers only visit13 High Street13 stores to check the prices before returning home to make a purchaseonline
It is the third of these effects that13 has the greatest13 potential for changing the High Street13 forever and it13 is making life for traditional retailers increasingly difficult13 at a time when highrents are crippling stores large and small It is difficult13 to see how this trend is likely tochange because consolidation in banking and estate agencies is already forcing the closure
31
of other High Street13 players while additional pressures on pubs has led to the closure ofthousands of pubs every year
Those figures however demonstrate that13 consumers still value what13 the high street13 canoffer -shy‐ the chance to inspect13 what13 theyrsquore thinking of buying -shy‐ as well as the new opennessof the internet Customer service makes a difference to people especially if there is aproblem and goods need to be returned One of the most13 common reasons for furniture tobe returned for example is that13 when a sofa13 or a wardrobe was delivered it13 couldnrsquot13 fit13 through the front13 door or up the stairs In the future people will be able to benefit from13 visualisation technology they will upload the floor plans of their homes enabling theretailer to inform them of the problem before they try to delivery Augmented reality viewwill similarly allow customers to see what13 a new item of furniture will look like in itsintended place so that13 they can be more informed about13 the effect13 of size and colour
In terms of improving the viability of the High Street stores will have to focus on theimportance of brand which could mean that13 individual independent13 retailers will have topartner with national suppliers to support13 a local tailored offering based on products that13 are designed for a more global market This is a lsquoconnected High Streetrsquo approach whichcould be enabled by the developments in internet13 availability and smart13 phone accessdescribed in the previous section
The overall effect13 of all these changes could mean that13 town centres become smaller but13 more vibrant13 areas They could thrive if people are attracted there in large numbers whichmeans that13 retail must13 be developed alongside restaurants pubs galleries and other leisureopportunities This is possible in new shopping centres which are already being integratedwith transport13 hubs including railway and bus stations but13 may be more of a design13 challenge for older towns and cities with large Victorian buildings To ensure that13 morepeople are welcomed into the new centres they should include attention to green spacesand areas where people can relax without13 feeling that13 they are second class citizensbecause they donrsquot13 have the same buying power
3513 Privacy
To some people privacy is their right13 to live their lives without13 interference they may seethe State as a potential lsquoBig Brotherrsquo spying on their every move and judging their actions13 and activities Other people have fewer concerns about13 the role of the State but13 great13 fearof individuals interfering with and invading their privacy Some embrace the concept13 of lsquomyspacersquo an area13 of a square metre or so into which nobody can enter without13 permissionThis allows them to avoid physical contact13 and to feel safe from any form of threateningbehaviour
Yet13 this idea13 of private space and its potential violation is merely the tip of the iceberg asfar as privacy is concerned more significant13 is the idea13 of personal (and private)information being shared with anyone and everyone This could be related to identityopinion or image for an individual who wants to remain anonymous or even secretive thisis going to become an increasing problem as technology provides the means of taking
32
photographs recording conversations and capturing environment13 with something as smalland ubiquitous as a mobile phone The fact13 that13 this information can then be shared withthe rest13 of the world using e-shy‐mail Twitter and Facebook makes the problem all the moredifficult So the threat13 is no longer solely from the long lenses of the Paparazzi but13 fromanyone (and that13 means everyone) who has even the most13 basic of mobile phones
This relates to the changing views of society on what13 information should remain privateand what13 should be shared with others The success of social media13 has been based on anattitude of lsquosharing everythingrsquo with either your friends or the world This has introduced anaiumlve idea13 in the minds of some younger people (especially those known as Millennials ieaged 18-shy‐30) that13 everyone can be their friends whilst13 perhaps failing to reinforce the bondsof genuine friendship with any form of test13 or restriction Technology could play a role indefining these friendships and allowing individuals to understand what13 makes a goodfriend but13 this approach has yet13 to be developed and may be slow to overcome the needfor some people to measure their own popularity simply as the number of people that13 theycan list13 as friends on their Facebook page
It follows that13 there may be a need for a new definition of privacy that13 is in keeping withthe web and its ability to display images and opinion in an unregulated manner This needsto embrace past13 concerns about13 the ability of an individual to live without13 the threat13 ofothers being able to watch them whilst13 offering some protection from random postingsabout13 them online Perhaps this could include a right13 to be able to edit13 or remove anythingrelating to themselves on the Web including images that13 are not13 news-shy‐worthy Theownership of image rights may be an associated issue that13 needs to be addressedespecially as modern technology can remove an individual from a group (or a background)13 view provide digital touch-shy‐up or air-shy‐brushing and then republish it13 in a different13 contextHowever there is general agreement13 that13 personal information (such as contact13 details andbank codes) should not13 have a place on the web Surprisingly few people take proactivemeasures to prevent13 tracking functions being activated
It follows that13 too much privacy could lead to younger people fearing that13 they maybecome lost13 in a digital world It is not13 surprising then that13 they are prepared to make lots13 of personal information available often with no fear of how it13 might13 be used by othersWhen Google glasses and similar technologies become available during the next13 few yearsthey will have the potential to identify a stranger walking down the street and to find manyof their secrets to present13 to the wearer in a fraction of a second They could know moreabout13 them than their genuine friends know -shy‐ so who will be their friends in the future
36 Data sharing and13 protection
By lsquodata13 sharingrsquo we mean the disclosure of data13 held by one organisation on an individualto a third party organisation(s) or the sharing of data13 between different13 parts of anorganisation Some data13 sharing doesnrsquot13 involve personal data13 because it13 has beenanonymised in such a way that13 the statistics can be used for the collective good without13 theidentification of the individual The Data13 Protection Act13 (DPA) is in place to provide a legal
33
framework that13 ensures that13 organisations that13 hold personal data13 must13 act13 responsibly atall times These principles adequately describe the position of public and government13 bodies especially social services departments who are responsible for the informationconcerning the health and well-shy‐being of individuals -shy‐ and hence by implication thesensitive data13 relating to their vulnerability
The legal framework that13 applies to private and third sector organisations differs from that13 which applies to public sector organisations which may only act13 within the defined limits oftheir statutory powers However all bodies must13 comply fully with the data13 protectionprinciples and this situation is unlikely to change within the next13 10 to 15 years In someprivate sector contexts there are legal constraints on the disclosure of personal dataHowever most13 private and third sector organisations have a general ability to shareinformation provided this does not13 breach the DPA or any other law It is advisable for acompany to check its constitutional documents such as its memorandum and articles13 ofassociation to make sure there are no restrictions that13 would prevent13 it13 from sharingpersonal data13 in a particular context The type of data13 held is therefore a subject13 ofconcern as it13 may be difficult13 for legislation to keep up with the additional layers of data13 created on-shy‐line and through the Internet13 of Things
Private and third sector organisations should have regard to any industry-shy‐specific regulationor guidance about13 handling individualsrsquo information as this may affect13 the organisationrsquosability to share information They should also be aware of the legal issues that13 can arisewhen sharing personal data13 with public sector bodies This becomes more of an issue asprivate and third sector bodies are carrying out13 a wider range of traditionally public sectorfunctions Opportunities for inappropriate sharing of sensitive data13 will therefore inevitablyincrease
Public authorities must13 comply with the Human Rights Act13 (HRA) legislation in theperformance of their functions The HRA also applies to organisations in the private sectorinsofar as they carry out13 functions of a public nature which could include delivering a socialcare activity Where the HRA applies organisations must13 not13 act13 in a way that13 would beincompatible with rights under the European Convention on Human Rights Article 8 of theConvention giving everyone the right13 to respect13 for their private and family life their homeand their correspondence is especially relevant13 to sharing personal data If personal data13 isdisclosed or shared in ways that13 comply with the DPA the sharing or disclosure of that13 information is also likely to comply with the HRA The problem may still be in policing theActs and the rights of an individual if they believe that13 their personal data13 has been sharedor accessed by an inappropriate organisation or individual
A legal industry may be born to deal with such matters but13 this is unlikely to benefit13 peoplewho cannot13 afford the fees involved They would require either legal aid or to employ13 more13 lsquono win no feersquo companies Public attitudes to such costs might13 become negative unlessthey prove successful in preventing breaches of data13 security There may need to belegislation to provide a stronger basis for forcing compliance with privacy laws
34
37 Connecting with13 people
We are social creatures most13 of us rely on our friendships and interactions with friendsand families to share our happiest13 moments and experiences Research suggests that13 thishappiness is infectious at all levels and leads to a 15 increase in the happiness of a closecontact 10 for a second degree contact13 such as the friendrsquos spouse and a 6 increase fora friend of a friend It is hardly surprising that13 the success of social media13 such as Facebookis intimately related to the ability of people to quickly share their happiest13 moments with asmany of their friends and connections as possible
All this has happened during the rise of the Internet13 and the corresponding increase inopportunities for connecting online ie this is a 21st Century phenomenon which has beenfacilitated by Information and Communications Technology But13 the Internet13 remains in itsinfancy and we are only beginning to understand and exploit13 its potential In terms ofaccessing the Internet there are now perhaps two billion people who have access with99 of them having gained this during the past13 decade This number will have doubled bythe period 2020 to 2025 It is likely that13 everyone who wants to be connected in the UK willby then be connected Turning this on its head only those who donrsquot13 want13 to be online willnot13 be on the Internet13 within a decade Connecting with the unconnected will therefore bea case of identifying those people who donrsquot13 want13 to be found unfortunately these mayinclude many people who need the support13 of social care organisations It means that13 theywill be looking for support13 only when they are in crisis unless other ways of finding andormonitoring them are found
While the number of people connected via the Internet13 has exploded this might13 bedwarfed by the number of connected lsquothingsrsquo During 2009 the number of thingsconnected to the Internet13 surpassed the number of connected people at which point13 webegan to experience what13 this report13 has described as the lsquoInternet13 of Thingsrsquo Yet 99 ofall physical objects that13 could join this network are not13 yet13 connected but13 the number couldgrow by 25 every year for the next13 decade so that13 there could be 100 billion connectedobjects by 2025 some of which will be owned or used by everyone in the UK includingthose people who donrsquot13 want13 to be connected themselves We will then have an Internet13 of Everything which will be the smart13 connection of people data events and actions
With each new person object or data13 that13 comes online the connection possibilitiesbetween all these elements grows exponentially The rise of big data mobile networkingcloud storage and data13 mining technologies will all play a critical role in the Internet13 ofEverything The result13 will be new capabilities richer experiences and unprecedentedvalue for individuals businesses communities and countries everywhere The lsquonetworkeffectrsquo of the Internet13 of Everything will be a very powerful thing the true impact13 of whichwe wonrsquot13 fully understand for several years As it13 develops however those who are not13 connected will feel even more digitally and socially excluded There will be a need to reachout13 to vulnerable people unless the process of claiming requires proof of online identityand the payments to be received can only be redeemed using a chipped card or adownloaded app onto a smartphone This is of course the way that13 welfare arrangementsare already developing thus it13 might13 prove impossible to make a successful claim without13
35
already being connected to lsquothe systemrsquo either through an online presence or through theInternet13 of Things
38 Downloading everything
Sixty years ago information was discovered by reading books often in a library wherenotes had to be made because the books or journals couldnrsquot13 be removed Then in theearly 1960s the first13 office photocopying machines were introduced into the UK theyimmediately meant13 that13 pages or articles from books could be copied and taken away to beread and summarised later Within a few years photocopying became a replacement13 forreading as researchers became less adept13 at selecting a few sentences and every deskbecame a depository for reams of printed paper Paper became the means of recordingeverything from bank statements through to music
We now appreciate that13 printing everything is a waste of both the ink (or toner) used tocreate the black print13 and of paper which requires trees to be chopped down and pulpedbefore it13 can be pressed into thin sheets Saving paper is therefore seen as green and goodfor the planet Fortunately we no longer need to print13 everything because computermemory is unlimited thanks to the cloud and we can then view pages and articles onportable or fixed screens
The internet13 has everything and it13 is all available instantly for downloading providing thereis a device available to accept13 it and there is sufficient13 communication bandwidth toperform the transfer of data13 sufficiently quickly Thus we can record all text13 articles that13 are relevant13 to us including digital records of birth certificates qualifications and passportsand the need for original printed versions will decline But13 we can also do this forphotographs Most13 handheld computing devices include at least13 one camera so they cangenerate enormous number of pictures which can be kept13 for posterity without13 having toconsume inks and special papers to print13 them
But13 the materials that13 can be downloaded donrsquot13 stop at pictures software is available that13 can grab TV shows after they air and movies as soon as theyre released In the same wayit13 is possible to schedule music comic books video games and practically anything else asa download with minimal effort People will need enormous hard drives if they want13 theirown digital copies of these files so will more than likely make use of cloud storage that13 willbe available from many organisations The location of the servers may become sensitivedue to border restrictions as will the security of the data13 and the way that13 it13 is backed up sothat13 it13 is resilient13 to failures
It may be evident13 that13 application forms for all types of welfare payment13 will be availableonly for downloading so that once digitised they can be processed by computer andrecords sent13 to various servers for subsequent13 storage and processing Some people maywant13 to keep their data13 on them once it13 has been downloaded Pen drives can already holdseveral GB of data so it13 is likely that13 people will be able to carry their downloaded data13 withthem at all times irrespective of the size and complexities of the information
36
39 Health13 and13 well-shy‐being
The general health of the population is unlikely to deteriorate noticeably within 10 to 20years Indeed expectations of the population are that13 things must13 improve as surgicaltechniques mature and as pharmaceutical interventions become more personalised andpowerful However the rising demand for health services due to an ageing population andthe increasing cost13 of providing sophisticated therapies will make delivering a free anduniversal health service difficult13 without13 substantial increases in taxation This is unlikely tohappen in the UK even though spending on health services will be protected against13 thecuts facing other services
There will have to be changes in how the NHS works For twenty years hospitals have beenclosed and replaced by fewer new facilities so that13 the bed count13 is reduced This has led toa significant13 shift13 in resources to primary care and community care supporting shorter staysin hospital and speedier transfer back home for people after surgery or illness This hasbeen13 successful but13 there remain problems with demand for GP services especially out-shy‐of-shy‐hours and at weekends Indeed despite the introduction of NHS24 and similar help-shy‐linesthe demand for GP appointments continues to increase Delays are inevitable and this willincrease system failures with more unnecessary deaths and a failure for people to access adiagnosis that13 might13 lead to early interventions and ultimately lower delivery costs Over250 more patients are added to waiting lists every day
This will lead to a new model of primary care consistent13 with existing changes which haveseen surgeries move from High Street13 locations to medical centres close to bus routes andwith more parking for patients The process of making an appointment13 is changing from atelephone-shy‐based interview process dominated by a medically-shy‐unqualified receptionist13 to achoose and book approach using an online process linked to electronic patient13 records Thiswill give patients more convenience but13 will allow priority for those who have Internet13 access at the expensive of those who are digitally excluded Making the process of bookingan appointment13 quick and easy may also increase demand from people who do not13 need tobe seen as it13 will fail to identify those in greatest13 need
A greater use of telehealth and telecare technologies will be inevitable beginning with thefirst13 contact13 as an encounter using the telephone e-shy‐mail or video conferencing -shy‐ a visit13 tothe GP surgery should be a last13 resort and should involve a nurse consultation in the first13 instance This would be consistent13 with three quarters of appointments currently involvinga chronic disease or long term condition which relates to improved self-shy‐care The support13 ofthese patients at home should be prioritised through tele-shy‐ and web-shy‐based technologies andshould involve training and coaching through a network of nurse practitioners Home visitsshould generally be unnecessary through the use of these technologies but13 could besupplemented by satellite surgeries manned by nursing in community premises or inpharmacies nurseries and Internet13 cafes
The homes13 of people who13 need13 closer monitoring can then become part13 of virtual wardswith real or electronic visits by health professionals University Hospital Southampton NHSFoundation Trust13 already looks after patients who have undergone surgery such as a hip orknee13 replacements in virtual wards with high levels of satisfaction The Royal Free London
37
NHS Foundation Trust13 offers a similar service but13 plans to add the possibility of videoconsultations between patient13 and consultant
310 Attitudes to public health issues ndash obesity smoking alcohol abuse drugs
As self-shy‐care becomes the focus of the NHS the public will increasingly understand that13 thecosts and availability of services are being harmed by the poor health behaviour ofrelatively small numbers of people The link between public health initiatives today andhealthcare needs and costs in the future will become increasingly evident13 as a result13 of theway that13 information is presented Thus the overweight13 smoker who currently attractsconcern and pity when they are diagnosed with diabetes and COPD is increasingly beingseen as the victim of their own stupidity or lack of self-shy‐discipline If they continue to neglect13 medical advice and continue with an unhealthy lifestyle then the way that13 they receivetreatment13 and consume resources will become a matter for the entire population
Obesity is seen as due to a combination of poor diet13 and a sedentary lifestyle No longer isthe idea13 that13 people are lsquobig bonedrsquo acceptable Governments will respond initially byrequiring manufacturers and food processors to provide nutritional information onpackaging and on menus in restaurants But13 people can choose not13 to read the data13 and toneglect13 both the importance of food quality content13 and quantity This will increasepressure to introduce fat13 or sugar taxes and these are likely to be in force within a decade
Although the high taxes on tobacco products has forced some smokers to reduce theirconsumption or to give up altogether the impact13 has been reduced by the smuggling ofproducts from overseas and by the availability of duty-shy‐free cigarettes for people returningfrom foreign holidays and business meetings Further measures are planned to changepackaging and to include even more graphic images and warnings on cigarette packages tomake smokers aware of the effects of smoking on their health and well-shy‐being There is asyet little evidence of how successful this might13 be More effective has been the banning ofsmoking in public places including trains and aircraft Expensive medical interventions suchas heart13 transplants will be denied to individuals until they change their lifestyle behaviourSmokers might13 therefore be increasingly ostracised leading to a loss of esteem This mayhave a particular impact13 on people who already suffer from mental health problems whoare more likely to smoke
The overuse of alcohol is being recognised as a major factor in hospital admissions withNHS figures showing an increase of over 40 in such admissions over the past13 decadeLinked to this has been a 75 increase in prescriptions to treat13 alcohol dependency Fewpeople have sympathy for those who waste their limited income on booze If they havechildren or other dependents they will be the ones who suffer and who may need thesupport13 of social care
Drug users are already significant13 users of social services as their habit13 is likely to makethem unemployable They receive little sympathy from the general public because they areseen as criminals and people who waste public resources Levels of drug abuse have been
38
slowly increasing over the years but13 this trend is slowly being reversed Indeed the numberof people using drugs during the past13 year has fallen to its lowest13 level for nearly 20 years(below 9) with cannabis being most13 likely often following excessive drinking Aselectronic noses and other technologies can detect13 traces of drugs it13 seems likely that13 success in overcoming addiction can be measured objectively This may become a two-shy‐edged sword rewarding those who can turn around their lives but13 further marginalisingthose who canrsquot13 or wont13 accept13 the lsquocold turkeyrsquo
311 Attitudes to surveillance
Issues associated with privacy confidentiality and data13 security have been discussedpreviously in the context13 of information technology the World Wide Web and the ease ofcollecting recording recalling analysing and displaying data The monitoring of individualsand their methods of using this information can be regarded as surveillance As thequantities of data13 increase along with the number of devices that13 can be used to access itthe surveillance tools will also increase in their sophistication Indeed the Big Data13 approaches described in the previous section will enable the combination of structureddata13 (such as the information held in databases) to be married with unstructured data13 fromimages in such a way that13 it13 can be mined
Whilst13 the lsquodigital surveillancersquo methods described above may cause most13 concern topeople because of its impact13 on anonymity it13 is the collection and analysis of images that13 are the major concern to people as they contemplate the ways that13 lsquoBig Brotherrsquo maydevelop to restrict13 freedom Every major UK city and town centre has an array of CCTVcameras that13 continually record activities from every angle If it13 used to be true that13 nobody in London was more than 10 yards from a rat it13 is certainly the case today that13 nobody can be more than this distance from being in view of a surveillance camera Yetthey receive so much positive publicity from TV programmes where their footage is used todetect13 vehicles close to a crime scene or to monitor the movements of suspects that13 theyare now accepted by the public as a deterrent13 in the same way as lsquobobbies on the beatrsquowere seen 25 years ago There is therefore little public reaction to the expansion in the useof video surveillance except13 for the practical observation of how so many views can beinspected and recorded
Looking to the future the tumbling cost13 of video technology will surely lead to anotherincrease in the number of devices The aerial views taken from towers will besupplemented by more local views taken by devices that13 are embedded in the fabric ofbuildings or carried by individuals either on their person (for example on clothing orspectacles) or in the bags that13 they carry The time and date-shy‐stamped images as Big Datawill be recorded to lsquothe Cloudrsquo where it13 can be added to other data It can then be usedwhen an incident13 has occurred or to provide further detail of night-shy‐time activities
It follows that13 there will be no hiding place for people who simply want13 to disappear Theymay respond by wearing clothing (such as hoodies) that13 hide their faces or which make it13 difficult13 to distinguish gait13 or mannerisms from which they might13 be identified New forms
39
of clothing may be designed to make shapes more difficult13 to analyse and these might13 become the uniforms of a class of person who wants to live in a way that13 they donrsquot13 interact13 with officials from any ministry or local government13 department If they also obstruct13 services then they will be considered to be anarchists of some form sparking protests fromother sectors of society
31213 Attitudes to driving
Motor cars have been a feature of UK roads for over a century but13 it13 is only during the past13 50 years that13 they have become a resource that13 most13 families have had access to enablingthem to travel without13 the restrictions imposed by a limited railway network and non-shy‐integrated bus transport People who have had a car throughout13 their lives often see theircars as an important13 factor in enabling them to remain independent13 and to exercise choicesrelating to where they shop and where they spend their leisure time This extends to theirspouse and to friends and neighbours that13 they might13 take with them on their variousexpeditions
Unfortunately there are incidents involving older drivers who perhaps go down amotorway in the wrong direction who are taken ill at the wheel or who are involved in anaccident13 involving no other vehicles These are small in number but13 often lead to a reactionthat13 they shouldnrsquot13 be allowed to drive lsquoat13 their agersquo Age itself is not13 an indicator ofdriving quality but13 because old age also brings more chance of having limited long termconditions and other illnesses it13 is easy to make a link between driving ability and age Thelicensing system does require continued driving to be linked with medical advice andforbids people with poor eyesight epilepsy and other conditions to hold a licence in oldage
Yet13 statistically older drivers cause far fewer accidents than younger drivers The reasonsfor this may be complex and are likely to include the fact13 that13 they drive less often covershorter distances and donrsquot13 go out13 in the dark or in poor weather However it13 does not13 wholly explain why the UKrsquos drivers aged over 70 and who represent13 some 8 of all driversare involved in only 4 of accidents that13 cause injury This compares favourably with the15 of13 drivers aged between 17 and 29 who are involved in over a third of crashes that13 result13 in injury
By 2020 the number of drivers aged over 70 on UK roads is likely to increase to over 7million This will require a new national strategy perhaps involving support13 for olderdrivers further training raising awareness of issues and making more use of adaptivetechnologies to support13 the driver in avoiding collision or forgetting to check on the statusof their vehicle Poor eyesight13 could be enhanced by camera technologies rather thanforcing people off the road if they are unable to read a licence plate
The International Longevity Centre has found that13 one in four Britons thought13 driversshould be made to switch off the ignition for good somewhere between the ages of 70 and75 The numbers may decrease as the population ages and as cars become safer Forcing
40
older people off the road may be a natural consequence of providing free bus passes andsubsidised rail fares but13 the growth in the pavement13 scooter industry demonstrates that13 older people value their independence and will do almost13 anything to get13 out13 and aboutPerhaps legislation will result13 in more regulation of electric vehicles and where they cantravel
There can be no doubt13 that13 getting out13 will be associated with better quality of life andwell-shy‐being and this is likely to be supported in the future as evidence of improvedoutcomes emerges It is to be hoped that13 positive stories will be publicised so that13 publicattitudes arenrsquot13 hardened This may be supported by more in-shy‐car monitoring of drivers andthe linking of performance with on-shy‐line driving records and licences These could throughremotely monitored ignition systems prevent13 the use of motor vehicles by people without13 a licence or without13 insurance
313 Climate change
There is a general view that13 the emissions of carbon gases are contributing to globalwarming in a manner that13 will change the UK climate in such a way that13 the climate maybecome more Mediterranean However some scientists believe that13 manrsquos impact13 on theenvironment13 may be small compared with natural variations caused for example bycyclical changes in the sunrsquos energy output13 or by the effects of volcanoes and earthquakesRecent13 evidence has suggested that13 we are going through a phase of changing extremesand that13 this is more likely to cause storms periods of excessive rainfall and unusualseasonal trends with snow and frost13 in the spring and warmer winters Considerableuncertainty remains and it13 might13 be necessary to plan for a number of different13 scenariosand for the impact13 on vulnerable people
I Colder winters UK properties are poorly insulated resulting in excess mortalitiesduring cold spells due to an increased number of people suffering from stroke aswell as bronchitis and other pulmonary diseases The cost13 of heating continues toincrease putting more households into a state of fuel poverty Any further coolingduring the winter months will result13 in more people living in unhealthy coldconditions Winter fuel payments are likely to be restricted to the poorest13 peoplebut13 this might13 exclude people who live in larger properties that13 are more difficult13 toheat
II More storms excessive winds and rain can cause flooding at any time of the yearMany UK communities are built13 close to rivers and these can surge during heavyrainfall causing houses to be filled with water and furniture and carpets lostInsurance can be problematic for properties built13 on flood plains which can blight13 properties and prevent13 owners from being able to sell and move on High winds canrip off roofs causing injury and also causing families to be left13 homeless anddependent13 on social services
III Hot13 summers Europe suffered high temperatures during the summers of 2003 and2004 leading to heat13 stroke and hypothermia The UK has not13 previously sufferedfrom such problems but13 might13 be expected to experience days of extreme
41
temperature and humidity at times Older people may not13 be prepared for suchweather Street13 dwellers may be unable to find shade and supplies of drinkingwater
Irrespective of what13 combination of weather scenarios arise it13 must13 be concluded that13 any extremes will have a major negative impact13 on vulnerable people especially if theyare not13 prepared because they havenrsquot13 received the weather warnings and advice that13 can be broadcast13 using the TV radio and online services Once again the digitallyexcluded will suffer and will pay a high cost Society will continue to pick up the bill interms of demands on social care services unless preventive actions are taken in theform of connecting these people to each other and to formal services
42
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
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13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
n13 13
13 s13
r13 n13
e13 at13
e13 y13 e13 ld13
ly13
13 e13 t13 e13
s13 er13 e13
f13
rt13 13
13 13
13
r13 13
s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
e13 g13 13
e13
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13
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d13 13
s13 y13
e13
13
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13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
bull Fingerprints have been accepted for over two thousand years to confirm identitymostly in criminal justice The technique has been applied to door-shy‐lock opening insome supported housing schemes There are practical problems associated withregistering lsquoallowedrsquo fingerprints and the useful lifetime of such products is also onlyabout13 three or four years
bull Retinal imaging and DNA analysis have been relatively slow to follow but13 only dueto the sophistication required for measurements and the time taken for testing Acombination of retinal imaging with facial gestures and blinking is possible in the labbut13 currently takes half a minute to achieve a match -shy‐ and this is achieved only withthe use of considerable computer processing power This sort13 of time makesapplications in mass people transfer impossible
Current13 research in this area13 is focusing on the uniqueness of other body parts such as earsand knees as biometric indicators The ears have great13 potential because they are usuallyexposed though hidden sometimes behind hair and other times by hats and other clothingOn the other hand the knees are rarely visible and however unique they may be there willbe cultural and religious obstacles to overcome before scanning could become a regularpart13 of identity confirmation The cameras which are central to such systems used to beexpensive but as the cost13 of high quality cameras continues to fall (there is one in nearlyevery mobile phone) it13 becomes feasible to devise identification devices that13 use multiplecameras to simultaneously recognise the eye and the ear
Movement analysis can be used to identify people by their walk gait13 and other biorhythmsprovide unique signatures It is possible to learn someone elsersquos gait13 though and injury orillness13 can have a temporary effect13 on gait
Over the next13 ten years with more sophisticated databases and image processing facilitiesthe cost13 of implementing advanced biometrics will fall enabling their application acrossmore diverse areas and in more social opportunities Potentially cameras will use cloud-shy‐technologies to provide individuals with instant13 recognition of anyone approaching them inthe street This could prompt13 a name or the occasion when they were last13 seen or spokento as a secondary method of control in much the same way as Internet13 banking seeks toavoid fraud This13 has13 the13 potential to remove13 the13 need for13 passwords13 and might13 then be13 the basis of machine-shy‐based13 communication13 either in front13 of a laptop or tablet13 device orwhen using13 a smart13 phone
There will need to be special measures introduced to support13 people with any form ofdisability as they might13 well have one or more sensory deficits Similarly people maystruggle to communicate following a stroke or a serious accident Nevertheless it13 may bereasonable to conclude that13 such systems will be both available and acceptable within thenext13 10 to 12 years
12
210 Health13 information
Health records in the form of written documents x-shy‐ray images and clinical observations arean important13 means of making all interventions efficient13 and safe Increasingly people havemany different13 conditions (comorbidities) and may be treated by several specialists Asthese physical records are moved inevitably some get13 lost estimates suggest13 that13 one inthree records is lsquolostrsquo at any one time
The best13 resource for information about13 a patient13 is his or her primary care record which isheld by the GP The UK was an early adopter of electronic primary care records and can beproud of the way that13 these have enabled population-shy‐based information to be collectedand analysed Scotland (and to a lesser extent13 Wales) has led the way in ensuring that13 allthese records are accessible through anonymised approaches that13 allow researchers toexamine trends and improve analysis of performance Fundamental to this has been theallocation of a unique identifier At13 the same time individuals can access these recordsboth to check for accuracy and to see what13 their doctor has said about13 them
This13 has13 the potential to make people more responsible for their own conditions andmight lead to better13 self-shy‐care13 and changes in behaviour13 that might reduce13 the13 incidence13 or severity13 of chronic conditions13 that are related13 to lifestyle
In the future we can expect13 the primary electronic health record to be linked with hospitaladministration systems picture archiving systems and other records held by hospitals sothat13 appropriate medical staff can have access to all relevant13 data
When the social care record is added to the mix then this will mean fewer but13 shorter andbetter assessments for social workers and for healthcare staff They will knowcircumstances and factors that13 could influence the choice of approaches This supports theidea13 of there being only one record consisting of several components all of which areaccessible by an appropriate professional at any time and in any place
The13 ambitions13 described above13 are not13 limited by technology most13 of the interoperabilityissues between rival commercial record systems have been resolved and databaseproviders are being compelled to support13 joint13 working The English NHS Mandate requiresTrusts to effectively replicate arrangements already in place in Scotland and in Wales andthis will go a long way towards achieving a genuinely paperless NHS well before 2020 Withnew biometric identification technologies individual records will be available to out-shy‐of-shy‐hours physicians and to those working in an AampE department13 irrespective of theconsciousness state of a patient
New telecare and telehealth technologies will produce significant13 more volumes of data13 which are currently held in different13 places and owned by different13 organisations rarely thepatient These data13 will also need to be shared but13 only in a manner that13 is acceptable toeveryone Patients may not13 want13 all their mental health information published in a formthat13 can be viewed by social workers GPs may not13 want13 to have access to all the data13 that13 might13 suggest13 that13 there is a domestic crisis to which they had neither the wish nor capacity
13
to respond Monitoring systems that13 support13 the lsquoquantified13 selfrsquo may also offer data13 that13 may or may not be added to the full recordThe future of health information might13 therefore be about13 providing individuals with themeans of producing relevant13 information storing it13 somewhere secure and then viewing it13 at a later time but13 in a format13 (or with advice) that13 is acceptable
See also httpmydexorg lsquoMydex gives individuals back control over their personal datarsquo
(see also Digital Scotland 2020 Achieving World-shy‐Class digital infrastructure a final report13 tothe Scottish Government13 httpwwwscotlandgovukPublications2013029054lsquoconnectivity by any device anywhere and anytimersquo)
211 The Future of Healthcare
The strains on our healthcare delivery system are becoming greater as they are in otherdeveloped countries as a result13 of an aging population rising expectations and unhealthylifestyles The necessary changes will require a significant13 shift13 in resources13 fromsecondary13 care13 where unit costs13 are high to community13 carewhere people can generallybe treated at home
The future must13 therefore necessarily involve efficiencies in hospitals and in the way that13 people can be treated in less expensive locations ultimately in their own homes Hospitalswill use more sophisticated diagnostic tools including scanners of all types to non-shy‐invasivelyprobe inside peoplersquos bodies This will result13 in more day cases and hospital stays (alreadyaveraging under a week) to even shorter periods with on-shy‐going support13 provided inintermediate care settings that13 might13 include hotels care homes or the personrsquos own homeif it13 is clean safe secure and has all the necessary amenities (include access to theInternet)
Advances in medical technology will allow more treatments to be delivered in the homeThis will mean fewer visits by clinical staff and fewer opportunities to attend primary carecentres Pharmacists will become suppliers of information as well as drugs so the balanceof care will shift13 significantly away from doctors who will work in different13 ways relying13 increasingly on telemedicine to bring the specialist13 to the patient13 for an online consultation13 For example if a patient13 complains of nausea13 and severe headaches a virtual consultationcan be offered almost13 immediately and without13 having to send a patient13 with a potentiallyserious and acute condition on a potentially long journey to a hospital
In the above example a neurologist13 may ask further questions as well as conduct13 acomplete neurological examination using videoconferencing technology Airedale GeneralHospital consultants have new contracts that13 require them all to be available for virtualconsultations The first13 benefit13 has been in reducing the need for prisoners at local jails tobe brought13 into AampE (which may need to be locked down depending on the circumstancesand the potential for violence of the individuals involved) potentially saving hundreds of
14
pounds in security costs It also avoids the need for healthcare staff to have to go into aprison environment
The principles described above are already saving lives through telestroke services whichlead to more people being thrombolysed appropriately and avoiding long term support13 that13 often follows a stroke incident Teledermatology has been practised for a number of yearsand results in rapid diagnosis and resolution of problems that13 previously required significant13 time for remedy
212 Gadgets and13 DIY13 healthcare
There are at least13 three elements to healthcare
bull Gathering information on symptoms and physiological parametersbull Interpreting the information andbull Responding to the diagnosis with treatment
Many people choose to exercise self-shy‐care because this gives them control whilst13 avoidingthe need to share their concerns and personal details with others A lsquodo It yourselfrsquoapproach might13 even be encouraged by the NHS as a viable way of using scare resources
Medical devices that monitor vital signs are mature and have been miniaturised so that13 they can be used in the home by individuals with little or no medical training Indeed bloodsugar monitors are being produced specifically for use outside the hospital and in such away that13 they can be used reliably by people with advice and training being provided onlinevia13 YouTube
Many medical monitoring devices do no more than produce a single measure which theuser may record or respond to Others link wirelessly to smart13 phones allowing data13 to bestored and entered into a personal health record where trending opportunities existingIndeed individuals can easily enter their data13 into an app running on their laptop tablet13 orsmart13 phone This trending information may be useful13 for self-shy‐care and could be passed onto a physician though the volume of data13 produced in this way and doubts about13 thequality of the data are likely to persuade GPs to discount13 data13 produced in this way
This gap in knowledge can be filled with advice information and diagnosis that13 can beobtained online using a lsquoDoctor Googlersquo approach The quality of such diagnosis may varysignificantly although there are many sources of information that13 are both supported andapproved by the NHS (and by similar sources in other countries) However with a data-shy‐richapproach and a choice of diagnosis people may be empowered to take a greater role inhealthcare
15
The final component13 for the DIY enthusiast13 is the treatment13 option Many people fear longterm use of medication produced by the big pharmaceutical industry and prefer morenatural remedies which are available over the counter More medical treatment13 devicesare available that13 stimulate blood flow and counter pain through the use of electrical andphysical stimulation
The evidence may be weak at present13 but13 might13 grow as more people use them and as theircost13 drops The13 impact13 of13 such technologies13 on vulnerable13 people13 is13 difficult13 to gauge
213 Telecare
Support13 provided at a distance to people in their own homes is known as telecare Thename implies remote monitoring and interaction and includes the monitoring of the homeenvironment13 and of the individual as well as the interaction of the individual with thisenvironment Definitions have become difficult13 due to some US medical devicemanufacturers introducing the term telehealth to describe medical telecare such as remotemeasurement13 and collection of vital signs data
In the UK telecare alarm services have matured quickly using the robust13 platform andinfrastructure of social alarm systems which were originally used by tenants in shelteredhousing schemes to seek help when they didnrsquot13 own a telephone The majority of telecareservice users today live in their own homes and use dispersed alarm units to link with amonitoring centre through the telephone network Improved assessments of needs andrisks to independence have resulted in combinations of sensors being used to support13 theoption of staying put13 rather than moving into residential care or having increasing levels ofdomiciliary support They support13 the policy of bringing care closer to home and ofencouraging people to become partners in their long term support13 arrangements
Telecare services developments over the past13 decade include standalone items such asautomatic lights which have achieved significant13 efficiencies especially for people who arefrail and prone to falling and to those suffering from mild cognitive impairment epilepsyand anxiety People who have long term conditions including chronic conditions such asdiabetes and hypertension can also be managed more effectively through telecare supportThe benefits of telecare services include a relief of stress for family caregivers enablingthem to continue to provide unpaid support13 while holding down a job and maintaining theirquality of life
New developments enable continuous monitoring of behaviour and smart13 devices that13 canfor example remotely control the cooker the water supply and door entry Such13 monitoring may detect13 incidents early and prevent13 emergencies arising Devices arebecoming smaller and easier to embed quickly within the home environment making themmore acceptable and less noticeable Longer battery life means less frequent13 maintenancevisits
16
The13 monitoring13 centre13 becomes13 an information hub13 offering13 both advice13 and a vehicle13 for checking that someone is coping especially following a trigger event such as a stay inhospital or the illness13 of an informal13 carer
New systems utilise web technology that13 allows family members to be more proactive inthe monitoring of their relatives This can lead to greater interaction with them especiallywhen the relatives live a considerable distance away (perhaps in another country) Thesenext13 generation systems might13 include video conferencing and the use of tablets smart13 phones or smart13 TVs but13 when an emergency response is required (perhaps to lift13 someoneup after a non-shy‐injurious fall) there remains a need for human intervention
The13 future13 of13 telecare13 might therefore13 include13 an increasing13 dependence13 on volunteersfrom13 the13 community to provide13 the13 required support Social networking may need to beused13 to support13 telecare technologies
214 Mobile healthcare
While telecare can support13 people effectively in their own homes it13 is now recognised that13 being able to go out13 to enjoy open spaces and to overcome the fear that13 the home is aprison is an important13 part13 of improving well being and supporting a higher quality of lifeExtending telecare technologies to operate outside the home is known as mobile healthcare(or mCare) and is based on mobile telephone networks rather than landlines
The simplest13 form of mCare requires only a basic mobile phone to deliver telephone callsvoice13 messages and SMS (text13 messages) The technology is mature and there are countlessapplications in use both in the UK and in developing countries such as Africa13 and India13 where mobile telephones have already achieved a saturation level and where fixedtelephone infrastructures are not13 likely to be established at any time Such telephones areuniversally available in the UK and are used by the vast13 majority of people including manyolder people especially if they have been introduced to the low cost13 (pound30) devices that13 have large buttons large displays and a separate large button for calling an emergencynumber
Smart13 phones are rapidly replacing basic phones and allow the use of a large range of lsquoappsrsquothat13 are being developed to provide information and for enhanced experiences In thehealthcare space Skype FaceTime Vidyo and GoToMeeting with HD Faces are all current13 examples of video conferencing software available on tablets and smartphones
The specific software will depend on the nature of the communication desired
bull Skype will13 manage a simple video phone callbull Where an AampE physician needs to share a CT scan of head with a Neurologist13 on call
from home GoToMeeting would be more appropriate
17
bull If the physician would rather have a dedicated online meeting room that13 patientsand colleagues can simply drop in for a virtual meeting a Vidyo virtual room may bemore appropriate
This technology can suit13 any form of lifestyle including many people with complex needswhose lifestyle is not13 consistent13 with a fixed address
Social care apps are available already to deal with problems of sensory deficit
bull Guiding a blind person through GPS navigation and reading signs through appslinked to the devicersquos camera13
bull The microphone can be used as a hearing aidbull Speech recognition software can be used either to replay speech at a slower speed
or for translation into a language of choicebull Speech can also be selected for people who have a stammer or who have a problem
with their larynxbull Apps are becoming contextually aware recognising situations and locations and are
thus becoming a personal assistant13 for people with disabilities
By 2020 it is therefore possible that a smartphone may13 be prescribed13 for people who13 need13 social13 care13 together with13 a range of apps that have been13 selected13 to meet13 theirassessed13 needs
Whilst13 smart13 phones tablet13 devices and apps may become an important13 part13 of anindividualrsquos personal support13 armoury the potential of mCare will be limited only by anindividualrsquos ability to make use of all its functions Each device could become a part13 of anindividualrsquos personality supporting them to improve behaviour take exercise avoidtemptation and manage their own health and well-shy‐being Potentially mCare could becomethe most13 important13 element13 of social care and support13 within 10 years
215 Artificial Sensing and Enhancement Devices
bull It is estimated that13 one in seven people has imperfect13 hearingbull The numbers who are born deaf are quite small and many of these people may
have some form of hearing restored through surgery or through technologybull Similarly while there may be nearly a million people registered as blind or having a
severe visual impairment the vast13 majority lose their sight13 during their lives as aresult13 of disease
bull New treatments will deliver sight13 recovery or restoration over the course of the next13 10 to 20 years
Fortunately technology can provide excellent13 sensing capabilities that13 are already providingpeople with external portable devices for enhancing their lives The simple hearing aid is anexcellent13 example of a device which has been improved through both miniaturisation
18
personalisation and enhanced performance Today digital hearing aids use sub-shy‐miniaturemicrophones that13 can be unidirectional or omnidirectional and which can be adjusted insensitivity over an extended range Tomorrowrsquos devices can be switched between modesby the user so that13 they can benefit13 from hearing perfectly in any environment Indeedthey can be used with adaptive filtering technologies (as used by helicopter pilot13 headsets)to eliminate some sounds so that13 the rich speech (or music) components alone remainFuture developments will be on optimising control so that13 the user can switch seamlesslybetween different13 amplification applications without13 appearing to be distracted A smart13 phone or mp3 music player may be used as either a processing unit13 or as a ubiquitousoutput13 device that13 looks cool and natural
These same technologies will also be developed for use within the home environment13 fortimes when a deaf user isnrsquot13 present13 or is asleep Acoustic signatures associated withadverse events and incidents such as the hiss of a gas leak the crackle of a fire the sound ofa smoke detector the drip or a water leak or the sound of breaking glass can be directlyassociated with programmed actions Speech will be recognised interpreted translatedsimplified or displayed so that13 an individual knows what13 is said and can be provided withclear instructions on how to respond
Video cameras have become smaller and cheaper and capable of producing high definitionimages The problem of storing and editing these large image files is being solved by thearrival of cloud computing
Electronic noses are already capable of detecting the quality of wine and fresh fruit Similartechnology will be based in smart13 phones and will be able to analyse the air to warn of13 foodthat is no longer fresh and of other indicators of danger including gases that13 have13 little13 natural13 smell These13 devices13 could support13 people with13 cognitive impairment13 -shy‐ whose13 sense of smell13 tends13 to deteriorate -shy‐ to live independently
Many older and vulnerable people are at risk of hypothermia during the winter Sensordevices can provide warnings of low temperature In the same way heat13 stress can be adanger during the summer months so sensors can alert13 people of the need to openwindows or to operate a fanFinally people who have damaged13 their fingers13 or hands will be able to wear sensorsembedded in artificial skin or in gloves that13 will enable them to identify textures and shapesand be able to dress and undress without13 the assistance of carers
216 Robotics
We may recoil at the idea13 of personal care being delivered by robotic devices but13 it13 is likelythat13 within a decade personal assistants will exist13 to assist13 with household tasks These areunlikely to be humanoid and are more likely to be machines dedicated to helping frailpeople to support13 their own weight13 and to carry trays of food around the home
19
There are four broad classes of robot13 under development13 that13 are likely to mature within 10to 12 years
1 Miniature industrial robots that13 have been programmed to perform specific taskswith precision They are likely to be relatively heavy enabling them to bear weight13 but13 still have the necessary flexibility to carry an individual over short13 distancesplacing them in a chair or on a bed They will have sensors and cameras to provideimmediate feedback and to adjust13 rapidly in response to verbal commands or cues13 from the user Some designs may build on existing assistive devices such as abathroom hoist13 or a bathing aid to become intelligent13 extensions of productsalready on the market A stair lift13 with intelligence is already being designed by a UKcompany and is aimed at providing the user with more control of the journeybetween floors of a house
2 The second group of devices might13 be described as intelligent13 furniture Beds andchairs are already available that13 adjust13 to make the user more comfortable and also13 to help them get13 into or out13 of bed The control units are fairly cumbersome andare suited to operation by a carer Voice activated controls and built-shy‐in intelligencewill give the user more control and independence Other items of furniture to whichintelligence might13 be added would be tables whose height13 can adjust13 and whichhold items of food and medicine securely The table would recognise these objectsand could provide prompts or reminders
3 Mobile robots form the third group These could be goffers that13 can either fetchand carry items such as newspapers drinks or trays or which can accompany theuser when they move between rooms providing them with support13 or prompts Thistype of robot13 could be an intelligent13 walking frame with wheels which13 could13 doubleup as a smart13 wheelchair when necessary
4 Finally there are companion robots These might13 be in the form of an electronicpet typically a cat13 or a dog though the Japanese Paro robot13 is a seal Pets canrespond to stroking and being patted they can also remind their owners that13 theyneed to take exercise and to eat drink and take their medication Various designsare already available which provide feedback but13 future models would includecameras and a screen to provide a mobile means of information and interactionwith other people over the Internet Intelligence within the device could allow themto have a personality of their own and gain knowledge by scraping data13 fromwebsites so that13 they can generate speech and have conversations about13 the newsthe weather or sports results
217 Transport and transfer technologies
Walking is good exercise and is a no-shy‐cost13 form of transport13 that13 is encouraged because of itsimpact13 on well-shy‐being For an individual with a chronic disability or suffering from theeffects of an accident13 or an injury this becomes impractical without13 an assistive technology(AT) A walking stick is the simplest13 example of AT
20
Within the home the stair lift13 has enabled people who live in conventional properties that13 are on two or more floors to continue to use facilities on different13 floors when climbing thestairs has become too difficult This is often the case for people who have arthritis a lowerlimb amputation a long term condition such as Chronic Obstructive Pulmonary Disease orpeople approaching the end of life and who have chosen to die in their own homes
Designs have improved so that13 a curved staircase is no longer an issue and the reliabilityhas reached a level where breakdown is a rare occurrence13 Through-shy‐floor lifts have been analternative proposition but13 they remain too large for most13 properties Alternativeapproaches may emerge using air pressure or water pressure as the driving force ABrazilian design already utilises a plastic tube in which a pod is moved effortlessly up anddown
Electronic wheelchairs are now available that13 allow the individual to become moreindependent13 as they allow the user to control both propulsion and steering Some modelshave the capability of mounting a pavement13 or a step or even a flight13 of stairs Personalmuscle amplification devices have been developed originally with the intention of helpingpeople who are confined to a wheelchair due to a neurological disorder to perform sometasks from a standing position Indeed the Rex walkerrsquos manufacturers claim that13 anyonewho can propel themselves in a wheelchair could walk by using Rex
Other approaches have focused on the rehabilitation of people after major accidents that13 have caused partial paralysis They quickly extend into exoskeleton designs that13 enableanyone to gain a mechanical advantage and thus to tackle physical tasks that13 would not13 otherwise be possible These suits are the focus of major research projects across theworld Some13 products such as the system developed by Honda are being tested inAssisted Living facilities and are likely to become more and more enabling over the next13 decade
Similar benefits are also occurring outside the home with a number of novel carryingsystems appearing over the past13 few years They are generally termed lsquoscootersrsquo but13 thiscovers a wide range of systems and devices ranging from the Segway a device that13 is amobile platform on which the user stands and navigates through to conventional electricvehicles that13 have been developed from golf buggies There remain a number of issuesconcerning their use on roads or on pavements but13 similar problems will need to beresolved for bicycles to play their full part13 in enabling people to get13 more exercise13 Thepotential for hybrid scooters remains
218 Smart domestic appliances and personal hygiene
The bathroom is a dangerous place and one where many older and disabled people slip andsuffer a fall Many older people recall taking a bath in a tin tub in front13 of an open fireToday the options tend to be a level access shower (ie a type of wet13 room) for anyoneunable to get13 into a bath There are various aids to help people get13 into and out13 of thebath most13 involving a seat13 that13 can be raised or lower with some bath-shy‐tubs having a door
21
There has been some research into alternative methods of keeping the body clean Sanyointroduced a machine in 1970 modelled on a clothes or dish washing machines the personsits on a seat13 inside the machine where13 they are cleaned by a set13 of water jets These havenot13 proved popular and furthermore require the individual to be transported to themachine Thus the technology may find application in nursing homes but13 are unlikely to beattractive to people living independently in the community
The washing needs of people change over time Over the past13 20 years body piercingshave appeared which have demanded additional attention to avoid the problemsassociated with poor hygiene and metals Similarly hair may be permed and dyed usingchemicals which are much stronger and which might13 damage the hair Add to this thepainting of finger and toe nails and the washing needs are rather different13 to what13 theymight13 have been even ten years ago Finally tattoos were once popular only with sailorsToday they are likely to be found on the arms backs and legs of both men and womenNew ways of cleaning these tattoos will be needed especially if they become infected orare sites at which pressure sores develop
Even if a personrsquos body is clean if their clothes are dirty they may become socially isolatedBut13 the washing of clothes can be strenuous even if a launderette is used The need toconserve water has driven research into ultrasound techniques to beat13 the dirt13 out13 ofclothing while some companies are experimenting with polymer chips These13 ldquogreenrdquo13 technologies are quickly maturing and are likely to be standard in the next 10 years
Other smart13 household appliances are already appearing on the market13 and may soonbecome common13 in UK homes13
bull Robovac devices have sensors to enable them to detect13 dirt13 on carpets and to adjust13 their operation accordingly
bull Refrigerators can read bar codes or RFID tags to identify their contents and theirldquouse byrdquo13 dates enabling them to inform the owner that13 they should use theproducts before they are out13 of date They can be linked to the Internet13 to reorderitems as they are consumed or to suggest13 menu options for the individual based ontheir preferences or according to the diet13 required to manage a condition
bull Ovens will automatically switch off if they are left13 without13 attention for too longand drying machines will set13 times automatically
Devices may be linked so that13 they are more efficient and report13 maintenance issues sothat13 they can be repaired (perhaps remotely) before they suffer a catastrophic breakdown
219 Personal and home13 security
It might13 appear perverse but13 people with very little personal wealth and property are morelikely to be the victims of crime than those who have expensive items This may be due towhere poorer people tend to live or because people who have valuable assets take greater
22
steps to protect13 them There can be no doubt13 that13 crime has a very negative effect13 onindividuals and on their families creating a fear factor that13 may be difficult13 to remove Theimpact13 on quality of life is therefore very considerable especially if it13 forces people to stayat home behind locked doors effectively isolating themselves from society
Modern policing places increasing reliance on the use of closed circuit13 television (CCTV)Town centres are covered by cameras used increasingly in the fight13 against13 crime by bothdetecting anti-shy‐social incidents and identifying the people involved They are also used tomonitor the movement13 of cars that13 may be involved in incidents of burglary and violenceand are fast13 becoming the primary mechanism of law enforcement13 agencies to solve crime
CCTV has moved into the home to record movement but13 monitoring the footage is timeconsuming and often not13 practical Cameras are now available which provide an instant13 video feed to a smart13 phone when movement13 is detected These may have intercomcapability allowing someone to remotely speak to an intruder sometimes before they havegained access to a building This may serve as a deterrent13 and when fitted alongside simpledevices that13 switch lights on randomly around the home may force burglars to goelsewhere
As the price of cameras continues to fall the option of carrying a camera13 on the body that13 continuously monitors personal space is becoming more useful Using wireless networksthe data13 collected can be sent13 continuously to the cloud for safe storage It cansubsequently be retrieved to provide evidence (video and audio) of confrontations enablingsuccessful prosecutions to be made The smart13 phone itself is becoming a valuable itemthat13 is attractive to criminals These can be tethered to personal attack buttons usingwireless technology allowing the device to be activated by the pressing of a button if theowner is being attacked The phones can then be tracked and located by the police whilebeing rendered useless to the assailant
Bogus callers are a perennial problem for vulnerable people Video door bells can beconfigured to display images and record the words of visitors before they are admittedallowing remote monitoring centres to oversee the situations and use image recognitionsoftware to confirm the bona13 fide of visitors Such13 arrangements may become13 commonplace13 over13 the13 next five13 or13 six years13 significantly13 improving the safety of peopleliving independently
220 Personal safety
The biggest13 risks to personal safety stem from fires and falls Most13 fires are the result13 ofpoor cooking practices resulting in burns or scalds Floods and gas emissions are caused bya failure to remember to close taps
The current13 approach involves detection of an emergency situation as soon as possible but13 always after a problem has already occurred This responsive approach can minimise therisks provided that13 there is a protocol in place for intervening This could increasingly be an
23
automated response such as the switching off of the gas of water or the switching on of asprinkler system or a water mist13 system
In the future monitoring systems will be more sophisticated and will have sensors and localintelligence to identify activities In this way reminders can be issued before an emergencyoccurs13 This lsquosmart kitchenrsquo approach may become13 an integral part of13 homes of13 vulnerable13 people
A prototype system has been developed at the Culture Lab in Newcastle Sensors havebeen embedded into cooking utensils enabling the kitchen to identify what13 the person istrying to cook or prepare It can provide interventions as messages on an instructionscreen
Accidents also occur out13 of doors People with dementia13 might13 become lost13 and may havepoor road safety awareness Location devices based on GPS have advanced from large andheavy receivers that13 were used on ships and boats to small battery-shy‐operated devices that13 can be carried in the hand or in a handbag The current13 generation of locators has limitedbattery life and are rather too large to be secreted about13 a personrsquos clothing while devicesthat13 are integrated into a wrist-shy‐watch are rather clunky and unattractive
Within 10 years the13 technologies13 will have13 matured and will be13 much smaller13 so that theycan be embedded in shoes in walking sticks hats or any other item of clothing Powerrequirements will have reduced so that13 energy harvesting from the movements of theindividual will be sufficient13 to keep these products working for several weeks without13 theneed for recharging The devices will not13 simply indicate to others where the individualhappens to be but13 will provide subtle guidance cues to direct13 them home
Cameras might13 also form part13 of the personal security systems that13 will protect13 people fromaccidents Data13 may be sent13 to the cloud and analysed in real time if the person is in adangerous location and can provide prompts either to the individual or broadcast13 advice toothers to clear the danger These systems may be embedded in items of clothing (such as ahat) or they may be attached to spectacles
221 Energy and13 portable power supplies
The demands of developing economies for more power will inevitably lead to higherdomestic fuel charges in the UK especially as oil and gas reserves dwindle
By 2018 UK homes should be fitted with new smart13 meters The specifications for these13 devices have yet13 to be finalised but13 will include a means of identifying wasteful use ofenergy including TV sets that13 are left13 on and unattended fridges and freezers that13 are set13 attoo low temperatures and dryers that13 are used for too long or when the weather is suitablefor using a washing line They could be an enabling factor that13 supports changes inbehaviour driven by a need to use less power but13 it13 is unlikely that13 they will offer a bigreduction in costs that13 are already a problem for many vulnerable families
24
More generally the need for power conservation will include devices that13 are moreefficient and a significant13 emphasis on heat13 retention in buildings through betterinsulation
The energy crisis may force many people to spend more time in community settingsincluding shops and public buildings where they can benefit13 from the warmth Increasingreliance on mobile communication devices will lead to increasing demand for batterycharging facilities
Greater use may be made of portable devices for generating power based on solar cellswind or hand motion
222 Smart cities and homes
The Digital City initiatives have been based on information and how it13 can be used most13 effectively to make people aware of what13 is going on around them This means bettercoordination of resources more rapid access to advice and a battery of sensors measuringevery conceivable parameter from sound and light13 levels through to air quality andtemperature fluctuations There are several Digital or Smart13 City initiatives currently beingimplemented both in the UK and across the world They may significantly impact13 the livesof the millions of people living in them but13 the timeframe for outcome benefits to influenceplanning and design elsewhere is likely to be at least13 20 years and therefore outside thetimeframe of the current13 project
Housing plays a big role in the lives of most13 people both through their aspirations to moveup in the world (usually to a bigger property with a garden) and as the heart13 of the familylife which is associated with good quality of life UK properties have a life span approaching100 years which is about13 double that13 of their European counterparts (and certainly longerthan the wooden-shy‐frame buildings built13 in North America13 for example) A shortage ofhouses has plagued improvements in social welfare for the past13 30 years There is anargument13 that13 there are enough houses but13 the wrong size and in the wrong places andthis has some basis in fact13 as demography changes lead to more people (and more olderpeople) living alone However if there are two million homes in Scotland each with alifespan of 100 years then the renewal rate needs only to be 20000 per annum to maintainthe status quo However it13 must13 be clear that13 the impact13 of smart13 house development13 willbe small The focus should therefore be on adapting existing properties to render themmore appropriate for vulnerable people
Housing adaptations are a branch of assistive technologies The technologies for providingdifferent13 forms of accessible bath and level access shower are well-shy‐established with littleresearch considering anything other than alternative building materials and methods formaintaining the temperature of the bathwater Different13 technologies for bathing will beconsidered separately
25
Thus housing technologies are not likely to impact on social work13 within the next 20years13 though13 the use of information13 technology13 to ensure that people are aware of what13 is available is likely to be commonplace well before then
26
3 BEHAVIOUR AND ATTITUDE CHANGES DUE TO TECHNOLOGICALADVANCES
Technology is only one factor that13 will affect13 the way society changes in the next13 10 or 15years This chapter will consider the context13 in which the technological developmentsoutlined in the previous chapter will be supported (or held back) by societal factors
When the impact13 of such factors has been considered we can then apply theseassumptions to a number of case studies listed in Appendix13 A13
The headings selected for this chapter are not13 arbitrary as they reflect13 the context13 in whichtechnological changes must13 be considered They must13 include consideration of factors suchas demography and long-shy‐term conditions already addressed in the introduction to thesepapers together with the aspects of workforce and citizenship considered in the parallelpapers The additional elements here focus on trends that13 are already occurring and whichmay leave people struggling with the changes that13 occur
Finally there is a need to consider the attitudes of people to technology generally andespecially to the issues of privacy and social responsibility that13 could be radically changedby technology In some cases public opinion will prevent13 some forms of technology beingdeveloped if not13 commercialised In other cases some technologies will be fast-shy‐trackedeither at the request13 of government13 or because of a clear public demand for theopportunities that13 it13 can bring
Predictions13 about the13 future13 must inevitably be13 subject to considerable13 uncertainty butthat is no reason to stop thinking what might happen
31 The Welfare State
The UK can be rightly proud of the way that13 its welfare state has developed during the past13 100 years to provide a safety net13 of financial support13 to people and to their families whenthey are unemployed destitute homeless or challenged by crises and emergencies Therange of benefits received is considerable some are complex and many people struggle tounderstand their entitlements Some are universal some are discretionary some apply onlyto parents others to anyone
The total cost13 of providing these benefits continues to rise and when the economy isstagnating there is inevitably both political pressure often supported by popular publicopinion to introduce welfare reform so that13 people who do not13 work cannot13 be better offthan they would be if they were in full-shy‐time employment This strategy requires a universalbenefit13 to be introduced so that13 it13 is easier for claimants to access support13 but13 also easierfor agencies to identify the total benefits received The idea13 of a benefits cap then becomes
27
more practical to introduce especially if all the processes involved in making a claim arehandled electronically Indeed this encourages government13 to insist13 on applications forbenefits to be made on-shy‐line Unfortunately this will marginalise those people who haveneither a computer nor access to the internet thus emphasising the digital divide in amanner which works against13 some of the most13 disadvantaged people in society
There are currently few tangible links between digital technology and welfare provisionThe most13 obvious are universal benefits such as a free television licence (worth pound14550)13 for13 everyone aged 75 or older with blind and visually impaired people entitled to a 50discount13 irrespective of their age The significance of this position is that13 6 of revenuesgenerated through licence fees are to fund BBC on-shy‐line services13 such13 as websites and i-shy‐player In Scotland the BBCrsquos Alba Gaelic language television service is predominantlyfunded13 by MG Alba an organisation funded by the Scottish Government It is thereforeconceivable that13 in the future licence fees may be used to directly subsidise access toinformation and advice through the Internet13 for vulnerable people whether it13 is throughbroadband access or through a set-shy‐top box which removes the need for a computer in thehome to access particular websites or to use e-shy‐mail services
A second age-shy‐related benefit13 available in the UK is the winter fuel subsidy People whoreceive certain benefits receive the payments automatically while others must13 make aclaim Those who are not13 eligible for benefit13 due to a lack of an address for example missout13 on these payments and also on Cold Weather payments of pound25 for each seven dayperiod of very cold weather between 1 November and 31 March
The development13 of new warm home initiatives plus the complex of subsidies that13 theelectricity supply industry and government13 offer to people with solar cells further changesthe economic arguments Global warming may lead to greater variations in weatherextremes but13 might13 also increase the amount13 of electricity that13 can be generated byalternative (green) sources such as wind and solar cells It is estimated that13 energyconsumption in the UK increased by 17 between Christmas and Easter 2013 compared toprevious years as a result13 of cold weather but13 the above subsidy scheme did not13 benefit13 older people because two of the seven day cold periods were after 31st March It must13 beassumed that13 there will be more people living in fuel poverty in the future and this will leadto more cases of cold related illness including influenza13 and stroke
32 Management of long term conditions
The management13 of long term conditions will be improved for patients who are compliant13 with their medication regime so it13 is possible that13 there may be compulsion to adhere tothe prescription Such compulsion may be monitored using technology Indeed the remotemonitoring of vital signs using telehealthcare will become commonplace as the old boxesand sensors are replaced by devices that13 can be worn continuously or which can beembedded into the fabric of homes (including furniture and bedding) or can be worn asvests or patches They will wirelessly transmit13 data13 to smartphones or tablets and mobile
28
transmission and cloud technology will enable real-shy‐time data13 collection analysis andfeedback
One of the diseases which is projected to increase most13 significantly over the comingdecade is Type 2 diabetes Whilst13 there is a hereditary susceptibility to this condition formany people including those from the Middle East13 and the Asian sub-shy‐continent it13 is also adisease which tends to affect13 those people who are overweight13 andor have a sedentarylifestyle If untreated diabetes can lead to dizziness and collapse at any time but13 can alsohave more devastating long term consequences which include kidney failure strokeblindness and in extreme cases lower limb amputations Management13 therefore includesdaily monitoring of blood glucose levels and major dietary changes such as a significant13 reduction in the consumption of carbohydrates as well as a rigid exercise regime
Many newly diagnosed diabetics follow this advice closely and can lead normal lives for 40years or more but13 some struggle to accept13 the change in lifestyle required as well asremembering which foods are allowed and how much exercise they need to takeIndividual support13 plans are now forthcoming and over the next13 ten years best13 practicewill emerge in the form of smartphone apps that13 are personalised and which can becomean individualrsquos health coach This level of support13 will be fine for some people but13 otherswill need incentives so it13 is likely that13 gaming technologies will be introduced perhapsoffering rewards for good compliance There will be a temptation for some people tocheat perhaps allowing others to perform exercise for them or changing theirconsumption details
Many of these opportunities for cheating will be removed through the use of a uniquebiometric identifier a technology that13 will be mature enough to use in place of passwordson smartphones However the biggest13 challenge may be in encouraging older people to usethe technology Many older people have multiple morbidities Indeed a survey of Scottishpatients implied that13 42 of people aged over 80 will suffer from three long termconditions It will be essential for those people to comply with treatment13 regimes if they arenot13 to have the functional deficits that13 follow
33 Finding people who13 donrsquot fit
People who have low social capital are likely to have few relatives and friends with whomthey regularly communicate and are also unlikely to be part13 of community or faithorganisations such as clubs societies and church groups They also die several yearsyounger than most13 of the population often because they donrsquot13 engage with public healthinitiatives such as vaccinations against13 flu regular checks on their blood pressure bloodsugar levels or in the case of women smear tests or mammography The most13 likelyreason for disappearing beneath the radar of such initiatives is their mobility which leadsalmost13 inevitably to them having no fixed abode and no fixed telephone line It thenbecomes very difficult13 for them to be contacted because their mobile telephones are likelyto have Pay-shy‐As-shy‐You-shy‐Go contracts that13 donrsquot13 require validated names addresses and bankaccounts
29
It follows that13 some of the most13 vulnerable people in society including those who live onthe streets are effectively unknown to both the NHS and to social work departments untilthey are referred in a crisis This could be an emergency presentation to a hospital Accident13 and Emergency Department13 where they will come into contact13 with a social worker becausedischarge may be unsafe This often highlights the importance of the prevention agenda13 and the potential for avoiding admissions to hospital by intervening at an earlier stage
The advantages of being able to locate people who are vulnerable to specific diseases willincrease as genetic testing becomes more routine It is already possible to determine whomight13 be most13 at risk of breast13 cancer and prostate cancer as a result13 of family history Addto this the evidence that13 particular diet13 and exposure to environmental factors can furtherincrease risk then it13 is evident13 that13 individuals can be identified and offered treatmentsthat13 could save their lives many years before they become ill In the case of cancersperhaps only the individual is involved but13 for infectious diseases it13 is the whole of societythat13 is at risk if someone contracts one of the new strains of influenza or if someonechooses not13 to be vaccinated against13 rubella In Chinese airports all visitors are screenedfor fever and refused entry if they tested positive in cities the public are monitored in thesame way Similar approaches may be necessary in the UK if potential carriers cannot13 otherwise be identified
34 Volunteering
It is estimated that13 72 per cent13 of people volunteered to perform a charitable act13 at least13 once during 2012 a rise from 65 per cent13 the previous year About13 four out13 of every 10volunteers offer their services formally to one or more organisations The remaindervolunteer informally by helping out13 a friend or a neighbour Around 50 per cent13 volunteered at least13 once a month in the past13 year up from 41 per cent13 on the previous13 year Most13 have retired many of them before the statutory retirement13 age Those whodonrsquot13 feel able to offer time have offered their financial support13 at a time when the fundingavailable from sources such as the National Lottery has been decreasing Despite economicausterity donations to charities have been increasing 74 per cent13 said they had given tocharity at least13 once in the previous month up from 72 per cent13 the previous year
Strikingly 78 per cent13 of people strongly believe that13 they are part13 of their localneighbourhood an increase from 70 per cent13 10 years previously Community cohesion isstronger than ever 87 per cent13 of people believe their local area13 is a place where peoplefrom different13 backgrounds get13 on well together compared to 80 per cent13 in 2003
The role of volunteers in supporting vulnerable people is therefore likely to increase overthe next13 decade perhaps exploiting the success of the army of volunteers that13 was highlysuccessful in London during the Olympic and Paralympic games The greatest13 role for suchvolunteers may be in providing informal care for older people Already the UK has someseven million informal carers whose value in monetary terms has been calculated to be
30
more than the combined budgets of the NHS and social care Maintaining or extending thisprovision will help to support13 services in the future and may be supported by technology
Whilst13 there is ample evidence to suggest13 that13 telecare services support13 informal carers asmuch as (if not13 more than) the people that13 they are caring for it13 is the potential for utilisingthe internet13 and apps to make their role easier to coordinate and hence more effectivethat13 is likely to be most13 successful moving forward
Many of these focus on particular tasks that13 informal carers can help offer to older peoplesuch as organising their medication A pillbox program is just13 one feature of an app calledBalance It also includes sections for caregiving tips notes for the doctor and the patientsappointments plus a lsquolearning sectionrsquo with articles on aspects of Alzheimers and an RSSfeed for news about13 the disease Tyze is another multi-shy‐functional app it13 allows carers to
bull Organise appointmentsbull Plan outingsbull Share storiesbull Send updates to other family members
Another application is Rally Round which helps carers to organise someone to perform littlejobs often on a temporary basis when someone has dementia physical frailty or isrecovering from accident13 or illness Similar applications are MeMaxi and Finerday
35 The High13 Street
The shape and appearance of UK shopping centres have been changing for half a centuryPeople complain that13 centres are losing their identity with one town looking like everyother both in terms of the stores and in terms of the layout But13 there are three trendswhich are having a profound impact13 on many of the most13 vulnerable people in society
bull Centres lock their doors at 6pm or in some cases 10pm -shy‐ thus denying people whosuffer from claustrophobia13 from window shopping at times when other shoppershave left
bull Out13 of town shopping malls -shy‐ these US style centres are ideal for people in carsbecause they offer free parking which is essential for people who want13 to buy largeritems but13 difficult13 for people who have no transport13 and who must13 rely on publictransport13 that13 is often deficient
bull The rise of online shopping -shy‐ which means that13 many potential shoppers only visit13 High Street13 stores to check the prices before returning home to make a purchaseonline
It is the third of these effects that13 has the greatest13 potential for changing the High Street13 forever and it13 is making life for traditional retailers increasingly difficult13 at a time when highrents are crippling stores large and small It is difficult13 to see how this trend is likely tochange because consolidation in banking and estate agencies is already forcing the closure
31
of other High Street13 players while additional pressures on pubs has led to the closure ofthousands of pubs every year
Those figures however demonstrate that13 consumers still value what13 the high street13 canoffer -shy‐ the chance to inspect13 what13 theyrsquore thinking of buying -shy‐ as well as the new opennessof the internet Customer service makes a difference to people especially if there is aproblem and goods need to be returned One of the most13 common reasons for furniture tobe returned for example is that13 when a sofa13 or a wardrobe was delivered it13 couldnrsquot13 fit13 through the front13 door or up the stairs In the future people will be able to benefit from13 visualisation technology they will upload the floor plans of their homes enabling theretailer to inform them of the problem before they try to delivery Augmented reality viewwill similarly allow customers to see what13 a new item of furniture will look like in itsintended place so that13 they can be more informed about13 the effect13 of size and colour
In terms of improving the viability of the High Street stores will have to focus on theimportance of brand which could mean that13 individual independent13 retailers will have topartner with national suppliers to support13 a local tailored offering based on products that13 are designed for a more global market This is a lsquoconnected High Streetrsquo approach whichcould be enabled by the developments in internet13 availability and smart13 phone accessdescribed in the previous section
The overall effect13 of all these changes could mean that13 town centres become smaller but13 more vibrant13 areas They could thrive if people are attracted there in large numbers whichmeans that13 retail must13 be developed alongside restaurants pubs galleries and other leisureopportunities This is possible in new shopping centres which are already being integratedwith transport13 hubs including railway and bus stations but13 may be more of a design13 challenge for older towns and cities with large Victorian buildings To ensure that13 morepeople are welcomed into the new centres they should include attention to green spacesand areas where people can relax without13 feeling that13 they are second class citizensbecause they donrsquot13 have the same buying power
3513 Privacy
To some people privacy is their right13 to live their lives without13 interference they may seethe State as a potential lsquoBig Brotherrsquo spying on their every move and judging their actions13 and activities Other people have fewer concerns about13 the role of the State but13 great13 fearof individuals interfering with and invading their privacy Some embrace the concept13 of lsquomyspacersquo an area13 of a square metre or so into which nobody can enter without13 permissionThis allows them to avoid physical contact13 and to feel safe from any form of threateningbehaviour
Yet13 this idea13 of private space and its potential violation is merely the tip of the iceberg asfar as privacy is concerned more significant13 is the idea13 of personal (and private)information being shared with anyone and everyone This could be related to identityopinion or image for an individual who wants to remain anonymous or even secretive thisis going to become an increasing problem as technology provides the means of taking
32
photographs recording conversations and capturing environment13 with something as smalland ubiquitous as a mobile phone The fact13 that13 this information can then be shared withthe rest13 of the world using e-shy‐mail Twitter and Facebook makes the problem all the moredifficult So the threat13 is no longer solely from the long lenses of the Paparazzi but13 fromanyone (and that13 means everyone) who has even the most13 basic of mobile phones
This relates to the changing views of society on what13 information should remain privateand what13 should be shared with others The success of social media13 has been based on anattitude of lsquosharing everythingrsquo with either your friends or the world This has introduced anaiumlve idea13 in the minds of some younger people (especially those known as Millennials ieaged 18-shy‐30) that13 everyone can be their friends whilst13 perhaps failing to reinforce the bondsof genuine friendship with any form of test13 or restriction Technology could play a role indefining these friendships and allowing individuals to understand what13 makes a goodfriend but13 this approach has yet13 to be developed and may be slow to overcome the needfor some people to measure their own popularity simply as the number of people that13 theycan list13 as friends on their Facebook page
It follows that13 there may be a need for a new definition of privacy that13 is in keeping withthe web and its ability to display images and opinion in an unregulated manner This needsto embrace past13 concerns about13 the ability of an individual to live without13 the threat13 ofothers being able to watch them whilst13 offering some protection from random postingsabout13 them online Perhaps this could include a right13 to be able to edit13 or remove anythingrelating to themselves on the Web including images that13 are not13 news-shy‐worthy Theownership of image rights may be an associated issue that13 needs to be addressedespecially as modern technology can remove an individual from a group (or a background)13 view provide digital touch-shy‐up or air-shy‐brushing and then republish it13 in a different13 contextHowever there is general agreement13 that13 personal information (such as contact13 details andbank codes) should not13 have a place on the web Surprisingly few people take proactivemeasures to prevent13 tracking functions being activated
It follows that13 too much privacy could lead to younger people fearing that13 they maybecome lost13 in a digital world It is not13 surprising then that13 they are prepared to make lots13 of personal information available often with no fear of how it13 might13 be used by othersWhen Google glasses and similar technologies become available during the next13 few yearsthey will have the potential to identify a stranger walking down the street and to find manyof their secrets to present13 to the wearer in a fraction of a second They could know moreabout13 them than their genuine friends know -shy‐ so who will be their friends in the future
36 Data sharing and13 protection
By lsquodata13 sharingrsquo we mean the disclosure of data13 held by one organisation on an individualto a third party organisation(s) or the sharing of data13 between different13 parts of anorganisation Some data13 sharing doesnrsquot13 involve personal data13 because it13 has beenanonymised in such a way that13 the statistics can be used for the collective good without13 theidentification of the individual The Data13 Protection Act13 (DPA) is in place to provide a legal
33
framework that13 ensures that13 organisations that13 hold personal data13 must13 act13 responsibly atall times These principles adequately describe the position of public and government13 bodies especially social services departments who are responsible for the informationconcerning the health and well-shy‐being of individuals -shy‐ and hence by implication thesensitive data13 relating to their vulnerability
The legal framework that13 applies to private and third sector organisations differs from that13 which applies to public sector organisations which may only act13 within the defined limits oftheir statutory powers However all bodies must13 comply fully with the data13 protectionprinciples and this situation is unlikely to change within the next13 10 to 15 years In someprivate sector contexts there are legal constraints on the disclosure of personal dataHowever most13 private and third sector organisations have a general ability to shareinformation provided this does not13 breach the DPA or any other law It is advisable for acompany to check its constitutional documents such as its memorandum and articles13 ofassociation to make sure there are no restrictions that13 would prevent13 it13 from sharingpersonal data13 in a particular context The type of data13 held is therefore a subject13 ofconcern as it13 may be difficult13 for legislation to keep up with the additional layers of data13 created on-shy‐line and through the Internet13 of Things
Private and third sector organisations should have regard to any industry-shy‐specific regulationor guidance about13 handling individualsrsquo information as this may affect13 the organisationrsquosability to share information They should also be aware of the legal issues that13 can arisewhen sharing personal data13 with public sector bodies This becomes more of an issue asprivate and third sector bodies are carrying out13 a wider range of traditionally public sectorfunctions Opportunities for inappropriate sharing of sensitive data13 will therefore inevitablyincrease
Public authorities must13 comply with the Human Rights Act13 (HRA) legislation in theperformance of their functions The HRA also applies to organisations in the private sectorinsofar as they carry out13 functions of a public nature which could include delivering a socialcare activity Where the HRA applies organisations must13 not13 act13 in a way that13 would beincompatible with rights under the European Convention on Human Rights Article 8 of theConvention giving everyone the right13 to respect13 for their private and family life their homeand their correspondence is especially relevant13 to sharing personal data If personal data13 isdisclosed or shared in ways that13 comply with the DPA the sharing or disclosure of that13 information is also likely to comply with the HRA The problem may still be in policing theActs and the rights of an individual if they believe that13 their personal data13 has been sharedor accessed by an inappropriate organisation or individual
A legal industry may be born to deal with such matters but13 this is unlikely to benefit13 peoplewho cannot13 afford the fees involved They would require either legal aid or to employ13 more13 lsquono win no feersquo companies Public attitudes to such costs might13 become negative unlessthey prove successful in preventing breaches of data13 security There may need to belegislation to provide a stronger basis for forcing compliance with privacy laws
34
37 Connecting with13 people
We are social creatures most13 of us rely on our friendships and interactions with friendsand families to share our happiest13 moments and experiences Research suggests that13 thishappiness is infectious at all levels and leads to a 15 increase in the happiness of a closecontact 10 for a second degree contact13 such as the friendrsquos spouse and a 6 increase fora friend of a friend It is hardly surprising that13 the success of social media13 such as Facebookis intimately related to the ability of people to quickly share their happiest13 moments with asmany of their friends and connections as possible
All this has happened during the rise of the Internet13 and the corresponding increase inopportunities for connecting online ie this is a 21st Century phenomenon which has beenfacilitated by Information and Communications Technology But13 the Internet13 remains in itsinfancy and we are only beginning to understand and exploit13 its potential In terms ofaccessing the Internet there are now perhaps two billion people who have access with99 of them having gained this during the past13 decade This number will have doubled bythe period 2020 to 2025 It is likely that13 everyone who wants to be connected in the UK willby then be connected Turning this on its head only those who donrsquot13 want13 to be online willnot13 be on the Internet13 within a decade Connecting with the unconnected will therefore bea case of identifying those people who donrsquot13 want13 to be found unfortunately these mayinclude many people who need the support13 of social care organisations It means that13 theywill be looking for support13 only when they are in crisis unless other ways of finding andormonitoring them are found
While the number of people connected via the Internet13 has exploded this might13 bedwarfed by the number of connected lsquothingsrsquo During 2009 the number of thingsconnected to the Internet13 surpassed the number of connected people at which point13 webegan to experience what13 this report13 has described as the lsquoInternet13 of Thingsrsquo Yet 99 ofall physical objects that13 could join this network are not13 yet13 connected but13 the number couldgrow by 25 every year for the next13 decade so that13 there could be 100 billion connectedobjects by 2025 some of which will be owned or used by everyone in the UK includingthose people who donrsquot13 want13 to be connected themselves We will then have an Internet13 of Everything which will be the smart13 connection of people data events and actions
With each new person object or data13 that13 comes online the connection possibilitiesbetween all these elements grows exponentially The rise of big data mobile networkingcloud storage and data13 mining technologies will all play a critical role in the Internet13 ofEverything The result13 will be new capabilities richer experiences and unprecedentedvalue for individuals businesses communities and countries everywhere The lsquonetworkeffectrsquo of the Internet13 of Everything will be a very powerful thing the true impact13 of whichwe wonrsquot13 fully understand for several years As it13 develops however those who are not13 connected will feel even more digitally and socially excluded There will be a need to reachout13 to vulnerable people unless the process of claiming requires proof of online identityand the payments to be received can only be redeemed using a chipped card or adownloaded app onto a smartphone This is of course the way that13 welfare arrangementsare already developing thus it13 might13 prove impossible to make a successful claim without13
35
already being connected to lsquothe systemrsquo either through an online presence or through theInternet13 of Things
38 Downloading everything
Sixty years ago information was discovered by reading books often in a library wherenotes had to be made because the books or journals couldnrsquot13 be removed Then in theearly 1960s the first13 office photocopying machines were introduced into the UK theyimmediately meant13 that13 pages or articles from books could be copied and taken away to beread and summarised later Within a few years photocopying became a replacement13 forreading as researchers became less adept13 at selecting a few sentences and every deskbecame a depository for reams of printed paper Paper became the means of recordingeverything from bank statements through to music
We now appreciate that13 printing everything is a waste of both the ink (or toner) used tocreate the black print13 and of paper which requires trees to be chopped down and pulpedbefore it13 can be pressed into thin sheets Saving paper is therefore seen as green and goodfor the planet Fortunately we no longer need to print13 everything because computermemory is unlimited thanks to the cloud and we can then view pages and articles onportable or fixed screens
The internet13 has everything and it13 is all available instantly for downloading providing thereis a device available to accept13 it and there is sufficient13 communication bandwidth toperform the transfer of data13 sufficiently quickly Thus we can record all text13 articles that13 are relevant13 to us including digital records of birth certificates qualifications and passportsand the need for original printed versions will decline But13 we can also do this forphotographs Most13 handheld computing devices include at least13 one camera so they cangenerate enormous number of pictures which can be kept13 for posterity without13 having toconsume inks and special papers to print13 them
But13 the materials that13 can be downloaded donrsquot13 stop at pictures software is available that13 can grab TV shows after they air and movies as soon as theyre released In the same wayit13 is possible to schedule music comic books video games and practically anything else asa download with minimal effort People will need enormous hard drives if they want13 theirown digital copies of these files so will more than likely make use of cloud storage that13 willbe available from many organisations The location of the servers may become sensitivedue to border restrictions as will the security of the data13 and the way that13 it13 is backed up sothat13 it13 is resilient13 to failures
It may be evident13 that13 application forms for all types of welfare payment13 will be availableonly for downloading so that once digitised they can be processed by computer andrecords sent13 to various servers for subsequent13 storage and processing Some people maywant13 to keep their data13 on them once it13 has been downloaded Pen drives can already holdseveral GB of data so it13 is likely that13 people will be able to carry their downloaded data13 withthem at all times irrespective of the size and complexities of the information
36
39 Health13 and13 well-shy‐being
The general health of the population is unlikely to deteriorate noticeably within 10 to 20years Indeed expectations of the population are that13 things must13 improve as surgicaltechniques mature and as pharmaceutical interventions become more personalised andpowerful However the rising demand for health services due to an ageing population andthe increasing cost13 of providing sophisticated therapies will make delivering a free anduniversal health service difficult13 without13 substantial increases in taxation This is unlikely tohappen in the UK even though spending on health services will be protected against13 thecuts facing other services
There will have to be changes in how the NHS works For twenty years hospitals have beenclosed and replaced by fewer new facilities so that13 the bed count13 is reduced This has led toa significant13 shift13 in resources to primary care and community care supporting shorter staysin hospital and speedier transfer back home for people after surgery or illness This hasbeen13 successful but13 there remain problems with demand for GP services especially out-shy‐of-shy‐hours and at weekends Indeed despite the introduction of NHS24 and similar help-shy‐linesthe demand for GP appointments continues to increase Delays are inevitable and this willincrease system failures with more unnecessary deaths and a failure for people to access adiagnosis that13 might13 lead to early interventions and ultimately lower delivery costs Over250 more patients are added to waiting lists every day
This will lead to a new model of primary care consistent13 with existing changes which haveseen surgeries move from High Street13 locations to medical centres close to bus routes andwith more parking for patients The process of making an appointment13 is changing from atelephone-shy‐based interview process dominated by a medically-shy‐unqualified receptionist13 to achoose and book approach using an online process linked to electronic patient13 records Thiswill give patients more convenience but13 will allow priority for those who have Internet13 access at the expensive of those who are digitally excluded Making the process of bookingan appointment13 quick and easy may also increase demand from people who do not13 need tobe seen as it13 will fail to identify those in greatest13 need
A greater use of telehealth and telecare technologies will be inevitable beginning with thefirst13 contact13 as an encounter using the telephone e-shy‐mail or video conferencing -shy‐ a visit13 tothe GP surgery should be a last13 resort and should involve a nurse consultation in the first13 instance This would be consistent13 with three quarters of appointments currently involvinga chronic disease or long term condition which relates to improved self-shy‐care The support13 ofthese patients at home should be prioritised through tele-shy‐ and web-shy‐based technologies andshould involve training and coaching through a network of nurse practitioners Home visitsshould generally be unnecessary through the use of these technologies but13 could besupplemented by satellite surgeries manned by nursing in community premises or inpharmacies nurseries and Internet13 cafes
The homes13 of people who13 need13 closer monitoring can then become part13 of virtual wardswith real or electronic visits by health professionals University Hospital Southampton NHSFoundation Trust13 already looks after patients who have undergone surgery such as a hip orknee13 replacements in virtual wards with high levels of satisfaction The Royal Free London
37
NHS Foundation Trust13 offers a similar service but13 plans to add the possibility of videoconsultations between patient13 and consultant
310 Attitudes to public health issues ndash obesity smoking alcohol abuse drugs
As self-shy‐care becomes the focus of the NHS the public will increasingly understand that13 thecosts and availability of services are being harmed by the poor health behaviour ofrelatively small numbers of people The link between public health initiatives today andhealthcare needs and costs in the future will become increasingly evident13 as a result13 of theway that13 information is presented Thus the overweight13 smoker who currently attractsconcern and pity when they are diagnosed with diabetes and COPD is increasingly beingseen as the victim of their own stupidity or lack of self-shy‐discipline If they continue to neglect13 medical advice and continue with an unhealthy lifestyle then the way that13 they receivetreatment13 and consume resources will become a matter for the entire population
Obesity is seen as due to a combination of poor diet13 and a sedentary lifestyle No longer isthe idea13 that13 people are lsquobig bonedrsquo acceptable Governments will respond initially byrequiring manufacturers and food processors to provide nutritional information onpackaging and on menus in restaurants But13 people can choose not13 to read the data13 and toneglect13 both the importance of food quality content13 and quantity This will increasepressure to introduce fat13 or sugar taxes and these are likely to be in force within a decade
Although the high taxes on tobacco products has forced some smokers to reduce theirconsumption or to give up altogether the impact13 has been reduced by the smuggling ofproducts from overseas and by the availability of duty-shy‐free cigarettes for people returningfrom foreign holidays and business meetings Further measures are planned to changepackaging and to include even more graphic images and warnings on cigarette packages tomake smokers aware of the effects of smoking on their health and well-shy‐being There is asyet little evidence of how successful this might13 be More effective has been the banning ofsmoking in public places including trains and aircraft Expensive medical interventions suchas heart13 transplants will be denied to individuals until they change their lifestyle behaviourSmokers might13 therefore be increasingly ostracised leading to a loss of esteem This mayhave a particular impact13 on people who already suffer from mental health problems whoare more likely to smoke
The overuse of alcohol is being recognised as a major factor in hospital admissions withNHS figures showing an increase of over 40 in such admissions over the past13 decadeLinked to this has been a 75 increase in prescriptions to treat13 alcohol dependency Fewpeople have sympathy for those who waste their limited income on booze If they havechildren or other dependents they will be the ones who suffer and who may need thesupport13 of social care
Drug users are already significant13 users of social services as their habit13 is likely to makethem unemployable They receive little sympathy from the general public because they areseen as criminals and people who waste public resources Levels of drug abuse have been
38
slowly increasing over the years but13 this trend is slowly being reversed Indeed the numberof people using drugs during the past13 year has fallen to its lowest13 level for nearly 20 years(below 9) with cannabis being most13 likely often following excessive drinking Aselectronic noses and other technologies can detect13 traces of drugs it13 seems likely that13 success in overcoming addiction can be measured objectively This may become a two-shy‐edged sword rewarding those who can turn around their lives but13 further marginalisingthose who canrsquot13 or wont13 accept13 the lsquocold turkeyrsquo
311 Attitudes to surveillance
Issues associated with privacy confidentiality and data13 security have been discussedpreviously in the context13 of information technology the World Wide Web and the ease ofcollecting recording recalling analysing and displaying data The monitoring of individualsand their methods of using this information can be regarded as surveillance As thequantities of data13 increase along with the number of devices that13 can be used to access itthe surveillance tools will also increase in their sophistication Indeed the Big Data13 approaches described in the previous section will enable the combination of structureddata13 (such as the information held in databases) to be married with unstructured data13 fromimages in such a way that13 it13 can be mined
Whilst13 the lsquodigital surveillancersquo methods described above may cause most13 concern topeople because of its impact13 on anonymity it13 is the collection and analysis of images that13 are the major concern to people as they contemplate the ways that13 lsquoBig Brotherrsquo maydevelop to restrict13 freedom Every major UK city and town centre has an array of CCTVcameras that13 continually record activities from every angle If it13 used to be true that13 nobody in London was more than 10 yards from a rat it13 is certainly the case today that13 nobody can be more than this distance from being in view of a surveillance camera Yetthey receive so much positive publicity from TV programmes where their footage is used todetect13 vehicles close to a crime scene or to monitor the movements of suspects that13 theyare now accepted by the public as a deterrent13 in the same way as lsquobobbies on the beatrsquowere seen 25 years ago There is therefore little public reaction to the expansion in the useof video surveillance except13 for the practical observation of how so many views can beinspected and recorded
Looking to the future the tumbling cost13 of video technology will surely lead to anotherincrease in the number of devices The aerial views taken from towers will besupplemented by more local views taken by devices that13 are embedded in the fabric ofbuildings or carried by individuals either on their person (for example on clothing orspectacles) or in the bags that13 they carry The time and date-shy‐stamped images as Big Datawill be recorded to lsquothe Cloudrsquo where it13 can be added to other data It can then be usedwhen an incident13 has occurred or to provide further detail of night-shy‐time activities
It follows that13 there will be no hiding place for people who simply want13 to disappear Theymay respond by wearing clothing (such as hoodies) that13 hide their faces or which make it13 difficult13 to distinguish gait13 or mannerisms from which they might13 be identified New forms
39
of clothing may be designed to make shapes more difficult13 to analyse and these might13 become the uniforms of a class of person who wants to live in a way that13 they donrsquot13 interact13 with officials from any ministry or local government13 department If they also obstruct13 services then they will be considered to be anarchists of some form sparking protests fromother sectors of society
31213 Attitudes to driving
Motor cars have been a feature of UK roads for over a century but13 it13 is only during the past13 50 years that13 they have become a resource that13 most13 families have had access to enablingthem to travel without13 the restrictions imposed by a limited railway network and non-shy‐integrated bus transport People who have had a car throughout13 their lives often see theircars as an important13 factor in enabling them to remain independent13 and to exercise choicesrelating to where they shop and where they spend their leisure time This extends to theirspouse and to friends and neighbours that13 they might13 take with them on their variousexpeditions
Unfortunately there are incidents involving older drivers who perhaps go down amotorway in the wrong direction who are taken ill at the wheel or who are involved in anaccident13 involving no other vehicles These are small in number but13 often lead to a reactionthat13 they shouldnrsquot13 be allowed to drive lsquoat13 their agersquo Age itself is not13 an indicator ofdriving quality but13 because old age also brings more chance of having limited long termconditions and other illnesses it13 is easy to make a link between driving ability and age Thelicensing system does require continued driving to be linked with medical advice andforbids people with poor eyesight epilepsy and other conditions to hold a licence in oldage
Yet13 statistically older drivers cause far fewer accidents than younger drivers The reasonsfor this may be complex and are likely to include the fact13 that13 they drive less often covershorter distances and donrsquot13 go out13 in the dark or in poor weather However it13 does not13 wholly explain why the UKrsquos drivers aged over 70 and who represent13 some 8 of all driversare involved in only 4 of accidents that13 cause injury This compares favourably with the15 of13 drivers aged between 17 and 29 who are involved in over a third of crashes that13 result13 in injury
By 2020 the number of drivers aged over 70 on UK roads is likely to increase to over 7million This will require a new national strategy perhaps involving support13 for olderdrivers further training raising awareness of issues and making more use of adaptivetechnologies to support13 the driver in avoiding collision or forgetting to check on the statusof their vehicle Poor eyesight13 could be enhanced by camera technologies rather thanforcing people off the road if they are unable to read a licence plate
The International Longevity Centre has found that13 one in four Britons thought13 driversshould be made to switch off the ignition for good somewhere between the ages of 70 and75 The numbers may decrease as the population ages and as cars become safer Forcing
40
older people off the road may be a natural consequence of providing free bus passes andsubsidised rail fares but13 the growth in the pavement13 scooter industry demonstrates that13 older people value their independence and will do almost13 anything to get13 out13 and aboutPerhaps legislation will result13 in more regulation of electric vehicles and where they cantravel
There can be no doubt13 that13 getting out13 will be associated with better quality of life andwell-shy‐being and this is likely to be supported in the future as evidence of improvedoutcomes emerges It is to be hoped that13 positive stories will be publicised so that13 publicattitudes arenrsquot13 hardened This may be supported by more in-shy‐car monitoring of drivers andthe linking of performance with on-shy‐line driving records and licences These could throughremotely monitored ignition systems prevent13 the use of motor vehicles by people without13 a licence or without13 insurance
313 Climate change
There is a general view that13 the emissions of carbon gases are contributing to globalwarming in a manner that13 will change the UK climate in such a way that13 the climate maybecome more Mediterranean However some scientists believe that13 manrsquos impact13 on theenvironment13 may be small compared with natural variations caused for example bycyclical changes in the sunrsquos energy output13 or by the effects of volcanoes and earthquakesRecent13 evidence has suggested that13 we are going through a phase of changing extremesand that13 this is more likely to cause storms periods of excessive rainfall and unusualseasonal trends with snow and frost13 in the spring and warmer winters Considerableuncertainty remains and it13 might13 be necessary to plan for a number of different13 scenariosand for the impact13 on vulnerable people
I Colder winters UK properties are poorly insulated resulting in excess mortalitiesduring cold spells due to an increased number of people suffering from stroke aswell as bronchitis and other pulmonary diseases The cost13 of heating continues toincrease putting more households into a state of fuel poverty Any further coolingduring the winter months will result13 in more people living in unhealthy coldconditions Winter fuel payments are likely to be restricted to the poorest13 peoplebut13 this might13 exclude people who live in larger properties that13 are more difficult13 toheat
II More storms excessive winds and rain can cause flooding at any time of the yearMany UK communities are built13 close to rivers and these can surge during heavyrainfall causing houses to be filled with water and furniture and carpets lostInsurance can be problematic for properties built13 on flood plains which can blight13 properties and prevent13 owners from being able to sell and move on High winds canrip off roofs causing injury and also causing families to be left13 homeless anddependent13 on social services
III Hot13 summers Europe suffered high temperatures during the summers of 2003 and2004 leading to heat13 stroke and hypothermia The UK has not13 previously sufferedfrom such problems but13 might13 be expected to experience days of extreme
41
temperature and humidity at times Older people may not13 be prepared for suchweather Street13 dwellers may be unable to find shade and supplies of drinkingwater
Irrespective of what13 combination of weather scenarios arise it13 must13 be concluded that13 any extremes will have a major negative impact13 on vulnerable people especially if theyare not13 prepared because they havenrsquot13 received the weather warnings and advice that13 can be broadcast13 using the TV radio and online services Once again the digitallyexcluded will suffer and will pay a high cost Society will continue to pick up the bill interms of demands on social care services unless preventive actions are taken in theform of connecting these people to each other and to formal services
42
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
s13 13
13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
n13 13
13 s13
r13 n13
e13 at13
e13 y13 e13 ld13
ly13
13 e13 t13 e13
s13 er13 e13
f13
rt13 13
13 13
13
r13 13
s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
e13 g13 13
e13
13 13 ial13
13
d13
13 d13 h13 r13
d13 13
s13 y13
e13
13
rd13 r13 e13
13
13
13
e13
e13
d13 13
13
13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
210 Health13 information
Health records in the form of written documents x-shy‐ray images and clinical observations arean important13 means of making all interventions efficient13 and safe Increasingly people havemany different13 conditions (comorbidities) and may be treated by several specialists Asthese physical records are moved inevitably some get13 lost estimates suggest13 that13 one inthree records is lsquolostrsquo at any one time
The best13 resource for information about13 a patient13 is his or her primary care record which isheld by the GP The UK was an early adopter of electronic primary care records and can beproud of the way that13 these have enabled population-shy‐based information to be collectedand analysed Scotland (and to a lesser extent13 Wales) has led the way in ensuring that13 allthese records are accessible through anonymised approaches that13 allow researchers toexamine trends and improve analysis of performance Fundamental to this has been theallocation of a unique identifier At13 the same time individuals can access these recordsboth to check for accuracy and to see what13 their doctor has said about13 them
This13 has13 the potential to make people more responsible for their own conditions andmight lead to better13 self-shy‐care13 and changes in behaviour13 that might reduce13 the13 incidence13 or severity13 of chronic conditions13 that are related13 to lifestyle
In the future we can expect13 the primary electronic health record to be linked with hospitaladministration systems picture archiving systems and other records held by hospitals sothat13 appropriate medical staff can have access to all relevant13 data
When the social care record is added to the mix then this will mean fewer but13 shorter andbetter assessments for social workers and for healthcare staff They will knowcircumstances and factors that13 could influence the choice of approaches This supports theidea13 of there being only one record consisting of several components all of which areaccessible by an appropriate professional at any time and in any place
The13 ambitions13 described above13 are not13 limited by technology most13 of the interoperabilityissues between rival commercial record systems have been resolved and databaseproviders are being compelled to support13 joint13 working The English NHS Mandate requiresTrusts to effectively replicate arrangements already in place in Scotland and in Wales andthis will go a long way towards achieving a genuinely paperless NHS well before 2020 Withnew biometric identification technologies individual records will be available to out-shy‐of-shy‐hours physicians and to those working in an AampE department13 irrespective of theconsciousness state of a patient
New telecare and telehealth technologies will produce significant13 more volumes of data13 which are currently held in different13 places and owned by different13 organisations rarely thepatient These data13 will also need to be shared but13 only in a manner that13 is acceptable toeveryone Patients may not13 want13 all their mental health information published in a formthat13 can be viewed by social workers GPs may not13 want13 to have access to all the data13 that13 might13 suggest13 that13 there is a domestic crisis to which they had neither the wish nor capacity
13
to respond Monitoring systems that13 support13 the lsquoquantified13 selfrsquo may also offer data13 that13 may or may not be added to the full recordThe future of health information might13 therefore be about13 providing individuals with themeans of producing relevant13 information storing it13 somewhere secure and then viewing it13 at a later time but13 in a format13 (or with advice) that13 is acceptable
See also httpmydexorg lsquoMydex gives individuals back control over their personal datarsquo
(see also Digital Scotland 2020 Achieving World-shy‐Class digital infrastructure a final report13 tothe Scottish Government13 httpwwwscotlandgovukPublications2013029054lsquoconnectivity by any device anywhere and anytimersquo)
211 The Future of Healthcare
The strains on our healthcare delivery system are becoming greater as they are in otherdeveloped countries as a result13 of an aging population rising expectations and unhealthylifestyles The necessary changes will require a significant13 shift13 in resources13 fromsecondary13 care13 where unit costs13 are high to community13 carewhere people can generallybe treated at home
The future must13 therefore necessarily involve efficiencies in hospitals and in the way that13 people can be treated in less expensive locations ultimately in their own homes Hospitalswill use more sophisticated diagnostic tools including scanners of all types to non-shy‐invasivelyprobe inside peoplersquos bodies This will result13 in more day cases and hospital stays (alreadyaveraging under a week) to even shorter periods with on-shy‐going support13 provided inintermediate care settings that13 might13 include hotels care homes or the personrsquos own homeif it13 is clean safe secure and has all the necessary amenities (include access to theInternet)
Advances in medical technology will allow more treatments to be delivered in the homeThis will mean fewer visits by clinical staff and fewer opportunities to attend primary carecentres Pharmacists will become suppliers of information as well as drugs so the balanceof care will shift13 significantly away from doctors who will work in different13 ways relying13 increasingly on telemedicine to bring the specialist13 to the patient13 for an online consultation13 For example if a patient13 complains of nausea13 and severe headaches a virtual consultationcan be offered almost13 immediately and without13 having to send a patient13 with a potentiallyserious and acute condition on a potentially long journey to a hospital
In the above example a neurologist13 may ask further questions as well as conduct13 acomplete neurological examination using videoconferencing technology Airedale GeneralHospital consultants have new contracts that13 require them all to be available for virtualconsultations The first13 benefit13 has been in reducing the need for prisoners at local jails tobe brought13 into AampE (which may need to be locked down depending on the circumstancesand the potential for violence of the individuals involved) potentially saving hundreds of
14
pounds in security costs It also avoids the need for healthcare staff to have to go into aprison environment
The principles described above are already saving lives through telestroke services whichlead to more people being thrombolysed appropriately and avoiding long term support13 that13 often follows a stroke incident Teledermatology has been practised for a number of yearsand results in rapid diagnosis and resolution of problems that13 previously required significant13 time for remedy
212 Gadgets and13 DIY13 healthcare
There are at least13 three elements to healthcare
bull Gathering information on symptoms and physiological parametersbull Interpreting the information andbull Responding to the diagnosis with treatment
Many people choose to exercise self-shy‐care because this gives them control whilst13 avoidingthe need to share their concerns and personal details with others A lsquodo It yourselfrsquoapproach might13 even be encouraged by the NHS as a viable way of using scare resources
Medical devices that monitor vital signs are mature and have been miniaturised so that13 they can be used in the home by individuals with little or no medical training Indeed bloodsugar monitors are being produced specifically for use outside the hospital and in such away that13 they can be used reliably by people with advice and training being provided onlinevia13 YouTube
Many medical monitoring devices do no more than produce a single measure which theuser may record or respond to Others link wirelessly to smart13 phones allowing data13 to bestored and entered into a personal health record where trending opportunities existingIndeed individuals can easily enter their data13 into an app running on their laptop tablet13 orsmart13 phone This trending information may be useful13 for self-shy‐care and could be passed onto a physician though the volume of data13 produced in this way and doubts about13 thequality of the data are likely to persuade GPs to discount13 data13 produced in this way
This gap in knowledge can be filled with advice information and diagnosis that13 can beobtained online using a lsquoDoctor Googlersquo approach The quality of such diagnosis may varysignificantly although there are many sources of information that13 are both supported andapproved by the NHS (and by similar sources in other countries) However with a data-shy‐richapproach and a choice of diagnosis people may be empowered to take a greater role inhealthcare
15
The final component13 for the DIY enthusiast13 is the treatment13 option Many people fear longterm use of medication produced by the big pharmaceutical industry and prefer morenatural remedies which are available over the counter More medical treatment13 devicesare available that13 stimulate blood flow and counter pain through the use of electrical andphysical stimulation
The evidence may be weak at present13 but13 might13 grow as more people use them and as theircost13 drops The13 impact13 of13 such technologies13 on vulnerable13 people13 is13 difficult13 to gauge
213 Telecare
Support13 provided at a distance to people in their own homes is known as telecare Thename implies remote monitoring and interaction and includes the monitoring of the homeenvironment13 and of the individual as well as the interaction of the individual with thisenvironment Definitions have become difficult13 due to some US medical devicemanufacturers introducing the term telehealth to describe medical telecare such as remotemeasurement13 and collection of vital signs data
In the UK telecare alarm services have matured quickly using the robust13 platform andinfrastructure of social alarm systems which were originally used by tenants in shelteredhousing schemes to seek help when they didnrsquot13 own a telephone The majority of telecareservice users today live in their own homes and use dispersed alarm units to link with amonitoring centre through the telephone network Improved assessments of needs andrisks to independence have resulted in combinations of sensors being used to support13 theoption of staying put13 rather than moving into residential care or having increasing levels ofdomiciliary support They support13 the policy of bringing care closer to home and ofencouraging people to become partners in their long term support13 arrangements
Telecare services developments over the past13 decade include standalone items such asautomatic lights which have achieved significant13 efficiencies especially for people who arefrail and prone to falling and to those suffering from mild cognitive impairment epilepsyand anxiety People who have long term conditions including chronic conditions such asdiabetes and hypertension can also be managed more effectively through telecare supportThe benefits of telecare services include a relief of stress for family caregivers enablingthem to continue to provide unpaid support13 while holding down a job and maintaining theirquality of life
New developments enable continuous monitoring of behaviour and smart13 devices that13 canfor example remotely control the cooker the water supply and door entry Such13 monitoring may detect13 incidents early and prevent13 emergencies arising Devices arebecoming smaller and easier to embed quickly within the home environment making themmore acceptable and less noticeable Longer battery life means less frequent13 maintenancevisits
16
The13 monitoring13 centre13 becomes13 an information hub13 offering13 both advice13 and a vehicle13 for checking that someone is coping especially following a trigger event such as a stay inhospital or the illness13 of an informal13 carer
New systems utilise web technology that13 allows family members to be more proactive inthe monitoring of their relatives This can lead to greater interaction with them especiallywhen the relatives live a considerable distance away (perhaps in another country) Thesenext13 generation systems might13 include video conferencing and the use of tablets smart13 phones or smart13 TVs but13 when an emergency response is required (perhaps to lift13 someoneup after a non-shy‐injurious fall) there remains a need for human intervention
The13 future13 of13 telecare13 might therefore13 include13 an increasing13 dependence13 on volunteersfrom13 the13 community to provide13 the13 required support Social networking may need to beused13 to support13 telecare technologies
214 Mobile healthcare
While telecare can support13 people effectively in their own homes it13 is now recognised that13 being able to go out13 to enjoy open spaces and to overcome the fear that13 the home is aprison is an important13 part13 of improving well being and supporting a higher quality of lifeExtending telecare technologies to operate outside the home is known as mobile healthcare(or mCare) and is based on mobile telephone networks rather than landlines
The simplest13 form of mCare requires only a basic mobile phone to deliver telephone callsvoice13 messages and SMS (text13 messages) The technology is mature and there are countlessapplications in use both in the UK and in developing countries such as Africa13 and India13 where mobile telephones have already achieved a saturation level and where fixedtelephone infrastructures are not13 likely to be established at any time Such telephones areuniversally available in the UK and are used by the vast13 majority of people including manyolder people especially if they have been introduced to the low cost13 (pound30) devices that13 have large buttons large displays and a separate large button for calling an emergencynumber
Smart13 phones are rapidly replacing basic phones and allow the use of a large range of lsquoappsrsquothat13 are being developed to provide information and for enhanced experiences In thehealthcare space Skype FaceTime Vidyo and GoToMeeting with HD Faces are all current13 examples of video conferencing software available on tablets and smartphones
The specific software will depend on the nature of the communication desired
bull Skype will13 manage a simple video phone callbull Where an AampE physician needs to share a CT scan of head with a Neurologist13 on call
from home GoToMeeting would be more appropriate
17
bull If the physician would rather have a dedicated online meeting room that13 patientsand colleagues can simply drop in for a virtual meeting a Vidyo virtual room may bemore appropriate
This technology can suit13 any form of lifestyle including many people with complex needswhose lifestyle is not13 consistent13 with a fixed address
Social care apps are available already to deal with problems of sensory deficit
bull Guiding a blind person through GPS navigation and reading signs through appslinked to the devicersquos camera13
bull The microphone can be used as a hearing aidbull Speech recognition software can be used either to replay speech at a slower speed
or for translation into a language of choicebull Speech can also be selected for people who have a stammer or who have a problem
with their larynxbull Apps are becoming contextually aware recognising situations and locations and are
thus becoming a personal assistant13 for people with disabilities
By 2020 it is therefore possible that a smartphone may13 be prescribed13 for people who13 need13 social13 care13 together with13 a range of apps that have been13 selected13 to meet13 theirassessed13 needs
Whilst13 smart13 phones tablet13 devices and apps may become an important13 part13 of anindividualrsquos personal support13 armoury the potential of mCare will be limited only by anindividualrsquos ability to make use of all its functions Each device could become a part13 of anindividualrsquos personality supporting them to improve behaviour take exercise avoidtemptation and manage their own health and well-shy‐being Potentially mCare could becomethe most13 important13 element13 of social care and support13 within 10 years
215 Artificial Sensing and Enhancement Devices
bull It is estimated that13 one in seven people has imperfect13 hearingbull The numbers who are born deaf are quite small and many of these people may
have some form of hearing restored through surgery or through technologybull Similarly while there may be nearly a million people registered as blind or having a
severe visual impairment the vast13 majority lose their sight13 during their lives as aresult13 of disease
bull New treatments will deliver sight13 recovery or restoration over the course of the next13 10 to 20 years
Fortunately technology can provide excellent13 sensing capabilities that13 are already providingpeople with external portable devices for enhancing their lives The simple hearing aid is anexcellent13 example of a device which has been improved through both miniaturisation
18
personalisation and enhanced performance Today digital hearing aids use sub-shy‐miniaturemicrophones that13 can be unidirectional or omnidirectional and which can be adjusted insensitivity over an extended range Tomorrowrsquos devices can be switched between modesby the user so that13 they can benefit13 from hearing perfectly in any environment Indeedthey can be used with adaptive filtering technologies (as used by helicopter pilot13 headsets)to eliminate some sounds so that13 the rich speech (or music) components alone remainFuture developments will be on optimising control so that13 the user can switch seamlesslybetween different13 amplification applications without13 appearing to be distracted A smart13 phone or mp3 music player may be used as either a processing unit13 or as a ubiquitousoutput13 device that13 looks cool and natural
These same technologies will also be developed for use within the home environment13 fortimes when a deaf user isnrsquot13 present13 or is asleep Acoustic signatures associated withadverse events and incidents such as the hiss of a gas leak the crackle of a fire the sound ofa smoke detector the drip or a water leak or the sound of breaking glass can be directlyassociated with programmed actions Speech will be recognised interpreted translatedsimplified or displayed so that13 an individual knows what13 is said and can be provided withclear instructions on how to respond
Video cameras have become smaller and cheaper and capable of producing high definitionimages The problem of storing and editing these large image files is being solved by thearrival of cloud computing
Electronic noses are already capable of detecting the quality of wine and fresh fruit Similartechnology will be based in smart13 phones and will be able to analyse the air to warn of13 foodthat is no longer fresh and of other indicators of danger including gases that13 have13 little13 natural13 smell These13 devices13 could support13 people with13 cognitive impairment13 -shy‐ whose13 sense of smell13 tends13 to deteriorate -shy‐ to live independently
Many older and vulnerable people are at risk of hypothermia during the winter Sensordevices can provide warnings of low temperature In the same way heat13 stress can be adanger during the summer months so sensors can alert13 people of the need to openwindows or to operate a fanFinally people who have damaged13 their fingers13 or hands will be able to wear sensorsembedded in artificial skin or in gloves that13 will enable them to identify textures and shapesand be able to dress and undress without13 the assistance of carers
216 Robotics
We may recoil at the idea13 of personal care being delivered by robotic devices but13 it13 is likelythat13 within a decade personal assistants will exist13 to assist13 with household tasks These areunlikely to be humanoid and are more likely to be machines dedicated to helping frailpeople to support13 their own weight13 and to carry trays of food around the home
19
There are four broad classes of robot13 under development13 that13 are likely to mature within 10to 12 years
1 Miniature industrial robots that13 have been programmed to perform specific taskswith precision They are likely to be relatively heavy enabling them to bear weight13 but13 still have the necessary flexibility to carry an individual over short13 distancesplacing them in a chair or on a bed They will have sensors and cameras to provideimmediate feedback and to adjust13 rapidly in response to verbal commands or cues13 from the user Some designs may build on existing assistive devices such as abathroom hoist13 or a bathing aid to become intelligent13 extensions of productsalready on the market A stair lift13 with intelligence is already being designed by a UKcompany and is aimed at providing the user with more control of the journeybetween floors of a house
2 The second group of devices might13 be described as intelligent13 furniture Beds andchairs are already available that13 adjust13 to make the user more comfortable and also13 to help them get13 into or out13 of bed The control units are fairly cumbersome andare suited to operation by a carer Voice activated controls and built-shy‐in intelligencewill give the user more control and independence Other items of furniture to whichintelligence might13 be added would be tables whose height13 can adjust13 and whichhold items of food and medicine securely The table would recognise these objectsand could provide prompts or reminders
3 Mobile robots form the third group These could be goffers that13 can either fetchand carry items such as newspapers drinks or trays or which can accompany theuser when they move between rooms providing them with support13 or prompts Thistype of robot13 could be an intelligent13 walking frame with wheels which13 could13 doubleup as a smart13 wheelchair when necessary
4 Finally there are companion robots These might13 be in the form of an electronicpet typically a cat13 or a dog though the Japanese Paro robot13 is a seal Pets canrespond to stroking and being patted they can also remind their owners that13 theyneed to take exercise and to eat drink and take their medication Various designsare already available which provide feedback but13 future models would includecameras and a screen to provide a mobile means of information and interactionwith other people over the Internet Intelligence within the device could allow themto have a personality of their own and gain knowledge by scraping data13 fromwebsites so that13 they can generate speech and have conversations about13 the newsthe weather or sports results
217 Transport and transfer technologies
Walking is good exercise and is a no-shy‐cost13 form of transport13 that13 is encouraged because of itsimpact13 on well-shy‐being For an individual with a chronic disability or suffering from theeffects of an accident13 or an injury this becomes impractical without13 an assistive technology(AT) A walking stick is the simplest13 example of AT
20
Within the home the stair lift13 has enabled people who live in conventional properties that13 are on two or more floors to continue to use facilities on different13 floors when climbing thestairs has become too difficult This is often the case for people who have arthritis a lowerlimb amputation a long term condition such as Chronic Obstructive Pulmonary Disease orpeople approaching the end of life and who have chosen to die in their own homes
Designs have improved so that13 a curved staircase is no longer an issue and the reliabilityhas reached a level where breakdown is a rare occurrence13 Through-shy‐floor lifts have been analternative proposition but13 they remain too large for most13 properties Alternativeapproaches may emerge using air pressure or water pressure as the driving force ABrazilian design already utilises a plastic tube in which a pod is moved effortlessly up anddown
Electronic wheelchairs are now available that13 allow the individual to become moreindependent13 as they allow the user to control both propulsion and steering Some modelshave the capability of mounting a pavement13 or a step or even a flight13 of stairs Personalmuscle amplification devices have been developed originally with the intention of helpingpeople who are confined to a wheelchair due to a neurological disorder to perform sometasks from a standing position Indeed the Rex walkerrsquos manufacturers claim that13 anyonewho can propel themselves in a wheelchair could walk by using Rex
Other approaches have focused on the rehabilitation of people after major accidents that13 have caused partial paralysis They quickly extend into exoskeleton designs that13 enableanyone to gain a mechanical advantage and thus to tackle physical tasks that13 would not13 otherwise be possible These suits are the focus of major research projects across theworld Some13 products such as the system developed by Honda are being tested inAssisted Living facilities and are likely to become more and more enabling over the next13 decade
Similar benefits are also occurring outside the home with a number of novel carryingsystems appearing over the past13 few years They are generally termed lsquoscootersrsquo but13 thiscovers a wide range of systems and devices ranging from the Segway a device that13 is amobile platform on which the user stands and navigates through to conventional electricvehicles that13 have been developed from golf buggies There remain a number of issuesconcerning their use on roads or on pavements but13 similar problems will need to beresolved for bicycles to play their full part13 in enabling people to get13 more exercise13 Thepotential for hybrid scooters remains
218 Smart domestic appliances and personal hygiene
The bathroom is a dangerous place and one where many older and disabled people slip andsuffer a fall Many older people recall taking a bath in a tin tub in front13 of an open fireToday the options tend to be a level access shower (ie a type of wet13 room) for anyoneunable to get13 into a bath There are various aids to help people get13 into and out13 of thebath most13 involving a seat13 that13 can be raised or lower with some bath-shy‐tubs having a door
21
There has been some research into alternative methods of keeping the body clean Sanyointroduced a machine in 1970 modelled on a clothes or dish washing machines the personsits on a seat13 inside the machine where13 they are cleaned by a set13 of water jets These havenot13 proved popular and furthermore require the individual to be transported to themachine Thus the technology may find application in nursing homes but13 are unlikely to beattractive to people living independently in the community
The washing needs of people change over time Over the past13 20 years body piercingshave appeared which have demanded additional attention to avoid the problemsassociated with poor hygiene and metals Similarly hair may be permed and dyed usingchemicals which are much stronger and which might13 damage the hair Add to this thepainting of finger and toe nails and the washing needs are rather different13 to what13 theymight13 have been even ten years ago Finally tattoos were once popular only with sailorsToday they are likely to be found on the arms backs and legs of both men and womenNew ways of cleaning these tattoos will be needed especially if they become infected orare sites at which pressure sores develop
Even if a personrsquos body is clean if their clothes are dirty they may become socially isolatedBut13 the washing of clothes can be strenuous even if a launderette is used The need toconserve water has driven research into ultrasound techniques to beat13 the dirt13 out13 ofclothing while some companies are experimenting with polymer chips These13 ldquogreenrdquo13 technologies are quickly maturing and are likely to be standard in the next 10 years
Other smart13 household appliances are already appearing on the market13 and may soonbecome common13 in UK homes13
bull Robovac devices have sensors to enable them to detect13 dirt13 on carpets and to adjust13 their operation accordingly
bull Refrigerators can read bar codes or RFID tags to identify their contents and theirldquouse byrdquo13 dates enabling them to inform the owner that13 they should use theproducts before they are out13 of date They can be linked to the Internet13 to reorderitems as they are consumed or to suggest13 menu options for the individual based ontheir preferences or according to the diet13 required to manage a condition
bull Ovens will automatically switch off if they are left13 without13 attention for too longand drying machines will set13 times automatically
Devices may be linked so that13 they are more efficient and report13 maintenance issues sothat13 they can be repaired (perhaps remotely) before they suffer a catastrophic breakdown
219 Personal and home13 security
It might13 appear perverse but13 people with very little personal wealth and property are morelikely to be the victims of crime than those who have expensive items This may be due towhere poorer people tend to live or because people who have valuable assets take greater
22
steps to protect13 them There can be no doubt13 that13 crime has a very negative effect13 onindividuals and on their families creating a fear factor that13 may be difficult13 to remove Theimpact13 on quality of life is therefore very considerable especially if it13 forces people to stayat home behind locked doors effectively isolating themselves from society
Modern policing places increasing reliance on the use of closed circuit13 television (CCTV)Town centres are covered by cameras used increasingly in the fight13 against13 crime by bothdetecting anti-shy‐social incidents and identifying the people involved They are also used tomonitor the movement13 of cars that13 may be involved in incidents of burglary and violenceand are fast13 becoming the primary mechanism of law enforcement13 agencies to solve crime
CCTV has moved into the home to record movement but13 monitoring the footage is timeconsuming and often not13 practical Cameras are now available which provide an instant13 video feed to a smart13 phone when movement13 is detected These may have intercomcapability allowing someone to remotely speak to an intruder sometimes before they havegained access to a building This may serve as a deterrent13 and when fitted alongside simpledevices that13 switch lights on randomly around the home may force burglars to goelsewhere
As the price of cameras continues to fall the option of carrying a camera13 on the body that13 continuously monitors personal space is becoming more useful Using wireless networksthe data13 collected can be sent13 continuously to the cloud for safe storage It cansubsequently be retrieved to provide evidence (video and audio) of confrontations enablingsuccessful prosecutions to be made The smart13 phone itself is becoming a valuable itemthat13 is attractive to criminals These can be tethered to personal attack buttons usingwireless technology allowing the device to be activated by the pressing of a button if theowner is being attacked The phones can then be tracked and located by the police whilebeing rendered useless to the assailant
Bogus callers are a perennial problem for vulnerable people Video door bells can beconfigured to display images and record the words of visitors before they are admittedallowing remote monitoring centres to oversee the situations and use image recognitionsoftware to confirm the bona13 fide of visitors Such13 arrangements may become13 commonplace13 over13 the13 next five13 or13 six years13 significantly13 improving the safety of peopleliving independently
220 Personal safety
The biggest13 risks to personal safety stem from fires and falls Most13 fires are the result13 ofpoor cooking practices resulting in burns or scalds Floods and gas emissions are caused bya failure to remember to close taps
The current13 approach involves detection of an emergency situation as soon as possible but13 always after a problem has already occurred This responsive approach can minimise therisks provided that13 there is a protocol in place for intervening This could increasingly be an
23
automated response such as the switching off of the gas of water or the switching on of asprinkler system or a water mist13 system
In the future monitoring systems will be more sophisticated and will have sensors and localintelligence to identify activities In this way reminders can be issued before an emergencyoccurs13 This lsquosmart kitchenrsquo approach may become13 an integral part of13 homes of13 vulnerable13 people
A prototype system has been developed at the Culture Lab in Newcastle Sensors havebeen embedded into cooking utensils enabling the kitchen to identify what13 the person istrying to cook or prepare It can provide interventions as messages on an instructionscreen
Accidents also occur out13 of doors People with dementia13 might13 become lost13 and may havepoor road safety awareness Location devices based on GPS have advanced from large andheavy receivers that13 were used on ships and boats to small battery-shy‐operated devices that13 can be carried in the hand or in a handbag The current13 generation of locators has limitedbattery life and are rather too large to be secreted about13 a personrsquos clothing while devicesthat13 are integrated into a wrist-shy‐watch are rather clunky and unattractive
Within 10 years the13 technologies13 will have13 matured and will be13 much smaller13 so that theycan be embedded in shoes in walking sticks hats or any other item of clothing Powerrequirements will have reduced so that13 energy harvesting from the movements of theindividual will be sufficient13 to keep these products working for several weeks without13 theneed for recharging The devices will not13 simply indicate to others where the individualhappens to be but13 will provide subtle guidance cues to direct13 them home
Cameras might13 also form part13 of the personal security systems that13 will protect13 people fromaccidents Data13 may be sent13 to the cloud and analysed in real time if the person is in adangerous location and can provide prompts either to the individual or broadcast13 advice toothers to clear the danger These systems may be embedded in items of clothing (such as ahat) or they may be attached to spectacles
221 Energy and13 portable power supplies
The demands of developing economies for more power will inevitably lead to higherdomestic fuel charges in the UK especially as oil and gas reserves dwindle
By 2018 UK homes should be fitted with new smart13 meters The specifications for these13 devices have yet13 to be finalised but13 will include a means of identifying wasteful use ofenergy including TV sets that13 are left13 on and unattended fridges and freezers that13 are set13 attoo low temperatures and dryers that13 are used for too long or when the weather is suitablefor using a washing line They could be an enabling factor that13 supports changes inbehaviour driven by a need to use less power but13 it13 is unlikely that13 they will offer a bigreduction in costs that13 are already a problem for many vulnerable families
24
More generally the need for power conservation will include devices that13 are moreefficient and a significant13 emphasis on heat13 retention in buildings through betterinsulation
The energy crisis may force many people to spend more time in community settingsincluding shops and public buildings where they can benefit13 from the warmth Increasingreliance on mobile communication devices will lead to increasing demand for batterycharging facilities
Greater use may be made of portable devices for generating power based on solar cellswind or hand motion
222 Smart cities and homes
The Digital City initiatives have been based on information and how it13 can be used most13 effectively to make people aware of what13 is going on around them This means bettercoordination of resources more rapid access to advice and a battery of sensors measuringevery conceivable parameter from sound and light13 levels through to air quality andtemperature fluctuations There are several Digital or Smart13 City initiatives currently beingimplemented both in the UK and across the world They may significantly impact13 the livesof the millions of people living in them but13 the timeframe for outcome benefits to influenceplanning and design elsewhere is likely to be at least13 20 years and therefore outside thetimeframe of the current13 project
Housing plays a big role in the lives of most13 people both through their aspirations to moveup in the world (usually to a bigger property with a garden) and as the heart13 of the familylife which is associated with good quality of life UK properties have a life span approaching100 years which is about13 double that13 of their European counterparts (and certainly longerthan the wooden-shy‐frame buildings built13 in North America13 for example) A shortage ofhouses has plagued improvements in social welfare for the past13 30 years There is anargument13 that13 there are enough houses but13 the wrong size and in the wrong places andthis has some basis in fact13 as demography changes lead to more people (and more olderpeople) living alone However if there are two million homes in Scotland each with alifespan of 100 years then the renewal rate needs only to be 20000 per annum to maintainthe status quo However it13 must13 be clear that13 the impact13 of smart13 house development13 willbe small The focus should therefore be on adapting existing properties to render themmore appropriate for vulnerable people
Housing adaptations are a branch of assistive technologies The technologies for providingdifferent13 forms of accessible bath and level access shower are well-shy‐established with littleresearch considering anything other than alternative building materials and methods formaintaining the temperature of the bathwater Different13 technologies for bathing will beconsidered separately
25
Thus housing technologies are not likely to impact on social work13 within the next 20years13 though13 the use of information13 technology13 to ensure that people are aware of what13 is available is likely to be commonplace well before then
26
3 BEHAVIOUR AND ATTITUDE CHANGES DUE TO TECHNOLOGICALADVANCES
Technology is only one factor that13 will affect13 the way society changes in the next13 10 or 15years This chapter will consider the context13 in which the technological developmentsoutlined in the previous chapter will be supported (or held back) by societal factors
When the impact13 of such factors has been considered we can then apply theseassumptions to a number of case studies listed in Appendix13 A13
The headings selected for this chapter are not13 arbitrary as they reflect13 the context13 in whichtechnological changes must13 be considered They must13 include consideration of factors suchas demography and long-shy‐term conditions already addressed in the introduction to thesepapers together with the aspects of workforce and citizenship considered in the parallelpapers The additional elements here focus on trends that13 are already occurring and whichmay leave people struggling with the changes that13 occur
Finally there is a need to consider the attitudes of people to technology generally andespecially to the issues of privacy and social responsibility that13 could be radically changedby technology In some cases public opinion will prevent13 some forms of technology beingdeveloped if not13 commercialised In other cases some technologies will be fast-shy‐trackedeither at the request13 of government13 or because of a clear public demand for theopportunities that13 it13 can bring
Predictions13 about the13 future13 must inevitably be13 subject to considerable13 uncertainty butthat is no reason to stop thinking what might happen
31 The Welfare State
The UK can be rightly proud of the way that13 its welfare state has developed during the past13 100 years to provide a safety net13 of financial support13 to people and to their families whenthey are unemployed destitute homeless or challenged by crises and emergencies Therange of benefits received is considerable some are complex and many people struggle tounderstand their entitlements Some are universal some are discretionary some apply onlyto parents others to anyone
The total cost13 of providing these benefits continues to rise and when the economy isstagnating there is inevitably both political pressure often supported by popular publicopinion to introduce welfare reform so that13 people who do not13 work cannot13 be better offthan they would be if they were in full-shy‐time employment This strategy requires a universalbenefit13 to be introduced so that13 it13 is easier for claimants to access support13 but13 also easierfor agencies to identify the total benefits received The idea13 of a benefits cap then becomes
27
more practical to introduce especially if all the processes involved in making a claim arehandled electronically Indeed this encourages government13 to insist13 on applications forbenefits to be made on-shy‐line Unfortunately this will marginalise those people who haveneither a computer nor access to the internet thus emphasising the digital divide in amanner which works against13 some of the most13 disadvantaged people in society
There are currently few tangible links between digital technology and welfare provisionThe most13 obvious are universal benefits such as a free television licence (worth pound14550)13 for13 everyone aged 75 or older with blind and visually impaired people entitled to a 50discount13 irrespective of their age The significance of this position is that13 6 of revenuesgenerated through licence fees are to fund BBC on-shy‐line services13 such13 as websites and i-shy‐player In Scotland the BBCrsquos Alba Gaelic language television service is predominantlyfunded13 by MG Alba an organisation funded by the Scottish Government It is thereforeconceivable that13 in the future licence fees may be used to directly subsidise access toinformation and advice through the Internet13 for vulnerable people whether it13 is throughbroadband access or through a set-shy‐top box which removes the need for a computer in thehome to access particular websites or to use e-shy‐mail services
A second age-shy‐related benefit13 available in the UK is the winter fuel subsidy People whoreceive certain benefits receive the payments automatically while others must13 make aclaim Those who are not13 eligible for benefit13 due to a lack of an address for example missout13 on these payments and also on Cold Weather payments of pound25 for each seven dayperiod of very cold weather between 1 November and 31 March
The development13 of new warm home initiatives plus the complex of subsidies that13 theelectricity supply industry and government13 offer to people with solar cells further changesthe economic arguments Global warming may lead to greater variations in weatherextremes but13 might13 also increase the amount13 of electricity that13 can be generated byalternative (green) sources such as wind and solar cells It is estimated that13 energyconsumption in the UK increased by 17 between Christmas and Easter 2013 compared toprevious years as a result13 of cold weather but13 the above subsidy scheme did not13 benefit13 older people because two of the seven day cold periods were after 31st March It must13 beassumed that13 there will be more people living in fuel poverty in the future and this will leadto more cases of cold related illness including influenza13 and stroke
32 Management of long term conditions
The management13 of long term conditions will be improved for patients who are compliant13 with their medication regime so it13 is possible that13 there may be compulsion to adhere tothe prescription Such compulsion may be monitored using technology Indeed the remotemonitoring of vital signs using telehealthcare will become commonplace as the old boxesand sensors are replaced by devices that13 can be worn continuously or which can beembedded into the fabric of homes (including furniture and bedding) or can be worn asvests or patches They will wirelessly transmit13 data13 to smartphones or tablets and mobile
28
transmission and cloud technology will enable real-shy‐time data13 collection analysis andfeedback
One of the diseases which is projected to increase most13 significantly over the comingdecade is Type 2 diabetes Whilst13 there is a hereditary susceptibility to this condition formany people including those from the Middle East13 and the Asian sub-shy‐continent it13 is also adisease which tends to affect13 those people who are overweight13 andor have a sedentarylifestyle If untreated diabetes can lead to dizziness and collapse at any time but13 can alsohave more devastating long term consequences which include kidney failure strokeblindness and in extreme cases lower limb amputations Management13 therefore includesdaily monitoring of blood glucose levels and major dietary changes such as a significant13 reduction in the consumption of carbohydrates as well as a rigid exercise regime
Many newly diagnosed diabetics follow this advice closely and can lead normal lives for 40years or more but13 some struggle to accept13 the change in lifestyle required as well asremembering which foods are allowed and how much exercise they need to takeIndividual support13 plans are now forthcoming and over the next13 ten years best13 practicewill emerge in the form of smartphone apps that13 are personalised and which can becomean individualrsquos health coach This level of support13 will be fine for some people but13 otherswill need incentives so it13 is likely that13 gaming technologies will be introduced perhapsoffering rewards for good compliance There will be a temptation for some people tocheat perhaps allowing others to perform exercise for them or changing theirconsumption details
Many of these opportunities for cheating will be removed through the use of a uniquebiometric identifier a technology that13 will be mature enough to use in place of passwordson smartphones However the biggest13 challenge may be in encouraging older people to usethe technology Many older people have multiple morbidities Indeed a survey of Scottishpatients implied that13 42 of people aged over 80 will suffer from three long termconditions It will be essential for those people to comply with treatment13 regimes if they arenot13 to have the functional deficits that13 follow
33 Finding people who13 donrsquot fit
People who have low social capital are likely to have few relatives and friends with whomthey regularly communicate and are also unlikely to be part13 of community or faithorganisations such as clubs societies and church groups They also die several yearsyounger than most13 of the population often because they donrsquot13 engage with public healthinitiatives such as vaccinations against13 flu regular checks on their blood pressure bloodsugar levels or in the case of women smear tests or mammography The most13 likelyreason for disappearing beneath the radar of such initiatives is their mobility which leadsalmost13 inevitably to them having no fixed abode and no fixed telephone line It thenbecomes very difficult13 for them to be contacted because their mobile telephones are likelyto have Pay-shy‐As-shy‐You-shy‐Go contracts that13 donrsquot13 require validated names addresses and bankaccounts
29
It follows that13 some of the most13 vulnerable people in society including those who live onthe streets are effectively unknown to both the NHS and to social work departments untilthey are referred in a crisis This could be an emergency presentation to a hospital Accident13 and Emergency Department13 where they will come into contact13 with a social worker becausedischarge may be unsafe This often highlights the importance of the prevention agenda13 and the potential for avoiding admissions to hospital by intervening at an earlier stage
The advantages of being able to locate people who are vulnerable to specific diseases willincrease as genetic testing becomes more routine It is already possible to determine whomight13 be most13 at risk of breast13 cancer and prostate cancer as a result13 of family history Addto this the evidence that13 particular diet13 and exposure to environmental factors can furtherincrease risk then it13 is evident13 that13 individuals can be identified and offered treatmentsthat13 could save their lives many years before they become ill In the case of cancersperhaps only the individual is involved but13 for infectious diseases it13 is the whole of societythat13 is at risk if someone contracts one of the new strains of influenza or if someonechooses not13 to be vaccinated against13 rubella In Chinese airports all visitors are screenedfor fever and refused entry if they tested positive in cities the public are monitored in thesame way Similar approaches may be necessary in the UK if potential carriers cannot13 otherwise be identified
34 Volunteering
It is estimated that13 72 per cent13 of people volunteered to perform a charitable act13 at least13 once during 2012 a rise from 65 per cent13 the previous year About13 four out13 of every 10volunteers offer their services formally to one or more organisations The remaindervolunteer informally by helping out13 a friend or a neighbour Around 50 per cent13 volunteered at least13 once a month in the past13 year up from 41 per cent13 on the previous13 year Most13 have retired many of them before the statutory retirement13 age Those whodonrsquot13 feel able to offer time have offered their financial support13 at a time when the fundingavailable from sources such as the National Lottery has been decreasing Despite economicausterity donations to charities have been increasing 74 per cent13 said they had given tocharity at least13 once in the previous month up from 72 per cent13 the previous year
Strikingly 78 per cent13 of people strongly believe that13 they are part13 of their localneighbourhood an increase from 70 per cent13 10 years previously Community cohesion isstronger than ever 87 per cent13 of people believe their local area13 is a place where peoplefrom different13 backgrounds get13 on well together compared to 80 per cent13 in 2003
The role of volunteers in supporting vulnerable people is therefore likely to increase overthe next13 decade perhaps exploiting the success of the army of volunteers that13 was highlysuccessful in London during the Olympic and Paralympic games The greatest13 role for suchvolunteers may be in providing informal care for older people Already the UK has someseven million informal carers whose value in monetary terms has been calculated to be
30
more than the combined budgets of the NHS and social care Maintaining or extending thisprovision will help to support13 services in the future and may be supported by technology
Whilst13 there is ample evidence to suggest13 that13 telecare services support13 informal carers asmuch as (if not13 more than) the people that13 they are caring for it13 is the potential for utilisingthe internet13 and apps to make their role easier to coordinate and hence more effectivethat13 is likely to be most13 successful moving forward
Many of these focus on particular tasks that13 informal carers can help offer to older peoplesuch as organising their medication A pillbox program is just13 one feature of an app calledBalance It also includes sections for caregiving tips notes for the doctor and the patientsappointments plus a lsquolearning sectionrsquo with articles on aspects of Alzheimers and an RSSfeed for news about13 the disease Tyze is another multi-shy‐functional app it13 allows carers to
bull Organise appointmentsbull Plan outingsbull Share storiesbull Send updates to other family members
Another application is Rally Round which helps carers to organise someone to perform littlejobs often on a temporary basis when someone has dementia physical frailty or isrecovering from accident13 or illness Similar applications are MeMaxi and Finerday
35 The High13 Street
The shape and appearance of UK shopping centres have been changing for half a centuryPeople complain that13 centres are losing their identity with one town looking like everyother both in terms of the stores and in terms of the layout But13 there are three trendswhich are having a profound impact13 on many of the most13 vulnerable people in society
bull Centres lock their doors at 6pm or in some cases 10pm -shy‐ thus denying people whosuffer from claustrophobia13 from window shopping at times when other shoppershave left
bull Out13 of town shopping malls -shy‐ these US style centres are ideal for people in carsbecause they offer free parking which is essential for people who want13 to buy largeritems but13 difficult13 for people who have no transport13 and who must13 rely on publictransport13 that13 is often deficient
bull The rise of online shopping -shy‐ which means that13 many potential shoppers only visit13 High Street13 stores to check the prices before returning home to make a purchaseonline
It is the third of these effects that13 has the greatest13 potential for changing the High Street13 forever and it13 is making life for traditional retailers increasingly difficult13 at a time when highrents are crippling stores large and small It is difficult13 to see how this trend is likely tochange because consolidation in banking and estate agencies is already forcing the closure
31
of other High Street13 players while additional pressures on pubs has led to the closure ofthousands of pubs every year
Those figures however demonstrate that13 consumers still value what13 the high street13 canoffer -shy‐ the chance to inspect13 what13 theyrsquore thinking of buying -shy‐ as well as the new opennessof the internet Customer service makes a difference to people especially if there is aproblem and goods need to be returned One of the most13 common reasons for furniture tobe returned for example is that13 when a sofa13 or a wardrobe was delivered it13 couldnrsquot13 fit13 through the front13 door or up the stairs In the future people will be able to benefit from13 visualisation technology they will upload the floor plans of their homes enabling theretailer to inform them of the problem before they try to delivery Augmented reality viewwill similarly allow customers to see what13 a new item of furniture will look like in itsintended place so that13 they can be more informed about13 the effect13 of size and colour
In terms of improving the viability of the High Street stores will have to focus on theimportance of brand which could mean that13 individual independent13 retailers will have topartner with national suppliers to support13 a local tailored offering based on products that13 are designed for a more global market This is a lsquoconnected High Streetrsquo approach whichcould be enabled by the developments in internet13 availability and smart13 phone accessdescribed in the previous section
The overall effect13 of all these changes could mean that13 town centres become smaller but13 more vibrant13 areas They could thrive if people are attracted there in large numbers whichmeans that13 retail must13 be developed alongside restaurants pubs galleries and other leisureopportunities This is possible in new shopping centres which are already being integratedwith transport13 hubs including railway and bus stations but13 may be more of a design13 challenge for older towns and cities with large Victorian buildings To ensure that13 morepeople are welcomed into the new centres they should include attention to green spacesand areas where people can relax without13 feeling that13 they are second class citizensbecause they donrsquot13 have the same buying power
3513 Privacy
To some people privacy is their right13 to live their lives without13 interference they may seethe State as a potential lsquoBig Brotherrsquo spying on their every move and judging their actions13 and activities Other people have fewer concerns about13 the role of the State but13 great13 fearof individuals interfering with and invading their privacy Some embrace the concept13 of lsquomyspacersquo an area13 of a square metre or so into which nobody can enter without13 permissionThis allows them to avoid physical contact13 and to feel safe from any form of threateningbehaviour
Yet13 this idea13 of private space and its potential violation is merely the tip of the iceberg asfar as privacy is concerned more significant13 is the idea13 of personal (and private)information being shared with anyone and everyone This could be related to identityopinion or image for an individual who wants to remain anonymous or even secretive thisis going to become an increasing problem as technology provides the means of taking
32
photographs recording conversations and capturing environment13 with something as smalland ubiquitous as a mobile phone The fact13 that13 this information can then be shared withthe rest13 of the world using e-shy‐mail Twitter and Facebook makes the problem all the moredifficult So the threat13 is no longer solely from the long lenses of the Paparazzi but13 fromanyone (and that13 means everyone) who has even the most13 basic of mobile phones
This relates to the changing views of society on what13 information should remain privateand what13 should be shared with others The success of social media13 has been based on anattitude of lsquosharing everythingrsquo with either your friends or the world This has introduced anaiumlve idea13 in the minds of some younger people (especially those known as Millennials ieaged 18-shy‐30) that13 everyone can be their friends whilst13 perhaps failing to reinforce the bondsof genuine friendship with any form of test13 or restriction Technology could play a role indefining these friendships and allowing individuals to understand what13 makes a goodfriend but13 this approach has yet13 to be developed and may be slow to overcome the needfor some people to measure their own popularity simply as the number of people that13 theycan list13 as friends on their Facebook page
It follows that13 there may be a need for a new definition of privacy that13 is in keeping withthe web and its ability to display images and opinion in an unregulated manner This needsto embrace past13 concerns about13 the ability of an individual to live without13 the threat13 ofothers being able to watch them whilst13 offering some protection from random postingsabout13 them online Perhaps this could include a right13 to be able to edit13 or remove anythingrelating to themselves on the Web including images that13 are not13 news-shy‐worthy Theownership of image rights may be an associated issue that13 needs to be addressedespecially as modern technology can remove an individual from a group (or a background)13 view provide digital touch-shy‐up or air-shy‐brushing and then republish it13 in a different13 contextHowever there is general agreement13 that13 personal information (such as contact13 details andbank codes) should not13 have a place on the web Surprisingly few people take proactivemeasures to prevent13 tracking functions being activated
It follows that13 too much privacy could lead to younger people fearing that13 they maybecome lost13 in a digital world It is not13 surprising then that13 they are prepared to make lots13 of personal information available often with no fear of how it13 might13 be used by othersWhen Google glasses and similar technologies become available during the next13 few yearsthey will have the potential to identify a stranger walking down the street and to find manyof their secrets to present13 to the wearer in a fraction of a second They could know moreabout13 them than their genuine friends know -shy‐ so who will be their friends in the future
36 Data sharing and13 protection
By lsquodata13 sharingrsquo we mean the disclosure of data13 held by one organisation on an individualto a third party organisation(s) or the sharing of data13 between different13 parts of anorganisation Some data13 sharing doesnrsquot13 involve personal data13 because it13 has beenanonymised in such a way that13 the statistics can be used for the collective good without13 theidentification of the individual The Data13 Protection Act13 (DPA) is in place to provide a legal
33
framework that13 ensures that13 organisations that13 hold personal data13 must13 act13 responsibly atall times These principles adequately describe the position of public and government13 bodies especially social services departments who are responsible for the informationconcerning the health and well-shy‐being of individuals -shy‐ and hence by implication thesensitive data13 relating to their vulnerability
The legal framework that13 applies to private and third sector organisations differs from that13 which applies to public sector organisations which may only act13 within the defined limits oftheir statutory powers However all bodies must13 comply fully with the data13 protectionprinciples and this situation is unlikely to change within the next13 10 to 15 years In someprivate sector contexts there are legal constraints on the disclosure of personal dataHowever most13 private and third sector organisations have a general ability to shareinformation provided this does not13 breach the DPA or any other law It is advisable for acompany to check its constitutional documents such as its memorandum and articles13 ofassociation to make sure there are no restrictions that13 would prevent13 it13 from sharingpersonal data13 in a particular context The type of data13 held is therefore a subject13 ofconcern as it13 may be difficult13 for legislation to keep up with the additional layers of data13 created on-shy‐line and through the Internet13 of Things
Private and third sector organisations should have regard to any industry-shy‐specific regulationor guidance about13 handling individualsrsquo information as this may affect13 the organisationrsquosability to share information They should also be aware of the legal issues that13 can arisewhen sharing personal data13 with public sector bodies This becomes more of an issue asprivate and third sector bodies are carrying out13 a wider range of traditionally public sectorfunctions Opportunities for inappropriate sharing of sensitive data13 will therefore inevitablyincrease
Public authorities must13 comply with the Human Rights Act13 (HRA) legislation in theperformance of their functions The HRA also applies to organisations in the private sectorinsofar as they carry out13 functions of a public nature which could include delivering a socialcare activity Where the HRA applies organisations must13 not13 act13 in a way that13 would beincompatible with rights under the European Convention on Human Rights Article 8 of theConvention giving everyone the right13 to respect13 for their private and family life their homeand their correspondence is especially relevant13 to sharing personal data If personal data13 isdisclosed or shared in ways that13 comply with the DPA the sharing or disclosure of that13 information is also likely to comply with the HRA The problem may still be in policing theActs and the rights of an individual if they believe that13 their personal data13 has been sharedor accessed by an inappropriate organisation or individual
A legal industry may be born to deal with such matters but13 this is unlikely to benefit13 peoplewho cannot13 afford the fees involved They would require either legal aid or to employ13 more13 lsquono win no feersquo companies Public attitudes to such costs might13 become negative unlessthey prove successful in preventing breaches of data13 security There may need to belegislation to provide a stronger basis for forcing compliance with privacy laws
34
37 Connecting with13 people
We are social creatures most13 of us rely on our friendships and interactions with friendsand families to share our happiest13 moments and experiences Research suggests that13 thishappiness is infectious at all levels and leads to a 15 increase in the happiness of a closecontact 10 for a second degree contact13 such as the friendrsquos spouse and a 6 increase fora friend of a friend It is hardly surprising that13 the success of social media13 such as Facebookis intimately related to the ability of people to quickly share their happiest13 moments with asmany of their friends and connections as possible
All this has happened during the rise of the Internet13 and the corresponding increase inopportunities for connecting online ie this is a 21st Century phenomenon which has beenfacilitated by Information and Communications Technology But13 the Internet13 remains in itsinfancy and we are only beginning to understand and exploit13 its potential In terms ofaccessing the Internet there are now perhaps two billion people who have access with99 of them having gained this during the past13 decade This number will have doubled bythe period 2020 to 2025 It is likely that13 everyone who wants to be connected in the UK willby then be connected Turning this on its head only those who donrsquot13 want13 to be online willnot13 be on the Internet13 within a decade Connecting with the unconnected will therefore bea case of identifying those people who donrsquot13 want13 to be found unfortunately these mayinclude many people who need the support13 of social care organisations It means that13 theywill be looking for support13 only when they are in crisis unless other ways of finding andormonitoring them are found
While the number of people connected via the Internet13 has exploded this might13 bedwarfed by the number of connected lsquothingsrsquo During 2009 the number of thingsconnected to the Internet13 surpassed the number of connected people at which point13 webegan to experience what13 this report13 has described as the lsquoInternet13 of Thingsrsquo Yet 99 ofall physical objects that13 could join this network are not13 yet13 connected but13 the number couldgrow by 25 every year for the next13 decade so that13 there could be 100 billion connectedobjects by 2025 some of which will be owned or used by everyone in the UK includingthose people who donrsquot13 want13 to be connected themselves We will then have an Internet13 of Everything which will be the smart13 connection of people data events and actions
With each new person object or data13 that13 comes online the connection possibilitiesbetween all these elements grows exponentially The rise of big data mobile networkingcloud storage and data13 mining technologies will all play a critical role in the Internet13 ofEverything The result13 will be new capabilities richer experiences and unprecedentedvalue for individuals businesses communities and countries everywhere The lsquonetworkeffectrsquo of the Internet13 of Everything will be a very powerful thing the true impact13 of whichwe wonrsquot13 fully understand for several years As it13 develops however those who are not13 connected will feel even more digitally and socially excluded There will be a need to reachout13 to vulnerable people unless the process of claiming requires proof of online identityand the payments to be received can only be redeemed using a chipped card or adownloaded app onto a smartphone This is of course the way that13 welfare arrangementsare already developing thus it13 might13 prove impossible to make a successful claim without13
35
already being connected to lsquothe systemrsquo either through an online presence or through theInternet13 of Things
38 Downloading everything
Sixty years ago information was discovered by reading books often in a library wherenotes had to be made because the books or journals couldnrsquot13 be removed Then in theearly 1960s the first13 office photocopying machines were introduced into the UK theyimmediately meant13 that13 pages or articles from books could be copied and taken away to beread and summarised later Within a few years photocopying became a replacement13 forreading as researchers became less adept13 at selecting a few sentences and every deskbecame a depository for reams of printed paper Paper became the means of recordingeverything from bank statements through to music
We now appreciate that13 printing everything is a waste of both the ink (or toner) used tocreate the black print13 and of paper which requires trees to be chopped down and pulpedbefore it13 can be pressed into thin sheets Saving paper is therefore seen as green and goodfor the planet Fortunately we no longer need to print13 everything because computermemory is unlimited thanks to the cloud and we can then view pages and articles onportable or fixed screens
The internet13 has everything and it13 is all available instantly for downloading providing thereis a device available to accept13 it and there is sufficient13 communication bandwidth toperform the transfer of data13 sufficiently quickly Thus we can record all text13 articles that13 are relevant13 to us including digital records of birth certificates qualifications and passportsand the need for original printed versions will decline But13 we can also do this forphotographs Most13 handheld computing devices include at least13 one camera so they cangenerate enormous number of pictures which can be kept13 for posterity without13 having toconsume inks and special papers to print13 them
But13 the materials that13 can be downloaded donrsquot13 stop at pictures software is available that13 can grab TV shows after they air and movies as soon as theyre released In the same wayit13 is possible to schedule music comic books video games and practically anything else asa download with minimal effort People will need enormous hard drives if they want13 theirown digital copies of these files so will more than likely make use of cloud storage that13 willbe available from many organisations The location of the servers may become sensitivedue to border restrictions as will the security of the data13 and the way that13 it13 is backed up sothat13 it13 is resilient13 to failures
It may be evident13 that13 application forms for all types of welfare payment13 will be availableonly for downloading so that once digitised they can be processed by computer andrecords sent13 to various servers for subsequent13 storage and processing Some people maywant13 to keep their data13 on them once it13 has been downloaded Pen drives can already holdseveral GB of data so it13 is likely that13 people will be able to carry their downloaded data13 withthem at all times irrespective of the size and complexities of the information
36
39 Health13 and13 well-shy‐being
The general health of the population is unlikely to deteriorate noticeably within 10 to 20years Indeed expectations of the population are that13 things must13 improve as surgicaltechniques mature and as pharmaceutical interventions become more personalised andpowerful However the rising demand for health services due to an ageing population andthe increasing cost13 of providing sophisticated therapies will make delivering a free anduniversal health service difficult13 without13 substantial increases in taxation This is unlikely tohappen in the UK even though spending on health services will be protected against13 thecuts facing other services
There will have to be changes in how the NHS works For twenty years hospitals have beenclosed and replaced by fewer new facilities so that13 the bed count13 is reduced This has led toa significant13 shift13 in resources to primary care and community care supporting shorter staysin hospital and speedier transfer back home for people after surgery or illness This hasbeen13 successful but13 there remain problems with demand for GP services especially out-shy‐of-shy‐hours and at weekends Indeed despite the introduction of NHS24 and similar help-shy‐linesthe demand for GP appointments continues to increase Delays are inevitable and this willincrease system failures with more unnecessary deaths and a failure for people to access adiagnosis that13 might13 lead to early interventions and ultimately lower delivery costs Over250 more patients are added to waiting lists every day
This will lead to a new model of primary care consistent13 with existing changes which haveseen surgeries move from High Street13 locations to medical centres close to bus routes andwith more parking for patients The process of making an appointment13 is changing from atelephone-shy‐based interview process dominated by a medically-shy‐unqualified receptionist13 to achoose and book approach using an online process linked to electronic patient13 records Thiswill give patients more convenience but13 will allow priority for those who have Internet13 access at the expensive of those who are digitally excluded Making the process of bookingan appointment13 quick and easy may also increase demand from people who do not13 need tobe seen as it13 will fail to identify those in greatest13 need
A greater use of telehealth and telecare technologies will be inevitable beginning with thefirst13 contact13 as an encounter using the telephone e-shy‐mail or video conferencing -shy‐ a visit13 tothe GP surgery should be a last13 resort and should involve a nurse consultation in the first13 instance This would be consistent13 with three quarters of appointments currently involvinga chronic disease or long term condition which relates to improved self-shy‐care The support13 ofthese patients at home should be prioritised through tele-shy‐ and web-shy‐based technologies andshould involve training and coaching through a network of nurse practitioners Home visitsshould generally be unnecessary through the use of these technologies but13 could besupplemented by satellite surgeries manned by nursing in community premises or inpharmacies nurseries and Internet13 cafes
The homes13 of people who13 need13 closer monitoring can then become part13 of virtual wardswith real or electronic visits by health professionals University Hospital Southampton NHSFoundation Trust13 already looks after patients who have undergone surgery such as a hip orknee13 replacements in virtual wards with high levels of satisfaction The Royal Free London
37
NHS Foundation Trust13 offers a similar service but13 plans to add the possibility of videoconsultations between patient13 and consultant
310 Attitudes to public health issues ndash obesity smoking alcohol abuse drugs
As self-shy‐care becomes the focus of the NHS the public will increasingly understand that13 thecosts and availability of services are being harmed by the poor health behaviour ofrelatively small numbers of people The link between public health initiatives today andhealthcare needs and costs in the future will become increasingly evident13 as a result13 of theway that13 information is presented Thus the overweight13 smoker who currently attractsconcern and pity when they are diagnosed with diabetes and COPD is increasingly beingseen as the victim of their own stupidity or lack of self-shy‐discipline If they continue to neglect13 medical advice and continue with an unhealthy lifestyle then the way that13 they receivetreatment13 and consume resources will become a matter for the entire population
Obesity is seen as due to a combination of poor diet13 and a sedentary lifestyle No longer isthe idea13 that13 people are lsquobig bonedrsquo acceptable Governments will respond initially byrequiring manufacturers and food processors to provide nutritional information onpackaging and on menus in restaurants But13 people can choose not13 to read the data13 and toneglect13 both the importance of food quality content13 and quantity This will increasepressure to introduce fat13 or sugar taxes and these are likely to be in force within a decade
Although the high taxes on tobacco products has forced some smokers to reduce theirconsumption or to give up altogether the impact13 has been reduced by the smuggling ofproducts from overseas and by the availability of duty-shy‐free cigarettes for people returningfrom foreign holidays and business meetings Further measures are planned to changepackaging and to include even more graphic images and warnings on cigarette packages tomake smokers aware of the effects of smoking on their health and well-shy‐being There is asyet little evidence of how successful this might13 be More effective has been the banning ofsmoking in public places including trains and aircraft Expensive medical interventions suchas heart13 transplants will be denied to individuals until they change their lifestyle behaviourSmokers might13 therefore be increasingly ostracised leading to a loss of esteem This mayhave a particular impact13 on people who already suffer from mental health problems whoare more likely to smoke
The overuse of alcohol is being recognised as a major factor in hospital admissions withNHS figures showing an increase of over 40 in such admissions over the past13 decadeLinked to this has been a 75 increase in prescriptions to treat13 alcohol dependency Fewpeople have sympathy for those who waste their limited income on booze If they havechildren or other dependents they will be the ones who suffer and who may need thesupport13 of social care
Drug users are already significant13 users of social services as their habit13 is likely to makethem unemployable They receive little sympathy from the general public because they areseen as criminals and people who waste public resources Levels of drug abuse have been
38
slowly increasing over the years but13 this trend is slowly being reversed Indeed the numberof people using drugs during the past13 year has fallen to its lowest13 level for nearly 20 years(below 9) with cannabis being most13 likely often following excessive drinking Aselectronic noses and other technologies can detect13 traces of drugs it13 seems likely that13 success in overcoming addiction can be measured objectively This may become a two-shy‐edged sword rewarding those who can turn around their lives but13 further marginalisingthose who canrsquot13 or wont13 accept13 the lsquocold turkeyrsquo
311 Attitudes to surveillance
Issues associated with privacy confidentiality and data13 security have been discussedpreviously in the context13 of information technology the World Wide Web and the ease ofcollecting recording recalling analysing and displaying data The monitoring of individualsand their methods of using this information can be regarded as surveillance As thequantities of data13 increase along with the number of devices that13 can be used to access itthe surveillance tools will also increase in their sophistication Indeed the Big Data13 approaches described in the previous section will enable the combination of structureddata13 (such as the information held in databases) to be married with unstructured data13 fromimages in such a way that13 it13 can be mined
Whilst13 the lsquodigital surveillancersquo methods described above may cause most13 concern topeople because of its impact13 on anonymity it13 is the collection and analysis of images that13 are the major concern to people as they contemplate the ways that13 lsquoBig Brotherrsquo maydevelop to restrict13 freedom Every major UK city and town centre has an array of CCTVcameras that13 continually record activities from every angle If it13 used to be true that13 nobody in London was more than 10 yards from a rat it13 is certainly the case today that13 nobody can be more than this distance from being in view of a surveillance camera Yetthey receive so much positive publicity from TV programmes where their footage is used todetect13 vehicles close to a crime scene or to monitor the movements of suspects that13 theyare now accepted by the public as a deterrent13 in the same way as lsquobobbies on the beatrsquowere seen 25 years ago There is therefore little public reaction to the expansion in the useof video surveillance except13 for the practical observation of how so many views can beinspected and recorded
Looking to the future the tumbling cost13 of video technology will surely lead to anotherincrease in the number of devices The aerial views taken from towers will besupplemented by more local views taken by devices that13 are embedded in the fabric ofbuildings or carried by individuals either on their person (for example on clothing orspectacles) or in the bags that13 they carry The time and date-shy‐stamped images as Big Datawill be recorded to lsquothe Cloudrsquo where it13 can be added to other data It can then be usedwhen an incident13 has occurred or to provide further detail of night-shy‐time activities
It follows that13 there will be no hiding place for people who simply want13 to disappear Theymay respond by wearing clothing (such as hoodies) that13 hide their faces or which make it13 difficult13 to distinguish gait13 or mannerisms from which they might13 be identified New forms
39
of clothing may be designed to make shapes more difficult13 to analyse and these might13 become the uniforms of a class of person who wants to live in a way that13 they donrsquot13 interact13 with officials from any ministry or local government13 department If they also obstruct13 services then they will be considered to be anarchists of some form sparking protests fromother sectors of society
31213 Attitudes to driving
Motor cars have been a feature of UK roads for over a century but13 it13 is only during the past13 50 years that13 they have become a resource that13 most13 families have had access to enablingthem to travel without13 the restrictions imposed by a limited railway network and non-shy‐integrated bus transport People who have had a car throughout13 their lives often see theircars as an important13 factor in enabling them to remain independent13 and to exercise choicesrelating to where they shop and where they spend their leisure time This extends to theirspouse and to friends and neighbours that13 they might13 take with them on their variousexpeditions
Unfortunately there are incidents involving older drivers who perhaps go down amotorway in the wrong direction who are taken ill at the wheel or who are involved in anaccident13 involving no other vehicles These are small in number but13 often lead to a reactionthat13 they shouldnrsquot13 be allowed to drive lsquoat13 their agersquo Age itself is not13 an indicator ofdriving quality but13 because old age also brings more chance of having limited long termconditions and other illnesses it13 is easy to make a link between driving ability and age Thelicensing system does require continued driving to be linked with medical advice andforbids people with poor eyesight epilepsy and other conditions to hold a licence in oldage
Yet13 statistically older drivers cause far fewer accidents than younger drivers The reasonsfor this may be complex and are likely to include the fact13 that13 they drive less often covershorter distances and donrsquot13 go out13 in the dark or in poor weather However it13 does not13 wholly explain why the UKrsquos drivers aged over 70 and who represent13 some 8 of all driversare involved in only 4 of accidents that13 cause injury This compares favourably with the15 of13 drivers aged between 17 and 29 who are involved in over a third of crashes that13 result13 in injury
By 2020 the number of drivers aged over 70 on UK roads is likely to increase to over 7million This will require a new national strategy perhaps involving support13 for olderdrivers further training raising awareness of issues and making more use of adaptivetechnologies to support13 the driver in avoiding collision or forgetting to check on the statusof their vehicle Poor eyesight13 could be enhanced by camera technologies rather thanforcing people off the road if they are unable to read a licence plate
The International Longevity Centre has found that13 one in four Britons thought13 driversshould be made to switch off the ignition for good somewhere between the ages of 70 and75 The numbers may decrease as the population ages and as cars become safer Forcing
40
older people off the road may be a natural consequence of providing free bus passes andsubsidised rail fares but13 the growth in the pavement13 scooter industry demonstrates that13 older people value their independence and will do almost13 anything to get13 out13 and aboutPerhaps legislation will result13 in more regulation of electric vehicles and where they cantravel
There can be no doubt13 that13 getting out13 will be associated with better quality of life andwell-shy‐being and this is likely to be supported in the future as evidence of improvedoutcomes emerges It is to be hoped that13 positive stories will be publicised so that13 publicattitudes arenrsquot13 hardened This may be supported by more in-shy‐car monitoring of drivers andthe linking of performance with on-shy‐line driving records and licences These could throughremotely monitored ignition systems prevent13 the use of motor vehicles by people without13 a licence or without13 insurance
313 Climate change
There is a general view that13 the emissions of carbon gases are contributing to globalwarming in a manner that13 will change the UK climate in such a way that13 the climate maybecome more Mediterranean However some scientists believe that13 manrsquos impact13 on theenvironment13 may be small compared with natural variations caused for example bycyclical changes in the sunrsquos energy output13 or by the effects of volcanoes and earthquakesRecent13 evidence has suggested that13 we are going through a phase of changing extremesand that13 this is more likely to cause storms periods of excessive rainfall and unusualseasonal trends with snow and frost13 in the spring and warmer winters Considerableuncertainty remains and it13 might13 be necessary to plan for a number of different13 scenariosand for the impact13 on vulnerable people
I Colder winters UK properties are poorly insulated resulting in excess mortalitiesduring cold spells due to an increased number of people suffering from stroke aswell as bronchitis and other pulmonary diseases The cost13 of heating continues toincrease putting more households into a state of fuel poverty Any further coolingduring the winter months will result13 in more people living in unhealthy coldconditions Winter fuel payments are likely to be restricted to the poorest13 peoplebut13 this might13 exclude people who live in larger properties that13 are more difficult13 toheat
II More storms excessive winds and rain can cause flooding at any time of the yearMany UK communities are built13 close to rivers and these can surge during heavyrainfall causing houses to be filled with water and furniture and carpets lostInsurance can be problematic for properties built13 on flood plains which can blight13 properties and prevent13 owners from being able to sell and move on High winds canrip off roofs causing injury and also causing families to be left13 homeless anddependent13 on social services
III Hot13 summers Europe suffered high temperatures during the summers of 2003 and2004 leading to heat13 stroke and hypothermia The UK has not13 previously sufferedfrom such problems but13 might13 be expected to experience days of extreme
41
temperature and humidity at times Older people may not13 be prepared for suchweather Street13 dwellers may be unable to find shade and supplies of drinkingwater
Irrespective of what13 combination of weather scenarios arise it13 must13 be concluded that13 any extremes will have a major negative impact13 on vulnerable people especially if theyare not13 prepared because they havenrsquot13 received the weather warnings and advice that13 can be broadcast13 using the TV radio and online services Once again the digitallyexcluded will suffer and will pay a high cost Society will continue to pick up the bill interms of demands on social care services unless preventive actions are taken in theform of connecting these people to each other and to formal services
42
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
s13 13
13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
n13 13
13 s13
r13 n13
e13 at13
e13 y13 e13 ld13
ly13
13 e13 t13 e13
s13 er13 e13
f13
rt13 13
13 13
13
r13 13
s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
e13 g13 13
e13
13 13 ial13
13
d13
13 d13 h13 r13
d13 13
s13 y13
e13
13
rd13 r13 e13
13
13
13
e13
e13
d13 13
13
13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
to respond Monitoring systems that13 support13 the lsquoquantified13 selfrsquo may also offer data13 that13 may or may not be added to the full recordThe future of health information might13 therefore be about13 providing individuals with themeans of producing relevant13 information storing it13 somewhere secure and then viewing it13 at a later time but13 in a format13 (or with advice) that13 is acceptable
See also httpmydexorg lsquoMydex gives individuals back control over their personal datarsquo
(see also Digital Scotland 2020 Achieving World-shy‐Class digital infrastructure a final report13 tothe Scottish Government13 httpwwwscotlandgovukPublications2013029054lsquoconnectivity by any device anywhere and anytimersquo)
211 The Future of Healthcare
The strains on our healthcare delivery system are becoming greater as they are in otherdeveloped countries as a result13 of an aging population rising expectations and unhealthylifestyles The necessary changes will require a significant13 shift13 in resources13 fromsecondary13 care13 where unit costs13 are high to community13 carewhere people can generallybe treated at home
The future must13 therefore necessarily involve efficiencies in hospitals and in the way that13 people can be treated in less expensive locations ultimately in their own homes Hospitalswill use more sophisticated diagnostic tools including scanners of all types to non-shy‐invasivelyprobe inside peoplersquos bodies This will result13 in more day cases and hospital stays (alreadyaveraging under a week) to even shorter periods with on-shy‐going support13 provided inintermediate care settings that13 might13 include hotels care homes or the personrsquos own homeif it13 is clean safe secure and has all the necessary amenities (include access to theInternet)
Advances in medical technology will allow more treatments to be delivered in the homeThis will mean fewer visits by clinical staff and fewer opportunities to attend primary carecentres Pharmacists will become suppliers of information as well as drugs so the balanceof care will shift13 significantly away from doctors who will work in different13 ways relying13 increasingly on telemedicine to bring the specialist13 to the patient13 for an online consultation13 For example if a patient13 complains of nausea13 and severe headaches a virtual consultationcan be offered almost13 immediately and without13 having to send a patient13 with a potentiallyserious and acute condition on a potentially long journey to a hospital
In the above example a neurologist13 may ask further questions as well as conduct13 acomplete neurological examination using videoconferencing technology Airedale GeneralHospital consultants have new contracts that13 require them all to be available for virtualconsultations The first13 benefit13 has been in reducing the need for prisoners at local jails tobe brought13 into AampE (which may need to be locked down depending on the circumstancesand the potential for violence of the individuals involved) potentially saving hundreds of
14
pounds in security costs It also avoids the need for healthcare staff to have to go into aprison environment
The principles described above are already saving lives through telestroke services whichlead to more people being thrombolysed appropriately and avoiding long term support13 that13 often follows a stroke incident Teledermatology has been practised for a number of yearsand results in rapid diagnosis and resolution of problems that13 previously required significant13 time for remedy
212 Gadgets and13 DIY13 healthcare
There are at least13 three elements to healthcare
bull Gathering information on symptoms and physiological parametersbull Interpreting the information andbull Responding to the diagnosis with treatment
Many people choose to exercise self-shy‐care because this gives them control whilst13 avoidingthe need to share their concerns and personal details with others A lsquodo It yourselfrsquoapproach might13 even be encouraged by the NHS as a viable way of using scare resources
Medical devices that monitor vital signs are mature and have been miniaturised so that13 they can be used in the home by individuals with little or no medical training Indeed bloodsugar monitors are being produced specifically for use outside the hospital and in such away that13 they can be used reliably by people with advice and training being provided onlinevia13 YouTube
Many medical monitoring devices do no more than produce a single measure which theuser may record or respond to Others link wirelessly to smart13 phones allowing data13 to bestored and entered into a personal health record where trending opportunities existingIndeed individuals can easily enter their data13 into an app running on their laptop tablet13 orsmart13 phone This trending information may be useful13 for self-shy‐care and could be passed onto a physician though the volume of data13 produced in this way and doubts about13 thequality of the data are likely to persuade GPs to discount13 data13 produced in this way
This gap in knowledge can be filled with advice information and diagnosis that13 can beobtained online using a lsquoDoctor Googlersquo approach The quality of such diagnosis may varysignificantly although there are many sources of information that13 are both supported andapproved by the NHS (and by similar sources in other countries) However with a data-shy‐richapproach and a choice of diagnosis people may be empowered to take a greater role inhealthcare
15
The final component13 for the DIY enthusiast13 is the treatment13 option Many people fear longterm use of medication produced by the big pharmaceutical industry and prefer morenatural remedies which are available over the counter More medical treatment13 devicesare available that13 stimulate blood flow and counter pain through the use of electrical andphysical stimulation
The evidence may be weak at present13 but13 might13 grow as more people use them and as theircost13 drops The13 impact13 of13 such technologies13 on vulnerable13 people13 is13 difficult13 to gauge
213 Telecare
Support13 provided at a distance to people in their own homes is known as telecare Thename implies remote monitoring and interaction and includes the monitoring of the homeenvironment13 and of the individual as well as the interaction of the individual with thisenvironment Definitions have become difficult13 due to some US medical devicemanufacturers introducing the term telehealth to describe medical telecare such as remotemeasurement13 and collection of vital signs data
In the UK telecare alarm services have matured quickly using the robust13 platform andinfrastructure of social alarm systems which were originally used by tenants in shelteredhousing schemes to seek help when they didnrsquot13 own a telephone The majority of telecareservice users today live in their own homes and use dispersed alarm units to link with amonitoring centre through the telephone network Improved assessments of needs andrisks to independence have resulted in combinations of sensors being used to support13 theoption of staying put13 rather than moving into residential care or having increasing levels ofdomiciliary support They support13 the policy of bringing care closer to home and ofencouraging people to become partners in their long term support13 arrangements
Telecare services developments over the past13 decade include standalone items such asautomatic lights which have achieved significant13 efficiencies especially for people who arefrail and prone to falling and to those suffering from mild cognitive impairment epilepsyand anxiety People who have long term conditions including chronic conditions such asdiabetes and hypertension can also be managed more effectively through telecare supportThe benefits of telecare services include a relief of stress for family caregivers enablingthem to continue to provide unpaid support13 while holding down a job and maintaining theirquality of life
New developments enable continuous monitoring of behaviour and smart13 devices that13 canfor example remotely control the cooker the water supply and door entry Such13 monitoring may detect13 incidents early and prevent13 emergencies arising Devices arebecoming smaller and easier to embed quickly within the home environment making themmore acceptable and less noticeable Longer battery life means less frequent13 maintenancevisits
16
The13 monitoring13 centre13 becomes13 an information hub13 offering13 both advice13 and a vehicle13 for checking that someone is coping especially following a trigger event such as a stay inhospital or the illness13 of an informal13 carer
New systems utilise web technology that13 allows family members to be more proactive inthe monitoring of their relatives This can lead to greater interaction with them especiallywhen the relatives live a considerable distance away (perhaps in another country) Thesenext13 generation systems might13 include video conferencing and the use of tablets smart13 phones or smart13 TVs but13 when an emergency response is required (perhaps to lift13 someoneup after a non-shy‐injurious fall) there remains a need for human intervention
The13 future13 of13 telecare13 might therefore13 include13 an increasing13 dependence13 on volunteersfrom13 the13 community to provide13 the13 required support Social networking may need to beused13 to support13 telecare technologies
214 Mobile healthcare
While telecare can support13 people effectively in their own homes it13 is now recognised that13 being able to go out13 to enjoy open spaces and to overcome the fear that13 the home is aprison is an important13 part13 of improving well being and supporting a higher quality of lifeExtending telecare technologies to operate outside the home is known as mobile healthcare(or mCare) and is based on mobile telephone networks rather than landlines
The simplest13 form of mCare requires only a basic mobile phone to deliver telephone callsvoice13 messages and SMS (text13 messages) The technology is mature and there are countlessapplications in use both in the UK and in developing countries such as Africa13 and India13 where mobile telephones have already achieved a saturation level and where fixedtelephone infrastructures are not13 likely to be established at any time Such telephones areuniversally available in the UK and are used by the vast13 majority of people including manyolder people especially if they have been introduced to the low cost13 (pound30) devices that13 have large buttons large displays and a separate large button for calling an emergencynumber
Smart13 phones are rapidly replacing basic phones and allow the use of a large range of lsquoappsrsquothat13 are being developed to provide information and for enhanced experiences In thehealthcare space Skype FaceTime Vidyo and GoToMeeting with HD Faces are all current13 examples of video conferencing software available on tablets and smartphones
The specific software will depend on the nature of the communication desired
bull Skype will13 manage a simple video phone callbull Where an AampE physician needs to share a CT scan of head with a Neurologist13 on call
from home GoToMeeting would be more appropriate
17
bull If the physician would rather have a dedicated online meeting room that13 patientsand colleagues can simply drop in for a virtual meeting a Vidyo virtual room may bemore appropriate
This technology can suit13 any form of lifestyle including many people with complex needswhose lifestyle is not13 consistent13 with a fixed address
Social care apps are available already to deal with problems of sensory deficit
bull Guiding a blind person through GPS navigation and reading signs through appslinked to the devicersquos camera13
bull The microphone can be used as a hearing aidbull Speech recognition software can be used either to replay speech at a slower speed
or for translation into a language of choicebull Speech can also be selected for people who have a stammer or who have a problem
with their larynxbull Apps are becoming contextually aware recognising situations and locations and are
thus becoming a personal assistant13 for people with disabilities
By 2020 it is therefore possible that a smartphone may13 be prescribed13 for people who13 need13 social13 care13 together with13 a range of apps that have been13 selected13 to meet13 theirassessed13 needs
Whilst13 smart13 phones tablet13 devices and apps may become an important13 part13 of anindividualrsquos personal support13 armoury the potential of mCare will be limited only by anindividualrsquos ability to make use of all its functions Each device could become a part13 of anindividualrsquos personality supporting them to improve behaviour take exercise avoidtemptation and manage their own health and well-shy‐being Potentially mCare could becomethe most13 important13 element13 of social care and support13 within 10 years
215 Artificial Sensing and Enhancement Devices
bull It is estimated that13 one in seven people has imperfect13 hearingbull The numbers who are born deaf are quite small and many of these people may
have some form of hearing restored through surgery or through technologybull Similarly while there may be nearly a million people registered as blind or having a
severe visual impairment the vast13 majority lose their sight13 during their lives as aresult13 of disease
bull New treatments will deliver sight13 recovery or restoration over the course of the next13 10 to 20 years
Fortunately technology can provide excellent13 sensing capabilities that13 are already providingpeople with external portable devices for enhancing their lives The simple hearing aid is anexcellent13 example of a device which has been improved through both miniaturisation
18
personalisation and enhanced performance Today digital hearing aids use sub-shy‐miniaturemicrophones that13 can be unidirectional or omnidirectional and which can be adjusted insensitivity over an extended range Tomorrowrsquos devices can be switched between modesby the user so that13 they can benefit13 from hearing perfectly in any environment Indeedthey can be used with adaptive filtering technologies (as used by helicopter pilot13 headsets)to eliminate some sounds so that13 the rich speech (or music) components alone remainFuture developments will be on optimising control so that13 the user can switch seamlesslybetween different13 amplification applications without13 appearing to be distracted A smart13 phone or mp3 music player may be used as either a processing unit13 or as a ubiquitousoutput13 device that13 looks cool and natural
These same technologies will also be developed for use within the home environment13 fortimes when a deaf user isnrsquot13 present13 or is asleep Acoustic signatures associated withadverse events and incidents such as the hiss of a gas leak the crackle of a fire the sound ofa smoke detector the drip or a water leak or the sound of breaking glass can be directlyassociated with programmed actions Speech will be recognised interpreted translatedsimplified or displayed so that13 an individual knows what13 is said and can be provided withclear instructions on how to respond
Video cameras have become smaller and cheaper and capable of producing high definitionimages The problem of storing and editing these large image files is being solved by thearrival of cloud computing
Electronic noses are already capable of detecting the quality of wine and fresh fruit Similartechnology will be based in smart13 phones and will be able to analyse the air to warn of13 foodthat is no longer fresh and of other indicators of danger including gases that13 have13 little13 natural13 smell These13 devices13 could support13 people with13 cognitive impairment13 -shy‐ whose13 sense of smell13 tends13 to deteriorate -shy‐ to live independently
Many older and vulnerable people are at risk of hypothermia during the winter Sensordevices can provide warnings of low temperature In the same way heat13 stress can be adanger during the summer months so sensors can alert13 people of the need to openwindows or to operate a fanFinally people who have damaged13 their fingers13 or hands will be able to wear sensorsembedded in artificial skin or in gloves that13 will enable them to identify textures and shapesand be able to dress and undress without13 the assistance of carers
216 Robotics
We may recoil at the idea13 of personal care being delivered by robotic devices but13 it13 is likelythat13 within a decade personal assistants will exist13 to assist13 with household tasks These areunlikely to be humanoid and are more likely to be machines dedicated to helping frailpeople to support13 their own weight13 and to carry trays of food around the home
19
There are four broad classes of robot13 under development13 that13 are likely to mature within 10to 12 years
1 Miniature industrial robots that13 have been programmed to perform specific taskswith precision They are likely to be relatively heavy enabling them to bear weight13 but13 still have the necessary flexibility to carry an individual over short13 distancesplacing them in a chair or on a bed They will have sensors and cameras to provideimmediate feedback and to adjust13 rapidly in response to verbal commands or cues13 from the user Some designs may build on existing assistive devices such as abathroom hoist13 or a bathing aid to become intelligent13 extensions of productsalready on the market A stair lift13 with intelligence is already being designed by a UKcompany and is aimed at providing the user with more control of the journeybetween floors of a house
2 The second group of devices might13 be described as intelligent13 furniture Beds andchairs are already available that13 adjust13 to make the user more comfortable and also13 to help them get13 into or out13 of bed The control units are fairly cumbersome andare suited to operation by a carer Voice activated controls and built-shy‐in intelligencewill give the user more control and independence Other items of furniture to whichintelligence might13 be added would be tables whose height13 can adjust13 and whichhold items of food and medicine securely The table would recognise these objectsand could provide prompts or reminders
3 Mobile robots form the third group These could be goffers that13 can either fetchand carry items such as newspapers drinks or trays or which can accompany theuser when they move between rooms providing them with support13 or prompts Thistype of robot13 could be an intelligent13 walking frame with wheels which13 could13 doubleup as a smart13 wheelchair when necessary
4 Finally there are companion robots These might13 be in the form of an electronicpet typically a cat13 or a dog though the Japanese Paro robot13 is a seal Pets canrespond to stroking and being patted they can also remind their owners that13 theyneed to take exercise and to eat drink and take their medication Various designsare already available which provide feedback but13 future models would includecameras and a screen to provide a mobile means of information and interactionwith other people over the Internet Intelligence within the device could allow themto have a personality of their own and gain knowledge by scraping data13 fromwebsites so that13 they can generate speech and have conversations about13 the newsthe weather or sports results
217 Transport and transfer technologies
Walking is good exercise and is a no-shy‐cost13 form of transport13 that13 is encouraged because of itsimpact13 on well-shy‐being For an individual with a chronic disability or suffering from theeffects of an accident13 or an injury this becomes impractical without13 an assistive technology(AT) A walking stick is the simplest13 example of AT
20
Within the home the stair lift13 has enabled people who live in conventional properties that13 are on two or more floors to continue to use facilities on different13 floors when climbing thestairs has become too difficult This is often the case for people who have arthritis a lowerlimb amputation a long term condition such as Chronic Obstructive Pulmonary Disease orpeople approaching the end of life and who have chosen to die in their own homes
Designs have improved so that13 a curved staircase is no longer an issue and the reliabilityhas reached a level where breakdown is a rare occurrence13 Through-shy‐floor lifts have been analternative proposition but13 they remain too large for most13 properties Alternativeapproaches may emerge using air pressure or water pressure as the driving force ABrazilian design already utilises a plastic tube in which a pod is moved effortlessly up anddown
Electronic wheelchairs are now available that13 allow the individual to become moreindependent13 as they allow the user to control both propulsion and steering Some modelshave the capability of mounting a pavement13 or a step or even a flight13 of stairs Personalmuscle amplification devices have been developed originally with the intention of helpingpeople who are confined to a wheelchair due to a neurological disorder to perform sometasks from a standing position Indeed the Rex walkerrsquos manufacturers claim that13 anyonewho can propel themselves in a wheelchair could walk by using Rex
Other approaches have focused on the rehabilitation of people after major accidents that13 have caused partial paralysis They quickly extend into exoskeleton designs that13 enableanyone to gain a mechanical advantage and thus to tackle physical tasks that13 would not13 otherwise be possible These suits are the focus of major research projects across theworld Some13 products such as the system developed by Honda are being tested inAssisted Living facilities and are likely to become more and more enabling over the next13 decade
Similar benefits are also occurring outside the home with a number of novel carryingsystems appearing over the past13 few years They are generally termed lsquoscootersrsquo but13 thiscovers a wide range of systems and devices ranging from the Segway a device that13 is amobile platform on which the user stands and navigates through to conventional electricvehicles that13 have been developed from golf buggies There remain a number of issuesconcerning their use on roads or on pavements but13 similar problems will need to beresolved for bicycles to play their full part13 in enabling people to get13 more exercise13 Thepotential for hybrid scooters remains
218 Smart domestic appliances and personal hygiene
The bathroom is a dangerous place and one where many older and disabled people slip andsuffer a fall Many older people recall taking a bath in a tin tub in front13 of an open fireToday the options tend to be a level access shower (ie a type of wet13 room) for anyoneunable to get13 into a bath There are various aids to help people get13 into and out13 of thebath most13 involving a seat13 that13 can be raised or lower with some bath-shy‐tubs having a door
21
There has been some research into alternative methods of keeping the body clean Sanyointroduced a machine in 1970 modelled on a clothes or dish washing machines the personsits on a seat13 inside the machine where13 they are cleaned by a set13 of water jets These havenot13 proved popular and furthermore require the individual to be transported to themachine Thus the technology may find application in nursing homes but13 are unlikely to beattractive to people living independently in the community
The washing needs of people change over time Over the past13 20 years body piercingshave appeared which have demanded additional attention to avoid the problemsassociated with poor hygiene and metals Similarly hair may be permed and dyed usingchemicals which are much stronger and which might13 damage the hair Add to this thepainting of finger and toe nails and the washing needs are rather different13 to what13 theymight13 have been even ten years ago Finally tattoos were once popular only with sailorsToday they are likely to be found on the arms backs and legs of both men and womenNew ways of cleaning these tattoos will be needed especially if they become infected orare sites at which pressure sores develop
Even if a personrsquos body is clean if their clothes are dirty they may become socially isolatedBut13 the washing of clothes can be strenuous even if a launderette is used The need toconserve water has driven research into ultrasound techniques to beat13 the dirt13 out13 ofclothing while some companies are experimenting with polymer chips These13 ldquogreenrdquo13 technologies are quickly maturing and are likely to be standard in the next 10 years
Other smart13 household appliances are already appearing on the market13 and may soonbecome common13 in UK homes13
bull Robovac devices have sensors to enable them to detect13 dirt13 on carpets and to adjust13 their operation accordingly
bull Refrigerators can read bar codes or RFID tags to identify their contents and theirldquouse byrdquo13 dates enabling them to inform the owner that13 they should use theproducts before they are out13 of date They can be linked to the Internet13 to reorderitems as they are consumed or to suggest13 menu options for the individual based ontheir preferences or according to the diet13 required to manage a condition
bull Ovens will automatically switch off if they are left13 without13 attention for too longand drying machines will set13 times automatically
Devices may be linked so that13 they are more efficient and report13 maintenance issues sothat13 they can be repaired (perhaps remotely) before they suffer a catastrophic breakdown
219 Personal and home13 security
It might13 appear perverse but13 people with very little personal wealth and property are morelikely to be the victims of crime than those who have expensive items This may be due towhere poorer people tend to live or because people who have valuable assets take greater
22
steps to protect13 them There can be no doubt13 that13 crime has a very negative effect13 onindividuals and on their families creating a fear factor that13 may be difficult13 to remove Theimpact13 on quality of life is therefore very considerable especially if it13 forces people to stayat home behind locked doors effectively isolating themselves from society
Modern policing places increasing reliance on the use of closed circuit13 television (CCTV)Town centres are covered by cameras used increasingly in the fight13 against13 crime by bothdetecting anti-shy‐social incidents and identifying the people involved They are also used tomonitor the movement13 of cars that13 may be involved in incidents of burglary and violenceand are fast13 becoming the primary mechanism of law enforcement13 agencies to solve crime
CCTV has moved into the home to record movement but13 monitoring the footage is timeconsuming and often not13 practical Cameras are now available which provide an instant13 video feed to a smart13 phone when movement13 is detected These may have intercomcapability allowing someone to remotely speak to an intruder sometimes before they havegained access to a building This may serve as a deterrent13 and when fitted alongside simpledevices that13 switch lights on randomly around the home may force burglars to goelsewhere
As the price of cameras continues to fall the option of carrying a camera13 on the body that13 continuously monitors personal space is becoming more useful Using wireless networksthe data13 collected can be sent13 continuously to the cloud for safe storage It cansubsequently be retrieved to provide evidence (video and audio) of confrontations enablingsuccessful prosecutions to be made The smart13 phone itself is becoming a valuable itemthat13 is attractive to criminals These can be tethered to personal attack buttons usingwireless technology allowing the device to be activated by the pressing of a button if theowner is being attacked The phones can then be tracked and located by the police whilebeing rendered useless to the assailant
Bogus callers are a perennial problem for vulnerable people Video door bells can beconfigured to display images and record the words of visitors before they are admittedallowing remote monitoring centres to oversee the situations and use image recognitionsoftware to confirm the bona13 fide of visitors Such13 arrangements may become13 commonplace13 over13 the13 next five13 or13 six years13 significantly13 improving the safety of peopleliving independently
220 Personal safety
The biggest13 risks to personal safety stem from fires and falls Most13 fires are the result13 ofpoor cooking practices resulting in burns or scalds Floods and gas emissions are caused bya failure to remember to close taps
The current13 approach involves detection of an emergency situation as soon as possible but13 always after a problem has already occurred This responsive approach can minimise therisks provided that13 there is a protocol in place for intervening This could increasingly be an
23
automated response such as the switching off of the gas of water or the switching on of asprinkler system or a water mist13 system
In the future monitoring systems will be more sophisticated and will have sensors and localintelligence to identify activities In this way reminders can be issued before an emergencyoccurs13 This lsquosmart kitchenrsquo approach may become13 an integral part of13 homes of13 vulnerable13 people
A prototype system has been developed at the Culture Lab in Newcastle Sensors havebeen embedded into cooking utensils enabling the kitchen to identify what13 the person istrying to cook or prepare It can provide interventions as messages on an instructionscreen
Accidents also occur out13 of doors People with dementia13 might13 become lost13 and may havepoor road safety awareness Location devices based on GPS have advanced from large andheavy receivers that13 were used on ships and boats to small battery-shy‐operated devices that13 can be carried in the hand or in a handbag The current13 generation of locators has limitedbattery life and are rather too large to be secreted about13 a personrsquos clothing while devicesthat13 are integrated into a wrist-shy‐watch are rather clunky and unattractive
Within 10 years the13 technologies13 will have13 matured and will be13 much smaller13 so that theycan be embedded in shoes in walking sticks hats or any other item of clothing Powerrequirements will have reduced so that13 energy harvesting from the movements of theindividual will be sufficient13 to keep these products working for several weeks without13 theneed for recharging The devices will not13 simply indicate to others where the individualhappens to be but13 will provide subtle guidance cues to direct13 them home
Cameras might13 also form part13 of the personal security systems that13 will protect13 people fromaccidents Data13 may be sent13 to the cloud and analysed in real time if the person is in adangerous location and can provide prompts either to the individual or broadcast13 advice toothers to clear the danger These systems may be embedded in items of clothing (such as ahat) or they may be attached to spectacles
221 Energy and13 portable power supplies
The demands of developing economies for more power will inevitably lead to higherdomestic fuel charges in the UK especially as oil and gas reserves dwindle
By 2018 UK homes should be fitted with new smart13 meters The specifications for these13 devices have yet13 to be finalised but13 will include a means of identifying wasteful use ofenergy including TV sets that13 are left13 on and unattended fridges and freezers that13 are set13 attoo low temperatures and dryers that13 are used for too long or when the weather is suitablefor using a washing line They could be an enabling factor that13 supports changes inbehaviour driven by a need to use less power but13 it13 is unlikely that13 they will offer a bigreduction in costs that13 are already a problem for many vulnerable families
24
More generally the need for power conservation will include devices that13 are moreefficient and a significant13 emphasis on heat13 retention in buildings through betterinsulation
The energy crisis may force many people to spend more time in community settingsincluding shops and public buildings where they can benefit13 from the warmth Increasingreliance on mobile communication devices will lead to increasing demand for batterycharging facilities
Greater use may be made of portable devices for generating power based on solar cellswind or hand motion
222 Smart cities and homes
The Digital City initiatives have been based on information and how it13 can be used most13 effectively to make people aware of what13 is going on around them This means bettercoordination of resources more rapid access to advice and a battery of sensors measuringevery conceivable parameter from sound and light13 levels through to air quality andtemperature fluctuations There are several Digital or Smart13 City initiatives currently beingimplemented both in the UK and across the world They may significantly impact13 the livesof the millions of people living in them but13 the timeframe for outcome benefits to influenceplanning and design elsewhere is likely to be at least13 20 years and therefore outside thetimeframe of the current13 project
Housing plays a big role in the lives of most13 people both through their aspirations to moveup in the world (usually to a bigger property with a garden) and as the heart13 of the familylife which is associated with good quality of life UK properties have a life span approaching100 years which is about13 double that13 of their European counterparts (and certainly longerthan the wooden-shy‐frame buildings built13 in North America13 for example) A shortage ofhouses has plagued improvements in social welfare for the past13 30 years There is anargument13 that13 there are enough houses but13 the wrong size and in the wrong places andthis has some basis in fact13 as demography changes lead to more people (and more olderpeople) living alone However if there are two million homes in Scotland each with alifespan of 100 years then the renewal rate needs only to be 20000 per annum to maintainthe status quo However it13 must13 be clear that13 the impact13 of smart13 house development13 willbe small The focus should therefore be on adapting existing properties to render themmore appropriate for vulnerable people
Housing adaptations are a branch of assistive technologies The technologies for providingdifferent13 forms of accessible bath and level access shower are well-shy‐established with littleresearch considering anything other than alternative building materials and methods formaintaining the temperature of the bathwater Different13 technologies for bathing will beconsidered separately
25
Thus housing technologies are not likely to impact on social work13 within the next 20years13 though13 the use of information13 technology13 to ensure that people are aware of what13 is available is likely to be commonplace well before then
26
3 BEHAVIOUR AND ATTITUDE CHANGES DUE TO TECHNOLOGICALADVANCES
Technology is only one factor that13 will affect13 the way society changes in the next13 10 or 15years This chapter will consider the context13 in which the technological developmentsoutlined in the previous chapter will be supported (or held back) by societal factors
When the impact13 of such factors has been considered we can then apply theseassumptions to a number of case studies listed in Appendix13 A13
The headings selected for this chapter are not13 arbitrary as they reflect13 the context13 in whichtechnological changes must13 be considered They must13 include consideration of factors suchas demography and long-shy‐term conditions already addressed in the introduction to thesepapers together with the aspects of workforce and citizenship considered in the parallelpapers The additional elements here focus on trends that13 are already occurring and whichmay leave people struggling with the changes that13 occur
Finally there is a need to consider the attitudes of people to technology generally andespecially to the issues of privacy and social responsibility that13 could be radically changedby technology In some cases public opinion will prevent13 some forms of technology beingdeveloped if not13 commercialised In other cases some technologies will be fast-shy‐trackedeither at the request13 of government13 or because of a clear public demand for theopportunities that13 it13 can bring
Predictions13 about the13 future13 must inevitably be13 subject to considerable13 uncertainty butthat is no reason to stop thinking what might happen
31 The Welfare State
The UK can be rightly proud of the way that13 its welfare state has developed during the past13 100 years to provide a safety net13 of financial support13 to people and to their families whenthey are unemployed destitute homeless or challenged by crises and emergencies Therange of benefits received is considerable some are complex and many people struggle tounderstand their entitlements Some are universal some are discretionary some apply onlyto parents others to anyone
The total cost13 of providing these benefits continues to rise and when the economy isstagnating there is inevitably both political pressure often supported by popular publicopinion to introduce welfare reform so that13 people who do not13 work cannot13 be better offthan they would be if they were in full-shy‐time employment This strategy requires a universalbenefit13 to be introduced so that13 it13 is easier for claimants to access support13 but13 also easierfor agencies to identify the total benefits received The idea13 of a benefits cap then becomes
27
more practical to introduce especially if all the processes involved in making a claim arehandled electronically Indeed this encourages government13 to insist13 on applications forbenefits to be made on-shy‐line Unfortunately this will marginalise those people who haveneither a computer nor access to the internet thus emphasising the digital divide in amanner which works against13 some of the most13 disadvantaged people in society
There are currently few tangible links between digital technology and welfare provisionThe most13 obvious are universal benefits such as a free television licence (worth pound14550)13 for13 everyone aged 75 or older with blind and visually impaired people entitled to a 50discount13 irrespective of their age The significance of this position is that13 6 of revenuesgenerated through licence fees are to fund BBC on-shy‐line services13 such13 as websites and i-shy‐player In Scotland the BBCrsquos Alba Gaelic language television service is predominantlyfunded13 by MG Alba an organisation funded by the Scottish Government It is thereforeconceivable that13 in the future licence fees may be used to directly subsidise access toinformation and advice through the Internet13 for vulnerable people whether it13 is throughbroadband access or through a set-shy‐top box which removes the need for a computer in thehome to access particular websites or to use e-shy‐mail services
A second age-shy‐related benefit13 available in the UK is the winter fuel subsidy People whoreceive certain benefits receive the payments automatically while others must13 make aclaim Those who are not13 eligible for benefit13 due to a lack of an address for example missout13 on these payments and also on Cold Weather payments of pound25 for each seven dayperiod of very cold weather between 1 November and 31 March
The development13 of new warm home initiatives plus the complex of subsidies that13 theelectricity supply industry and government13 offer to people with solar cells further changesthe economic arguments Global warming may lead to greater variations in weatherextremes but13 might13 also increase the amount13 of electricity that13 can be generated byalternative (green) sources such as wind and solar cells It is estimated that13 energyconsumption in the UK increased by 17 between Christmas and Easter 2013 compared toprevious years as a result13 of cold weather but13 the above subsidy scheme did not13 benefit13 older people because two of the seven day cold periods were after 31st March It must13 beassumed that13 there will be more people living in fuel poverty in the future and this will leadto more cases of cold related illness including influenza13 and stroke
32 Management of long term conditions
The management13 of long term conditions will be improved for patients who are compliant13 with their medication regime so it13 is possible that13 there may be compulsion to adhere tothe prescription Such compulsion may be monitored using technology Indeed the remotemonitoring of vital signs using telehealthcare will become commonplace as the old boxesand sensors are replaced by devices that13 can be worn continuously or which can beembedded into the fabric of homes (including furniture and bedding) or can be worn asvests or patches They will wirelessly transmit13 data13 to smartphones or tablets and mobile
28
transmission and cloud technology will enable real-shy‐time data13 collection analysis andfeedback
One of the diseases which is projected to increase most13 significantly over the comingdecade is Type 2 diabetes Whilst13 there is a hereditary susceptibility to this condition formany people including those from the Middle East13 and the Asian sub-shy‐continent it13 is also adisease which tends to affect13 those people who are overweight13 andor have a sedentarylifestyle If untreated diabetes can lead to dizziness and collapse at any time but13 can alsohave more devastating long term consequences which include kidney failure strokeblindness and in extreme cases lower limb amputations Management13 therefore includesdaily monitoring of blood glucose levels and major dietary changes such as a significant13 reduction in the consumption of carbohydrates as well as a rigid exercise regime
Many newly diagnosed diabetics follow this advice closely and can lead normal lives for 40years or more but13 some struggle to accept13 the change in lifestyle required as well asremembering which foods are allowed and how much exercise they need to takeIndividual support13 plans are now forthcoming and over the next13 ten years best13 practicewill emerge in the form of smartphone apps that13 are personalised and which can becomean individualrsquos health coach This level of support13 will be fine for some people but13 otherswill need incentives so it13 is likely that13 gaming technologies will be introduced perhapsoffering rewards for good compliance There will be a temptation for some people tocheat perhaps allowing others to perform exercise for them or changing theirconsumption details
Many of these opportunities for cheating will be removed through the use of a uniquebiometric identifier a technology that13 will be mature enough to use in place of passwordson smartphones However the biggest13 challenge may be in encouraging older people to usethe technology Many older people have multiple morbidities Indeed a survey of Scottishpatients implied that13 42 of people aged over 80 will suffer from three long termconditions It will be essential for those people to comply with treatment13 regimes if they arenot13 to have the functional deficits that13 follow
33 Finding people who13 donrsquot fit
People who have low social capital are likely to have few relatives and friends with whomthey regularly communicate and are also unlikely to be part13 of community or faithorganisations such as clubs societies and church groups They also die several yearsyounger than most13 of the population often because they donrsquot13 engage with public healthinitiatives such as vaccinations against13 flu regular checks on their blood pressure bloodsugar levels or in the case of women smear tests or mammography The most13 likelyreason for disappearing beneath the radar of such initiatives is their mobility which leadsalmost13 inevitably to them having no fixed abode and no fixed telephone line It thenbecomes very difficult13 for them to be contacted because their mobile telephones are likelyto have Pay-shy‐As-shy‐You-shy‐Go contracts that13 donrsquot13 require validated names addresses and bankaccounts
29
It follows that13 some of the most13 vulnerable people in society including those who live onthe streets are effectively unknown to both the NHS and to social work departments untilthey are referred in a crisis This could be an emergency presentation to a hospital Accident13 and Emergency Department13 where they will come into contact13 with a social worker becausedischarge may be unsafe This often highlights the importance of the prevention agenda13 and the potential for avoiding admissions to hospital by intervening at an earlier stage
The advantages of being able to locate people who are vulnerable to specific diseases willincrease as genetic testing becomes more routine It is already possible to determine whomight13 be most13 at risk of breast13 cancer and prostate cancer as a result13 of family history Addto this the evidence that13 particular diet13 and exposure to environmental factors can furtherincrease risk then it13 is evident13 that13 individuals can be identified and offered treatmentsthat13 could save their lives many years before they become ill In the case of cancersperhaps only the individual is involved but13 for infectious diseases it13 is the whole of societythat13 is at risk if someone contracts one of the new strains of influenza or if someonechooses not13 to be vaccinated against13 rubella In Chinese airports all visitors are screenedfor fever and refused entry if they tested positive in cities the public are monitored in thesame way Similar approaches may be necessary in the UK if potential carriers cannot13 otherwise be identified
34 Volunteering
It is estimated that13 72 per cent13 of people volunteered to perform a charitable act13 at least13 once during 2012 a rise from 65 per cent13 the previous year About13 four out13 of every 10volunteers offer their services formally to one or more organisations The remaindervolunteer informally by helping out13 a friend or a neighbour Around 50 per cent13 volunteered at least13 once a month in the past13 year up from 41 per cent13 on the previous13 year Most13 have retired many of them before the statutory retirement13 age Those whodonrsquot13 feel able to offer time have offered their financial support13 at a time when the fundingavailable from sources such as the National Lottery has been decreasing Despite economicausterity donations to charities have been increasing 74 per cent13 said they had given tocharity at least13 once in the previous month up from 72 per cent13 the previous year
Strikingly 78 per cent13 of people strongly believe that13 they are part13 of their localneighbourhood an increase from 70 per cent13 10 years previously Community cohesion isstronger than ever 87 per cent13 of people believe their local area13 is a place where peoplefrom different13 backgrounds get13 on well together compared to 80 per cent13 in 2003
The role of volunteers in supporting vulnerable people is therefore likely to increase overthe next13 decade perhaps exploiting the success of the army of volunteers that13 was highlysuccessful in London during the Olympic and Paralympic games The greatest13 role for suchvolunteers may be in providing informal care for older people Already the UK has someseven million informal carers whose value in monetary terms has been calculated to be
30
more than the combined budgets of the NHS and social care Maintaining or extending thisprovision will help to support13 services in the future and may be supported by technology
Whilst13 there is ample evidence to suggest13 that13 telecare services support13 informal carers asmuch as (if not13 more than) the people that13 they are caring for it13 is the potential for utilisingthe internet13 and apps to make their role easier to coordinate and hence more effectivethat13 is likely to be most13 successful moving forward
Many of these focus on particular tasks that13 informal carers can help offer to older peoplesuch as organising their medication A pillbox program is just13 one feature of an app calledBalance It also includes sections for caregiving tips notes for the doctor and the patientsappointments plus a lsquolearning sectionrsquo with articles on aspects of Alzheimers and an RSSfeed for news about13 the disease Tyze is another multi-shy‐functional app it13 allows carers to
bull Organise appointmentsbull Plan outingsbull Share storiesbull Send updates to other family members
Another application is Rally Round which helps carers to organise someone to perform littlejobs often on a temporary basis when someone has dementia physical frailty or isrecovering from accident13 or illness Similar applications are MeMaxi and Finerday
35 The High13 Street
The shape and appearance of UK shopping centres have been changing for half a centuryPeople complain that13 centres are losing their identity with one town looking like everyother both in terms of the stores and in terms of the layout But13 there are three trendswhich are having a profound impact13 on many of the most13 vulnerable people in society
bull Centres lock their doors at 6pm or in some cases 10pm -shy‐ thus denying people whosuffer from claustrophobia13 from window shopping at times when other shoppershave left
bull Out13 of town shopping malls -shy‐ these US style centres are ideal for people in carsbecause they offer free parking which is essential for people who want13 to buy largeritems but13 difficult13 for people who have no transport13 and who must13 rely on publictransport13 that13 is often deficient
bull The rise of online shopping -shy‐ which means that13 many potential shoppers only visit13 High Street13 stores to check the prices before returning home to make a purchaseonline
It is the third of these effects that13 has the greatest13 potential for changing the High Street13 forever and it13 is making life for traditional retailers increasingly difficult13 at a time when highrents are crippling stores large and small It is difficult13 to see how this trend is likely tochange because consolidation in banking and estate agencies is already forcing the closure
31
of other High Street13 players while additional pressures on pubs has led to the closure ofthousands of pubs every year
Those figures however demonstrate that13 consumers still value what13 the high street13 canoffer -shy‐ the chance to inspect13 what13 theyrsquore thinking of buying -shy‐ as well as the new opennessof the internet Customer service makes a difference to people especially if there is aproblem and goods need to be returned One of the most13 common reasons for furniture tobe returned for example is that13 when a sofa13 or a wardrobe was delivered it13 couldnrsquot13 fit13 through the front13 door or up the stairs In the future people will be able to benefit from13 visualisation technology they will upload the floor plans of their homes enabling theretailer to inform them of the problem before they try to delivery Augmented reality viewwill similarly allow customers to see what13 a new item of furniture will look like in itsintended place so that13 they can be more informed about13 the effect13 of size and colour
In terms of improving the viability of the High Street stores will have to focus on theimportance of brand which could mean that13 individual independent13 retailers will have topartner with national suppliers to support13 a local tailored offering based on products that13 are designed for a more global market This is a lsquoconnected High Streetrsquo approach whichcould be enabled by the developments in internet13 availability and smart13 phone accessdescribed in the previous section
The overall effect13 of all these changes could mean that13 town centres become smaller but13 more vibrant13 areas They could thrive if people are attracted there in large numbers whichmeans that13 retail must13 be developed alongside restaurants pubs galleries and other leisureopportunities This is possible in new shopping centres which are already being integratedwith transport13 hubs including railway and bus stations but13 may be more of a design13 challenge for older towns and cities with large Victorian buildings To ensure that13 morepeople are welcomed into the new centres they should include attention to green spacesand areas where people can relax without13 feeling that13 they are second class citizensbecause they donrsquot13 have the same buying power
3513 Privacy
To some people privacy is their right13 to live their lives without13 interference they may seethe State as a potential lsquoBig Brotherrsquo spying on their every move and judging their actions13 and activities Other people have fewer concerns about13 the role of the State but13 great13 fearof individuals interfering with and invading their privacy Some embrace the concept13 of lsquomyspacersquo an area13 of a square metre or so into which nobody can enter without13 permissionThis allows them to avoid physical contact13 and to feel safe from any form of threateningbehaviour
Yet13 this idea13 of private space and its potential violation is merely the tip of the iceberg asfar as privacy is concerned more significant13 is the idea13 of personal (and private)information being shared with anyone and everyone This could be related to identityopinion or image for an individual who wants to remain anonymous or even secretive thisis going to become an increasing problem as technology provides the means of taking
32
photographs recording conversations and capturing environment13 with something as smalland ubiquitous as a mobile phone The fact13 that13 this information can then be shared withthe rest13 of the world using e-shy‐mail Twitter and Facebook makes the problem all the moredifficult So the threat13 is no longer solely from the long lenses of the Paparazzi but13 fromanyone (and that13 means everyone) who has even the most13 basic of mobile phones
This relates to the changing views of society on what13 information should remain privateand what13 should be shared with others The success of social media13 has been based on anattitude of lsquosharing everythingrsquo with either your friends or the world This has introduced anaiumlve idea13 in the minds of some younger people (especially those known as Millennials ieaged 18-shy‐30) that13 everyone can be their friends whilst13 perhaps failing to reinforce the bondsof genuine friendship with any form of test13 or restriction Technology could play a role indefining these friendships and allowing individuals to understand what13 makes a goodfriend but13 this approach has yet13 to be developed and may be slow to overcome the needfor some people to measure their own popularity simply as the number of people that13 theycan list13 as friends on their Facebook page
It follows that13 there may be a need for a new definition of privacy that13 is in keeping withthe web and its ability to display images and opinion in an unregulated manner This needsto embrace past13 concerns about13 the ability of an individual to live without13 the threat13 ofothers being able to watch them whilst13 offering some protection from random postingsabout13 them online Perhaps this could include a right13 to be able to edit13 or remove anythingrelating to themselves on the Web including images that13 are not13 news-shy‐worthy Theownership of image rights may be an associated issue that13 needs to be addressedespecially as modern technology can remove an individual from a group (or a background)13 view provide digital touch-shy‐up or air-shy‐brushing and then republish it13 in a different13 contextHowever there is general agreement13 that13 personal information (such as contact13 details andbank codes) should not13 have a place on the web Surprisingly few people take proactivemeasures to prevent13 tracking functions being activated
It follows that13 too much privacy could lead to younger people fearing that13 they maybecome lost13 in a digital world It is not13 surprising then that13 they are prepared to make lots13 of personal information available often with no fear of how it13 might13 be used by othersWhen Google glasses and similar technologies become available during the next13 few yearsthey will have the potential to identify a stranger walking down the street and to find manyof their secrets to present13 to the wearer in a fraction of a second They could know moreabout13 them than their genuine friends know -shy‐ so who will be their friends in the future
36 Data sharing and13 protection
By lsquodata13 sharingrsquo we mean the disclosure of data13 held by one organisation on an individualto a third party organisation(s) or the sharing of data13 between different13 parts of anorganisation Some data13 sharing doesnrsquot13 involve personal data13 because it13 has beenanonymised in such a way that13 the statistics can be used for the collective good without13 theidentification of the individual The Data13 Protection Act13 (DPA) is in place to provide a legal
33
framework that13 ensures that13 organisations that13 hold personal data13 must13 act13 responsibly atall times These principles adequately describe the position of public and government13 bodies especially social services departments who are responsible for the informationconcerning the health and well-shy‐being of individuals -shy‐ and hence by implication thesensitive data13 relating to their vulnerability
The legal framework that13 applies to private and third sector organisations differs from that13 which applies to public sector organisations which may only act13 within the defined limits oftheir statutory powers However all bodies must13 comply fully with the data13 protectionprinciples and this situation is unlikely to change within the next13 10 to 15 years In someprivate sector contexts there are legal constraints on the disclosure of personal dataHowever most13 private and third sector organisations have a general ability to shareinformation provided this does not13 breach the DPA or any other law It is advisable for acompany to check its constitutional documents such as its memorandum and articles13 ofassociation to make sure there are no restrictions that13 would prevent13 it13 from sharingpersonal data13 in a particular context The type of data13 held is therefore a subject13 ofconcern as it13 may be difficult13 for legislation to keep up with the additional layers of data13 created on-shy‐line and through the Internet13 of Things
Private and third sector organisations should have regard to any industry-shy‐specific regulationor guidance about13 handling individualsrsquo information as this may affect13 the organisationrsquosability to share information They should also be aware of the legal issues that13 can arisewhen sharing personal data13 with public sector bodies This becomes more of an issue asprivate and third sector bodies are carrying out13 a wider range of traditionally public sectorfunctions Opportunities for inappropriate sharing of sensitive data13 will therefore inevitablyincrease
Public authorities must13 comply with the Human Rights Act13 (HRA) legislation in theperformance of their functions The HRA also applies to organisations in the private sectorinsofar as they carry out13 functions of a public nature which could include delivering a socialcare activity Where the HRA applies organisations must13 not13 act13 in a way that13 would beincompatible with rights under the European Convention on Human Rights Article 8 of theConvention giving everyone the right13 to respect13 for their private and family life their homeand their correspondence is especially relevant13 to sharing personal data If personal data13 isdisclosed or shared in ways that13 comply with the DPA the sharing or disclosure of that13 information is also likely to comply with the HRA The problem may still be in policing theActs and the rights of an individual if they believe that13 their personal data13 has been sharedor accessed by an inappropriate organisation or individual
A legal industry may be born to deal with such matters but13 this is unlikely to benefit13 peoplewho cannot13 afford the fees involved They would require either legal aid or to employ13 more13 lsquono win no feersquo companies Public attitudes to such costs might13 become negative unlessthey prove successful in preventing breaches of data13 security There may need to belegislation to provide a stronger basis for forcing compliance with privacy laws
34
37 Connecting with13 people
We are social creatures most13 of us rely on our friendships and interactions with friendsand families to share our happiest13 moments and experiences Research suggests that13 thishappiness is infectious at all levels and leads to a 15 increase in the happiness of a closecontact 10 for a second degree contact13 such as the friendrsquos spouse and a 6 increase fora friend of a friend It is hardly surprising that13 the success of social media13 such as Facebookis intimately related to the ability of people to quickly share their happiest13 moments with asmany of their friends and connections as possible
All this has happened during the rise of the Internet13 and the corresponding increase inopportunities for connecting online ie this is a 21st Century phenomenon which has beenfacilitated by Information and Communications Technology But13 the Internet13 remains in itsinfancy and we are only beginning to understand and exploit13 its potential In terms ofaccessing the Internet there are now perhaps two billion people who have access with99 of them having gained this during the past13 decade This number will have doubled bythe period 2020 to 2025 It is likely that13 everyone who wants to be connected in the UK willby then be connected Turning this on its head only those who donrsquot13 want13 to be online willnot13 be on the Internet13 within a decade Connecting with the unconnected will therefore bea case of identifying those people who donrsquot13 want13 to be found unfortunately these mayinclude many people who need the support13 of social care organisations It means that13 theywill be looking for support13 only when they are in crisis unless other ways of finding andormonitoring them are found
While the number of people connected via the Internet13 has exploded this might13 bedwarfed by the number of connected lsquothingsrsquo During 2009 the number of thingsconnected to the Internet13 surpassed the number of connected people at which point13 webegan to experience what13 this report13 has described as the lsquoInternet13 of Thingsrsquo Yet 99 ofall physical objects that13 could join this network are not13 yet13 connected but13 the number couldgrow by 25 every year for the next13 decade so that13 there could be 100 billion connectedobjects by 2025 some of which will be owned or used by everyone in the UK includingthose people who donrsquot13 want13 to be connected themselves We will then have an Internet13 of Everything which will be the smart13 connection of people data events and actions
With each new person object or data13 that13 comes online the connection possibilitiesbetween all these elements grows exponentially The rise of big data mobile networkingcloud storage and data13 mining technologies will all play a critical role in the Internet13 ofEverything The result13 will be new capabilities richer experiences and unprecedentedvalue for individuals businesses communities and countries everywhere The lsquonetworkeffectrsquo of the Internet13 of Everything will be a very powerful thing the true impact13 of whichwe wonrsquot13 fully understand for several years As it13 develops however those who are not13 connected will feel even more digitally and socially excluded There will be a need to reachout13 to vulnerable people unless the process of claiming requires proof of online identityand the payments to be received can only be redeemed using a chipped card or adownloaded app onto a smartphone This is of course the way that13 welfare arrangementsare already developing thus it13 might13 prove impossible to make a successful claim without13
35
already being connected to lsquothe systemrsquo either through an online presence or through theInternet13 of Things
38 Downloading everything
Sixty years ago information was discovered by reading books often in a library wherenotes had to be made because the books or journals couldnrsquot13 be removed Then in theearly 1960s the first13 office photocopying machines were introduced into the UK theyimmediately meant13 that13 pages or articles from books could be copied and taken away to beread and summarised later Within a few years photocopying became a replacement13 forreading as researchers became less adept13 at selecting a few sentences and every deskbecame a depository for reams of printed paper Paper became the means of recordingeverything from bank statements through to music
We now appreciate that13 printing everything is a waste of both the ink (or toner) used tocreate the black print13 and of paper which requires trees to be chopped down and pulpedbefore it13 can be pressed into thin sheets Saving paper is therefore seen as green and goodfor the planet Fortunately we no longer need to print13 everything because computermemory is unlimited thanks to the cloud and we can then view pages and articles onportable or fixed screens
The internet13 has everything and it13 is all available instantly for downloading providing thereis a device available to accept13 it and there is sufficient13 communication bandwidth toperform the transfer of data13 sufficiently quickly Thus we can record all text13 articles that13 are relevant13 to us including digital records of birth certificates qualifications and passportsand the need for original printed versions will decline But13 we can also do this forphotographs Most13 handheld computing devices include at least13 one camera so they cangenerate enormous number of pictures which can be kept13 for posterity without13 having toconsume inks and special papers to print13 them
But13 the materials that13 can be downloaded donrsquot13 stop at pictures software is available that13 can grab TV shows after they air and movies as soon as theyre released In the same wayit13 is possible to schedule music comic books video games and practically anything else asa download with minimal effort People will need enormous hard drives if they want13 theirown digital copies of these files so will more than likely make use of cloud storage that13 willbe available from many organisations The location of the servers may become sensitivedue to border restrictions as will the security of the data13 and the way that13 it13 is backed up sothat13 it13 is resilient13 to failures
It may be evident13 that13 application forms for all types of welfare payment13 will be availableonly for downloading so that once digitised they can be processed by computer andrecords sent13 to various servers for subsequent13 storage and processing Some people maywant13 to keep their data13 on them once it13 has been downloaded Pen drives can already holdseveral GB of data so it13 is likely that13 people will be able to carry their downloaded data13 withthem at all times irrespective of the size and complexities of the information
36
39 Health13 and13 well-shy‐being
The general health of the population is unlikely to deteriorate noticeably within 10 to 20years Indeed expectations of the population are that13 things must13 improve as surgicaltechniques mature and as pharmaceutical interventions become more personalised andpowerful However the rising demand for health services due to an ageing population andthe increasing cost13 of providing sophisticated therapies will make delivering a free anduniversal health service difficult13 without13 substantial increases in taxation This is unlikely tohappen in the UK even though spending on health services will be protected against13 thecuts facing other services
There will have to be changes in how the NHS works For twenty years hospitals have beenclosed and replaced by fewer new facilities so that13 the bed count13 is reduced This has led toa significant13 shift13 in resources to primary care and community care supporting shorter staysin hospital and speedier transfer back home for people after surgery or illness This hasbeen13 successful but13 there remain problems with demand for GP services especially out-shy‐of-shy‐hours and at weekends Indeed despite the introduction of NHS24 and similar help-shy‐linesthe demand for GP appointments continues to increase Delays are inevitable and this willincrease system failures with more unnecessary deaths and a failure for people to access adiagnosis that13 might13 lead to early interventions and ultimately lower delivery costs Over250 more patients are added to waiting lists every day
This will lead to a new model of primary care consistent13 with existing changes which haveseen surgeries move from High Street13 locations to medical centres close to bus routes andwith more parking for patients The process of making an appointment13 is changing from atelephone-shy‐based interview process dominated by a medically-shy‐unqualified receptionist13 to achoose and book approach using an online process linked to electronic patient13 records Thiswill give patients more convenience but13 will allow priority for those who have Internet13 access at the expensive of those who are digitally excluded Making the process of bookingan appointment13 quick and easy may also increase demand from people who do not13 need tobe seen as it13 will fail to identify those in greatest13 need
A greater use of telehealth and telecare technologies will be inevitable beginning with thefirst13 contact13 as an encounter using the telephone e-shy‐mail or video conferencing -shy‐ a visit13 tothe GP surgery should be a last13 resort and should involve a nurse consultation in the first13 instance This would be consistent13 with three quarters of appointments currently involvinga chronic disease or long term condition which relates to improved self-shy‐care The support13 ofthese patients at home should be prioritised through tele-shy‐ and web-shy‐based technologies andshould involve training and coaching through a network of nurse practitioners Home visitsshould generally be unnecessary through the use of these technologies but13 could besupplemented by satellite surgeries manned by nursing in community premises or inpharmacies nurseries and Internet13 cafes
The homes13 of people who13 need13 closer monitoring can then become part13 of virtual wardswith real or electronic visits by health professionals University Hospital Southampton NHSFoundation Trust13 already looks after patients who have undergone surgery such as a hip orknee13 replacements in virtual wards with high levels of satisfaction The Royal Free London
37
NHS Foundation Trust13 offers a similar service but13 plans to add the possibility of videoconsultations between patient13 and consultant
310 Attitudes to public health issues ndash obesity smoking alcohol abuse drugs
As self-shy‐care becomes the focus of the NHS the public will increasingly understand that13 thecosts and availability of services are being harmed by the poor health behaviour ofrelatively small numbers of people The link between public health initiatives today andhealthcare needs and costs in the future will become increasingly evident13 as a result13 of theway that13 information is presented Thus the overweight13 smoker who currently attractsconcern and pity when they are diagnosed with diabetes and COPD is increasingly beingseen as the victim of their own stupidity or lack of self-shy‐discipline If they continue to neglect13 medical advice and continue with an unhealthy lifestyle then the way that13 they receivetreatment13 and consume resources will become a matter for the entire population
Obesity is seen as due to a combination of poor diet13 and a sedentary lifestyle No longer isthe idea13 that13 people are lsquobig bonedrsquo acceptable Governments will respond initially byrequiring manufacturers and food processors to provide nutritional information onpackaging and on menus in restaurants But13 people can choose not13 to read the data13 and toneglect13 both the importance of food quality content13 and quantity This will increasepressure to introduce fat13 or sugar taxes and these are likely to be in force within a decade
Although the high taxes on tobacco products has forced some smokers to reduce theirconsumption or to give up altogether the impact13 has been reduced by the smuggling ofproducts from overseas and by the availability of duty-shy‐free cigarettes for people returningfrom foreign holidays and business meetings Further measures are planned to changepackaging and to include even more graphic images and warnings on cigarette packages tomake smokers aware of the effects of smoking on their health and well-shy‐being There is asyet little evidence of how successful this might13 be More effective has been the banning ofsmoking in public places including trains and aircraft Expensive medical interventions suchas heart13 transplants will be denied to individuals until they change their lifestyle behaviourSmokers might13 therefore be increasingly ostracised leading to a loss of esteem This mayhave a particular impact13 on people who already suffer from mental health problems whoare more likely to smoke
The overuse of alcohol is being recognised as a major factor in hospital admissions withNHS figures showing an increase of over 40 in such admissions over the past13 decadeLinked to this has been a 75 increase in prescriptions to treat13 alcohol dependency Fewpeople have sympathy for those who waste their limited income on booze If they havechildren or other dependents they will be the ones who suffer and who may need thesupport13 of social care
Drug users are already significant13 users of social services as their habit13 is likely to makethem unemployable They receive little sympathy from the general public because they areseen as criminals and people who waste public resources Levels of drug abuse have been
38
slowly increasing over the years but13 this trend is slowly being reversed Indeed the numberof people using drugs during the past13 year has fallen to its lowest13 level for nearly 20 years(below 9) with cannabis being most13 likely often following excessive drinking Aselectronic noses and other technologies can detect13 traces of drugs it13 seems likely that13 success in overcoming addiction can be measured objectively This may become a two-shy‐edged sword rewarding those who can turn around their lives but13 further marginalisingthose who canrsquot13 or wont13 accept13 the lsquocold turkeyrsquo
311 Attitudes to surveillance
Issues associated with privacy confidentiality and data13 security have been discussedpreviously in the context13 of information technology the World Wide Web and the ease ofcollecting recording recalling analysing and displaying data The monitoring of individualsand their methods of using this information can be regarded as surveillance As thequantities of data13 increase along with the number of devices that13 can be used to access itthe surveillance tools will also increase in their sophistication Indeed the Big Data13 approaches described in the previous section will enable the combination of structureddata13 (such as the information held in databases) to be married with unstructured data13 fromimages in such a way that13 it13 can be mined
Whilst13 the lsquodigital surveillancersquo methods described above may cause most13 concern topeople because of its impact13 on anonymity it13 is the collection and analysis of images that13 are the major concern to people as they contemplate the ways that13 lsquoBig Brotherrsquo maydevelop to restrict13 freedom Every major UK city and town centre has an array of CCTVcameras that13 continually record activities from every angle If it13 used to be true that13 nobody in London was more than 10 yards from a rat it13 is certainly the case today that13 nobody can be more than this distance from being in view of a surveillance camera Yetthey receive so much positive publicity from TV programmes where their footage is used todetect13 vehicles close to a crime scene or to monitor the movements of suspects that13 theyare now accepted by the public as a deterrent13 in the same way as lsquobobbies on the beatrsquowere seen 25 years ago There is therefore little public reaction to the expansion in the useof video surveillance except13 for the practical observation of how so many views can beinspected and recorded
Looking to the future the tumbling cost13 of video technology will surely lead to anotherincrease in the number of devices The aerial views taken from towers will besupplemented by more local views taken by devices that13 are embedded in the fabric ofbuildings or carried by individuals either on their person (for example on clothing orspectacles) or in the bags that13 they carry The time and date-shy‐stamped images as Big Datawill be recorded to lsquothe Cloudrsquo where it13 can be added to other data It can then be usedwhen an incident13 has occurred or to provide further detail of night-shy‐time activities
It follows that13 there will be no hiding place for people who simply want13 to disappear Theymay respond by wearing clothing (such as hoodies) that13 hide their faces or which make it13 difficult13 to distinguish gait13 or mannerisms from which they might13 be identified New forms
39
of clothing may be designed to make shapes more difficult13 to analyse and these might13 become the uniforms of a class of person who wants to live in a way that13 they donrsquot13 interact13 with officials from any ministry or local government13 department If they also obstruct13 services then they will be considered to be anarchists of some form sparking protests fromother sectors of society
31213 Attitudes to driving
Motor cars have been a feature of UK roads for over a century but13 it13 is only during the past13 50 years that13 they have become a resource that13 most13 families have had access to enablingthem to travel without13 the restrictions imposed by a limited railway network and non-shy‐integrated bus transport People who have had a car throughout13 their lives often see theircars as an important13 factor in enabling them to remain independent13 and to exercise choicesrelating to where they shop and where they spend their leisure time This extends to theirspouse and to friends and neighbours that13 they might13 take with them on their variousexpeditions
Unfortunately there are incidents involving older drivers who perhaps go down amotorway in the wrong direction who are taken ill at the wheel or who are involved in anaccident13 involving no other vehicles These are small in number but13 often lead to a reactionthat13 they shouldnrsquot13 be allowed to drive lsquoat13 their agersquo Age itself is not13 an indicator ofdriving quality but13 because old age also brings more chance of having limited long termconditions and other illnesses it13 is easy to make a link between driving ability and age Thelicensing system does require continued driving to be linked with medical advice andforbids people with poor eyesight epilepsy and other conditions to hold a licence in oldage
Yet13 statistically older drivers cause far fewer accidents than younger drivers The reasonsfor this may be complex and are likely to include the fact13 that13 they drive less often covershorter distances and donrsquot13 go out13 in the dark or in poor weather However it13 does not13 wholly explain why the UKrsquos drivers aged over 70 and who represent13 some 8 of all driversare involved in only 4 of accidents that13 cause injury This compares favourably with the15 of13 drivers aged between 17 and 29 who are involved in over a third of crashes that13 result13 in injury
By 2020 the number of drivers aged over 70 on UK roads is likely to increase to over 7million This will require a new national strategy perhaps involving support13 for olderdrivers further training raising awareness of issues and making more use of adaptivetechnologies to support13 the driver in avoiding collision or forgetting to check on the statusof their vehicle Poor eyesight13 could be enhanced by camera technologies rather thanforcing people off the road if they are unable to read a licence plate
The International Longevity Centre has found that13 one in four Britons thought13 driversshould be made to switch off the ignition for good somewhere between the ages of 70 and75 The numbers may decrease as the population ages and as cars become safer Forcing
40
older people off the road may be a natural consequence of providing free bus passes andsubsidised rail fares but13 the growth in the pavement13 scooter industry demonstrates that13 older people value their independence and will do almost13 anything to get13 out13 and aboutPerhaps legislation will result13 in more regulation of electric vehicles and where they cantravel
There can be no doubt13 that13 getting out13 will be associated with better quality of life andwell-shy‐being and this is likely to be supported in the future as evidence of improvedoutcomes emerges It is to be hoped that13 positive stories will be publicised so that13 publicattitudes arenrsquot13 hardened This may be supported by more in-shy‐car monitoring of drivers andthe linking of performance with on-shy‐line driving records and licences These could throughremotely monitored ignition systems prevent13 the use of motor vehicles by people without13 a licence or without13 insurance
313 Climate change
There is a general view that13 the emissions of carbon gases are contributing to globalwarming in a manner that13 will change the UK climate in such a way that13 the climate maybecome more Mediterranean However some scientists believe that13 manrsquos impact13 on theenvironment13 may be small compared with natural variations caused for example bycyclical changes in the sunrsquos energy output13 or by the effects of volcanoes and earthquakesRecent13 evidence has suggested that13 we are going through a phase of changing extremesand that13 this is more likely to cause storms periods of excessive rainfall and unusualseasonal trends with snow and frost13 in the spring and warmer winters Considerableuncertainty remains and it13 might13 be necessary to plan for a number of different13 scenariosand for the impact13 on vulnerable people
I Colder winters UK properties are poorly insulated resulting in excess mortalitiesduring cold spells due to an increased number of people suffering from stroke aswell as bronchitis and other pulmonary diseases The cost13 of heating continues toincrease putting more households into a state of fuel poverty Any further coolingduring the winter months will result13 in more people living in unhealthy coldconditions Winter fuel payments are likely to be restricted to the poorest13 peoplebut13 this might13 exclude people who live in larger properties that13 are more difficult13 toheat
II More storms excessive winds and rain can cause flooding at any time of the yearMany UK communities are built13 close to rivers and these can surge during heavyrainfall causing houses to be filled with water and furniture and carpets lostInsurance can be problematic for properties built13 on flood plains which can blight13 properties and prevent13 owners from being able to sell and move on High winds canrip off roofs causing injury and also causing families to be left13 homeless anddependent13 on social services
III Hot13 summers Europe suffered high temperatures during the summers of 2003 and2004 leading to heat13 stroke and hypothermia The UK has not13 previously sufferedfrom such problems but13 might13 be expected to experience days of extreme
41
temperature and humidity at times Older people may not13 be prepared for suchweather Street13 dwellers may be unable to find shade and supplies of drinkingwater
Irrespective of what13 combination of weather scenarios arise it13 must13 be concluded that13 any extremes will have a major negative impact13 on vulnerable people especially if theyare not13 prepared because they havenrsquot13 received the weather warnings and advice that13 can be broadcast13 using the TV radio and online services Once again the digitallyexcluded will suffer and will pay a high cost Society will continue to pick up the bill interms of demands on social care services unless preventive actions are taken in theform of connecting these people to each other and to formal services
42
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
s13 13
13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
n13 13
13 s13
r13 n13
e13 at13
e13 y13 e13 ld13
ly13
13 e13 t13 e13
s13 er13 e13
f13
rt13 13
13 13
13
r13 13
s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
e13 g13 13
e13
13 13 ial13
13
d13
13 d13 h13 r13
d13 13
s13 y13
e13
13
rd13 r13 e13
13
13
13
e13
e13
d13 13
13
13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
pounds in security costs It also avoids the need for healthcare staff to have to go into aprison environment
The principles described above are already saving lives through telestroke services whichlead to more people being thrombolysed appropriately and avoiding long term support13 that13 often follows a stroke incident Teledermatology has been practised for a number of yearsand results in rapid diagnosis and resolution of problems that13 previously required significant13 time for remedy
212 Gadgets and13 DIY13 healthcare
There are at least13 three elements to healthcare
bull Gathering information on symptoms and physiological parametersbull Interpreting the information andbull Responding to the diagnosis with treatment
Many people choose to exercise self-shy‐care because this gives them control whilst13 avoidingthe need to share their concerns and personal details with others A lsquodo It yourselfrsquoapproach might13 even be encouraged by the NHS as a viable way of using scare resources
Medical devices that monitor vital signs are mature and have been miniaturised so that13 they can be used in the home by individuals with little or no medical training Indeed bloodsugar monitors are being produced specifically for use outside the hospital and in such away that13 they can be used reliably by people with advice and training being provided onlinevia13 YouTube
Many medical monitoring devices do no more than produce a single measure which theuser may record or respond to Others link wirelessly to smart13 phones allowing data13 to bestored and entered into a personal health record where trending opportunities existingIndeed individuals can easily enter their data13 into an app running on their laptop tablet13 orsmart13 phone This trending information may be useful13 for self-shy‐care and could be passed onto a physician though the volume of data13 produced in this way and doubts about13 thequality of the data are likely to persuade GPs to discount13 data13 produced in this way
This gap in knowledge can be filled with advice information and diagnosis that13 can beobtained online using a lsquoDoctor Googlersquo approach The quality of such diagnosis may varysignificantly although there are many sources of information that13 are both supported andapproved by the NHS (and by similar sources in other countries) However with a data-shy‐richapproach and a choice of diagnosis people may be empowered to take a greater role inhealthcare
15
The final component13 for the DIY enthusiast13 is the treatment13 option Many people fear longterm use of medication produced by the big pharmaceutical industry and prefer morenatural remedies which are available over the counter More medical treatment13 devicesare available that13 stimulate blood flow and counter pain through the use of electrical andphysical stimulation
The evidence may be weak at present13 but13 might13 grow as more people use them and as theircost13 drops The13 impact13 of13 such technologies13 on vulnerable13 people13 is13 difficult13 to gauge
213 Telecare
Support13 provided at a distance to people in their own homes is known as telecare Thename implies remote monitoring and interaction and includes the monitoring of the homeenvironment13 and of the individual as well as the interaction of the individual with thisenvironment Definitions have become difficult13 due to some US medical devicemanufacturers introducing the term telehealth to describe medical telecare such as remotemeasurement13 and collection of vital signs data
In the UK telecare alarm services have matured quickly using the robust13 platform andinfrastructure of social alarm systems which were originally used by tenants in shelteredhousing schemes to seek help when they didnrsquot13 own a telephone The majority of telecareservice users today live in their own homes and use dispersed alarm units to link with amonitoring centre through the telephone network Improved assessments of needs andrisks to independence have resulted in combinations of sensors being used to support13 theoption of staying put13 rather than moving into residential care or having increasing levels ofdomiciliary support They support13 the policy of bringing care closer to home and ofencouraging people to become partners in their long term support13 arrangements
Telecare services developments over the past13 decade include standalone items such asautomatic lights which have achieved significant13 efficiencies especially for people who arefrail and prone to falling and to those suffering from mild cognitive impairment epilepsyand anxiety People who have long term conditions including chronic conditions such asdiabetes and hypertension can also be managed more effectively through telecare supportThe benefits of telecare services include a relief of stress for family caregivers enablingthem to continue to provide unpaid support13 while holding down a job and maintaining theirquality of life
New developments enable continuous monitoring of behaviour and smart13 devices that13 canfor example remotely control the cooker the water supply and door entry Such13 monitoring may detect13 incidents early and prevent13 emergencies arising Devices arebecoming smaller and easier to embed quickly within the home environment making themmore acceptable and less noticeable Longer battery life means less frequent13 maintenancevisits
16
The13 monitoring13 centre13 becomes13 an information hub13 offering13 both advice13 and a vehicle13 for checking that someone is coping especially following a trigger event such as a stay inhospital or the illness13 of an informal13 carer
New systems utilise web technology that13 allows family members to be more proactive inthe monitoring of their relatives This can lead to greater interaction with them especiallywhen the relatives live a considerable distance away (perhaps in another country) Thesenext13 generation systems might13 include video conferencing and the use of tablets smart13 phones or smart13 TVs but13 when an emergency response is required (perhaps to lift13 someoneup after a non-shy‐injurious fall) there remains a need for human intervention
The13 future13 of13 telecare13 might therefore13 include13 an increasing13 dependence13 on volunteersfrom13 the13 community to provide13 the13 required support Social networking may need to beused13 to support13 telecare technologies
214 Mobile healthcare
While telecare can support13 people effectively in their own homes it13 is now recognised that13 being able to go out13 to enjoy open spaces and to overcome the fear that13 the home is aprison is an important13 part13 of improving well being and supporting a higher quality of lifeExtending telecare technologies to operate outside the home is known as mobile healthcare(or mCare) and is based on mobile telephone networks rather than landlines
The simplest13 form of mCare requires only a basic mobile phone to deliver telephone callsvoice13 messages and SMS (text13 messages) The technology is mature and there are countlessapplications in use both in the UK and in developing countries such as Africa13 and India13 where mobile telephones have already achieved a saturation level and where fixedtelephone infrastructures are not13 likely to be established at any time Such telephones areuniversally available in the UK and are used by the vast13 majority of people including manyolder people especially if they have been introduced to the low cost13 (pound30) devices that13 have large buttons large displays and a separate large button for calling an emergencynumber
Smart13 phones are rapidly replacing basic phones and allow the use of a large range of lsquoappsrsquothat13 are being developed to provide information and for enhanced experiences In thehealthcare space Skype FaceTime Vidyo and GoToMeeting with HD Faces are all current13 examples of video conferencing software available on tablets and smartphones
The specific software will depend on the nature of the communication desired
bull Skype will13 manage a simple video phone callbull Where an AampE physician needs to share a CT scan of head with a Neurologist13 on call
from home GoToMeeting would be more appropriate
17
bull If the physician would rather have a dedicated online meeting room that13 patientsand colleagues can simply drop in for a virtual meeting a Vidyo virtual room may bemore appropriate
This technology can suit13 any form of lifestyle including many people with complex needswhose lifestyle is not13 consistent13 with a fixed address
Social care apps are available already to deal with problems of sensory deficit
bull Guiding a blind person through GPS navigation and reading signs through appslinked to the devicersquos camera13
bull The microphone can be used as a hearing aidbull Speech recognition software can be used either to replay speech at a slower speed
or for translation into a language of choicebull Speech can also be selected for people who have a stammer or who have a problem
with their larynxbull Apps are becoming contextually aware recognising situations and locations and are
thus becoming a personal assistant13 for people with disabilities
By 2020 it is therefore possible that a smartphone may13 be prescribed13 for people who13 need13 social13 care13 together with13 a range of apps that have been13 selected13 to meet13 theirassessed13 needs
Whilst13 smart13 phones tablet13 devices and apps may become an important13 part13 of anindividualrsquos personal support13 armoury the potential of mCare will be limited only by anindividualrsquos ability to make use of all its functions Each device could become a part13 of anindividualrsquos personality supporting them to improve behaviour take exercise avoidtemptation and manage their own health and well-shy‐being Potentially mCare could becomethe most13 important13 element13 of social care and support13 within 10 years
215 Artificial Sensing and Enhancement Devices
bull It is estimated that13 one in seven people has imperfect13 hearingbull The numbers who are born deaf are quite small and many of these people may
have some form of hearing restored through surgery or through technologybull Similarly while there may be nearly a million people registered as blind or having a
severe visual impairment the vast13 majority lose their sight13 during their lives as aresult13 of disease
bull New treatments will deliver sight13 recovery or restoration over the course of the next13 10 to 20 years
Fortunately technology can provide excellent13 sensing capabilities that13 are already providingpeople with external portable devices for enhancing their lives The simple hearing aid is anexcellent13 example of a device which has been improved through both miniaturisation
18
personalisation and enhanced performance Today digital hearing aids use sub-shy‐miniaturemicrophones that13 can be unidirectional or omnidirectional and which can be adjusted insensitivity over an extended range Tomorrowrsquos devices can be switched between modesby the user so that13 they can benefit13 from hearing perfectly in any environment Indeedthey can be used with adaptive filtering technologies (as used by helicopter pilot13 headsets)to eliminate some sounds so that13 the rich speech (or music) components alone remainFuture developments will be on optimising control so that13 the user can switch seamlesslybetween different13 amplification applications without13 appearing to be distracted A smart13 phone or mp3 music player may be used as either a processing unit13 or as a ubiquitousoutput13 device that13 looks cool and natural
These same technologies will also be developed for use within the home environment13 fortimes when a deaf user isnrsquot13 present13 or is asleep Acoustic signatures associated withadverse events and incidents such as the hiss of a gas leak the crackle of a fire the sound ofa smoke detector the drip or a water leak or the sound of breaking glass can be directlyassociated with programmed actions Speech will be recognised interpreted translatedsimplified or displayed so that13 an individual knows what13 is said and can be provided withclear instructions on how to respond
Video cameras have become smaller and cheaper and capable of producing high definitionimages The problem of storing and editing these large image files is being solved by thearrival of cloud computing
Electronic noses are already capable of detecting the quality of wine and fresh fruit Similartechnology will be based in smart13 phones and will be able to analyse the air to warn of13 foodthat is no longer fresh and of other indicators of danger including gases that13 have13 little13 natural13 smell These13 devices13 could support13 people with13 cognitive impairment13 -shy‐ whose13 sense of smell13 tends13 to deteriorate -shy‐ to live independently
Many older and vulnerable people are at risk of hypothermia during the winter Sensordevices can provide warnings of low temperature In the same way heat13 stress can be adanger during the summer months so sensors can alert13 people of the need to openwindows or to operate a fanFinally people who have damaged13 their fingers13 or hands will be able to wear sensorsembedded in artificial skin or in gloves that13 will enable them to identify textures and shapesand be able to dress and undress without13 the assistance of carers
216 Robotics
We may recoil at the idea13 of personal care being delivered by robotic devices but13 it13 is likelythat13 within a decade personal assistants will exist13 to assist13 with household tasks These areunlikely to be humanoid and are more likely to be machines dedicated to helping frailpeople to support13 their own weight13 and to carry trays of food around the home
19
There are four broad classes of robot13 under development13 that13 are likely to mature within 10to 12 years
1 Miniature industrial robots that13 have been programmed to perform specific taskswith precision They are likely to be relatively heavy enabling them to bear weight13 but13 still have the necessary flexibility to carry an individual over short13 distancesplacing them in a chair or on a bed They will have sensors and cameras to provideimmediate feedback and to adjust13 rapidly in response to verbal commands or cues13 from the user Some designs may build on existing assistive devices such as abathroom hoist13 or a bathing aid to become intelligent13 extensions of productsalready on the market A stair lift13 with intelligence is already being designed by a UKcompany and is aimed at providing the user with more control of the journeybetween floors of a house
2 The second group of devices might13 be described as intelligent13 furniture Beds andchairs are already available that13 adjust13 to make the user more comfortable and also13 to help them get13 into or out13 of bed The control units are fairly cumbersome andare suited to operation by a carer Voice activated controls and built-shy‐in intelligencewill give the user more control and independence Other items of furniture to whichintelligence might13 be added would be tables whose height13 can adjust13 and whichhold items of food and medicine securely The table would recognise these objectsand could provide prompts or reminders
3 Mobile robots form the third group These could be goffers that13 can either fetchand carry items such as newspapers drinks or trays or which can accompany theuser when they move between rooms providing them with support13 or prompts Thistype of robot13 could be an intelligent13 walking frame with wheels which13 could13 doubleup as a smart13 wheelchair when necessary
4 Finally there are companion robots These might13 be in the form of an electronicpet typically a cat13 or a dog though the Japanese Paro robot13 is a seal Pets canrespond to stroking and being patted they can also remind their owners that13 theyneed to take exercise and to eat drink and take their medication Various designsare already available which provide feedback but13 future models would includecameras and a screen to provide a mobile means of information and interactionwith other people over the Internet Intelligence within the device could allow themto have a personality of their own and gain knowledge by scraping data13 fromwebsites so that13 they can generate speech and have conversations about13 the newsthe weather or sports results
217 Transport and transfer technologies
Walking is good exercise and is a no-shy‐cost13 form of transport13 that13 is encouraged because of itsimpact13 on well-shy‐being For an individual with a chronic disability or suffering from theeffects of an accident13 or an injury this becomes impractical without13 an assistive technology(AT) A walking stick is the simplest13 example of AT
20
Within the home the stair lift13 has enabled people who live in conventional properties that13 are on two or more floors to continue to use facilities on different13 floors when climbing thestairs has become too difficult This is often the case for people who have arthritis a lowerlimb amputation a long term condition such as Chronic Obstructive Pulmonary Disease orpeople approaching the end of life and who have chosen to die in their own homes
Designs have improved so that13 a curved staircase is no longer an issue and the reliabilityhas reached a level where breakdown is a rare occurrence13 Through-shy‐floor lifts have been analternative proposition but13 they remain too large for most13 properties Alternativeapproaches may emerge using air pressure or water pressure as the driving force ABrazilian design already utilises a plastic tube in which a pod is moved effortlessly up anddown
Electronic wheelchairs are now available that13 allow the individual to become moreindependent13 as they allow the user to control both propulsion and steering Some modelshave the capability of mounting a pavement13 or a step or even a flight13 of stairs Personalmuscle amplification devices have been developed originally with the intention of helpingpeople who are confined to a wheelchair due to a neurological disorder to perform sometasks from a standing position Indeed the Rex walkerrsquos manufacturers claim that13 anyonewho can propel themselves in a wheelchair could walk by using Rex
Other approaches have focused on the rehabilitation of people after major accidents that13 have caused partial paralysis They quickly extend into exoskeleton designs that13 enableanyone to gain a mechanical advantage and thus to tackle physical tasks that13 would not13 otherwise be possible These suits are the focus of major research projects across theworld Some13 products such as the system developed by Honda are being tested inAssisted Living facilities and are likely to become more and more enabling over the next13 decade
Similar benefits are also occurring outside the home with a number of novel carryingsystems appearing over the past13 few years They are generally termed lsquoscootersrsquo but13 thiscovers a wide range of systems and devices ranging from the Segway a device that13 is amobile platform on which the user stands and navigates through to conventional electricvehicles that13 have been developed from golf buggies There remain a number of issuesconcerning their use on roads or on pavements but13 similar problems will need to beresolved for bicycles to play their full part13 in enabling people to get13 more exercise13 Thepotential for hybrid scooters remains
218 Smart domestic appliances and personal hygiene
The bathroom is a dangerous place and one where many older and disabled people slip andsuffer a fall Many older people recall taking a bath in a tin tub in front13 of an open fireToday the options tend to be a level access shower (ie a type of wet13 room) for anyoneunable to get13 into a bath There are various aids to help people get13 into and out13 of thebath most13 involving a seat13 that13 can be raised or lower with some bath-shy‐tubs having a door
21
There has been some research into alternative methods of keeping the body clean Sanyointroduced a machine in 1970 modelled on a clothes or dish washing machines the personsits on a seat13 inside the machine where13 they are cleaned by a set13 of water jets These havenot13 proved popular and furthermore require the individual to be transported to themachine Thus the technology may find application in nursing homes but13 are unlikely to beattractive to people living independently in the community
The washing needs of people change over time Over the past13 20 years body piercingshave appeared which have demanded additional attention to avoid the problemsassociated with poor hygiene and metals Similarly hair may be permed and dyed usingchemicals which are much stronger and which might13 damage the hair Add to this thepainting of finger and toe nails and the washing needs are rather different13 to what13 theymight13 have been even ten years ago Finally tattoos were once popular only with sailorsToday they are likely to be found on the arms backs and legs of both men and womenNew ways of cleaning these tattoos will be needed especially if they become infected orare sites at which pressure sores develop
Even if a personrsquos body is clean if their clothes are dirty they may become socially isolatedBut13 the washing of clothes can be strenuous even if a launderette is used The need toconserve water has driven research into ultrasound techniques to beat13 the dirt13 out13 ofclothing while some companies are experimenting with polymer chips These13 ldquogreenrdquo13 technologies are quickly maturing and are likely to be standard in the next 10 years
Other smart13 household appliances are already appearing on the market13 and may soonbecome common13 in UK homes13
bull Robovac devices have sensors to enable them to detect13 dirt13 on carpets and to adjust13 their operation accordingly
bull Refrigerators can read bar codes or RFID tags to identify their contents and theirldquouse byrdquo13 dates enabling them to inform the owner that13 they should use theproducts before they are out13 of date They can be linked to the Internet13 to reorderitems as they are consumed or to suggest13 menu options for the individual based ontheir preferences or according to the diet13 required to manage a condition
bull Ovens will automatically switch off if they are left13 without13 attention for too longand drying machines will set13 times automatically
Devices may be linked so that13 they are more efficient and report13 maintenance issues sothat13 they can be repaired (perhaps remotely) before they suffer a catastrophic breakdown
219 Personal and home13 security
It might13 appear perverse but13 people with very little personal wealth and property are morelikely to be the victims of crime than those who have expensive items This may be due towhere poorer people tend to live or because people who have valuable assets take greater
22
steps to protect13 them There can be no doubt13 that13 crime has a very negative effect13 onindividuals and on their families creating a fear factor that13 may be difficult13 to remove Theimpact13 on quality of life is therefore very considerable especially if it13 forces people to stayat home behind locked doors effectively isolating themselves from society
Modern policing places increasing reliance on the use of closed circuit13 television (CCTV)Town centres are covered by cameras used increasingly in the fight13 against13 crime by bothdetecting anti-shy‐social incidents and identifying the people involved They are also used tomonitor the movement13 of cars that13 may be involved in incidents of burglary and violenceand are fast13 becoming the primary mechanism of law enforcement13 agencies to solve crime
CCTV has moved into the home to record movement but13 monitoring the footage is timeconsuming and often not13 practical Cameras are now available which provide an instant13 video feed to a smart13 phone when movement13 is detected These may have intercomcapability allowing someone to remotely speak to an intruder sometimes before they havegained access to a building This may serve as a deterrent13 and when fitted alongside simpledevices that13 switch lights on randomly around the home may force burglars to goelsewhere
As the price of cameras continues to fall the option of carrying a camera13 on the body that13 continuously monitors personal space is becoming more useful Using wireless networksthe data13 collected can be sent13 continuously to the cloud for safe storage It cansubsequently be retrieved to provide evidence (video and audio) of confrontations enablingsuccessful prosecutions to be made The smart13 phone itself is becoming a valuable itemthat13 is attractive to criminals These can be tethered to personal attack buttons usingwireless technology allowing the device to be activated by the pressing of a button if theowner is being attacked The phones can then be tracked and located by the police whilebeing rendered useless to the assailant
Bogus callers are a perennial problem for vulnerable people Video door bells can beconfigured to display images and record the words of visitors before they are admittedallowing remote monitoring centres to oversee the situations and use image recognitionsoftware to confirm the bona13 fide of visitors Such13 arrangements may become13 commonplace13 over13 the13 next five13 or13 six years13 significantly13 improving the safety of peopleliving independently
220 Personal safety
The biggest13 risks to personal safety stem from fires and falls Most13 fires are the result13 ofpoor cooking practices resulting in burns or scalds Floods and gas emissions are caused bya failure to remember to close taps
The current13 approach involves detection of an emergency situation as soon as possible but13 always after a problem has already occurred This responsive approach can minimise therisks provided that13 there is a protocol in place for intervening This could increasingly be an
23
automated response such as the switching off of the gas of water or the switching on of asprinkler system or a water mist13 system
In the future monitoring systems will be more sophisticated and will have sensors and localintelligence to identify activities In this way reminders can be issued before an emergencyoccurs13 This lsquosmart kitchenrsquo approach may become13 an integral part of13 homes of13 vulnerable13 people
A prototype system has been developed at the Culture Lab in Newcastle Sensors havebeen embedded into cooking utensils enabling the kitchen to identify what13 the person istrying to cook or prepare It can provide interventions as messages on an instructionscreen
Accidents also occur out13 of doors People with dementia13 might13 become lost13 and may havepoor road safety awareness Location devices based on GPS have advanced from large andheavy receivers that13 were used on ships and boats to small battery-shy‐operated devices that13 can be carried in the hand or in a handbag The current13 generation of locators has limitedbattery life and are rather too large to be secreted about13 a personrsquos clothing while devicesthat13 are integrated into a wrist-shy‐watch are rather clunky and unattractive
Within 10 years the13 technologies13 will have13 matured and will be13 much smaller13 so that theycan be embedded in shoes in walking sticks hats or any other item of clothing Powerrequirements will have reduced so that13 energy harvesting from the movements of theindividual will be sufficient13 to keep these products working for several weeks without13 theneed for recharging The devices will not13 simply indicate to others where the individualhappens to be but13 will provide subtle guidance cues to direct13 them home
Cameras might13 also form part13 of the personal security systems that13 will protect13 people fromaccidents Data13 may be sent13 to the cloud and analysed in real time if the person is in adangerous location and can provide prompts either to the individual or broadcast13 advice toothers to clear the danger These systems may be embedded in items of clothing (such as ahat) or they may be attached to spectacles
221 Energy and13 portable power supplies
The demands of developing economies for more power will inevitably lead to higherdomestic fuel charges in the UK especially as oil and gas reserves dwindle
By 2018 UK homes should be fitted with new smart13 meters The specifications for these13 devices have yet13 to be finalised but13 will include a means of identifying wasteful use ofenergy including TV sets that13 are left13 on and unattended fridges and freezers that13 are set13 attoo low temperatures and dryers that13 are used for too long or when the weather is suitablefor using a washing line They could be an enabling factor that13 supports changes inbehaviour driven by a need to use less power but13 it13 is unlikely that13 they will offer a bigreduction in costs that13 are already a problem for many vulnerable families
24
More generally the need for power conservation will include devices that13 are moreefficient and a significant13 emphasis on heat13 retention in buildings through betterinsulation
The energy crisis may force many people to spend more time in community settingsincluding shops and public buildings where they can benefit13 from the warmth Increasingreliance on mobile communication devices will lead to increasing demand for batterycharging facilities
Greater use may be made of portable devices for generating power based on solar cellswind or hand motion
222 Smart cities and homes
The Digital City initiatives have been based on information and how it13 can be used most13 effectively to make people aware of what13 is going on around them This means bettercoordination of resources more rapid access to advice and a battery of sensors measuringevery conceivable parameter from sound and light13 levels through to air quality andtemperature fluctuations There are several Digital or Smart13 City initiatives currently beingimplemented both in the UK and across the world They may significantly impact13 the livesof the millions of people living in them but13 the timeframe for outcome benefits to influenceplanning and design elsewhere is likely to be at least13 20 years and therefore outside thetimeframe of the current13 project
Housing plays a big role in the lives of most13 people both through their aspirations to moveup in the world (usually to a bigger property with a garden) and as the heart13 of the familylife which is associated with good quality of life UK properties have a life span approaching100 years which is about13 double that13 of their European counterparts (and certainly longerthan the wooden-shy‐frame buildings built13 in North America13 for example) A shortage ofhouses has plagued improvements in social welfare for the past13 30 years There is anargument13 that13 there are enough houses but13 the wrong size and in the wrong places andthis has some basis in fact13 as demography changes lead to more people (and more olderpeople) living alone However if there are two million homes in Scotland each with alifespan of 100 years then the renewal rate needs only to be 20000 per annum to maintainthe status quo However it13 must13 be clear that13 the impact13 of smart13 house development13 willbe small The focus should therefore be on adapting existing properties to render themmore appropriate for vulnerable people
Housing adaptations are a branch of assistive technologies The technologies for providingdifferent13 forms of accessible bath and level access shower are well-shy‐established with littleresearch considering anything other than alternative building materials and methods formaintaining the temperature of the bathwater Different13 technologies for bathing will beconsidered separately
25
Thus housing technologies are not likely to impact on social work13 within the next 20years13 though13 the use of information13 technology13 to ensure that people are aware of what13 is available is likely to be commonplace well before then
26
3 BEHAVIOUR AND ATTITUDE CHANGES DUE TO TECHNOLOGICALADVANCES
Technology is only one factor that13 will affect13 the way society changes in the next13 10 or 15years This chapter will consider the context13 in which the technological developmentsoutlined in the previous chapter will be supported (or held back) by societal factors
When the impact13 of such factors has been considered we can then apply theseassumptions to a number of case studies listed in Appendix13 A13
The headings selected for this chapter are not13 arbitrary as they reflect13 the context13 in whichtechnological changes must13 be considered They must13 include consideration of factors suchas demography and long-shy‐term conditions already addressed in the introduction to thesepapers together with the aspects of workforce and citizenship considered in the parallelpapers The additional elements here focus on trends that13 are already occurring and whichmay leave people struggling with the changes that13 occur
Finally there is a need to consider the attitudes of people to technology generally andespecially to the issues of privacy and social responsibility that13 could be radically changedby technology In some cases public opinion will prevent13 some forms of technology beingdeveloped if not13 commercialised In other cases some technologies will be fast-shy‐trackedeither at the request13 of government13 or because of a clear public demand for theopportunities that13 it13 can bring
Predictions13 about the13 future13 must inevitably be13 subject to considerable13 uncertainty butthat is no reason to stop thinking what might happen
31 The Welfare State
The UK can be rightly proud of the way that13 its welfare state has developed during the past13 100 years to provide a safety net13 of financial support13 to people and to their families whenthey are unemployed destitute homeless or challenged by crises and emergencies Therange of benefits received is considerable some are complex and many people struggle tounderstand their entitlements Some are universal some are discretionary some apply onlyto parents others to anyone
The total cost13 of providing these benefits continues to rise and when the economy isstagnating there is inevitably both political pressure often supported by popular publicopinion to introduce welfare reform so that13 people who do not13 work cannot13 be better offthan they would be if they were in full-shy‐time employment This strategy requires a universalbenefit13 to be introduced so that13 it13 is easier for claimants to access support13 but13 also easierfor agencies to identify the total benefits received The idea13 of a benefits cap then becomes
27
more practical to introduce especially if all the processes involved in making a claim arehandled electronically Indeed this encourages government13 to insist13 on applications forbenefits to be made on-shy‐line Unfortunately this will marginalise those people who haveneither a computer nor access to the internet thus emphasising the digital divide in amanner which works against13 some of the most13 disadvantaged people in society
There are currently few tangible links between digital technology and welfare provisionThe most13 obvious are universal benefits such as a free television licence (worth pound14550)13 for13 everyone aged 75 or older with blind and visually impaired people entitled to a 50discount13 irrespective of their age The significance of this position is that13 6 of revenuesgenerated through licence fees are to fund BBC on-shy‐line services13 such13 as websites and i-shy‐player In Scotland the BBCrsquos Alba Gaelic language television service is predominantlyfunded13 by MG Alba an organisation funded by the Scottish Government It is thereforeconceivable that13 in the future licence fees may be used to directly subsidise access toinformation and advice through the Internet13 for vulnerable people whether it13 is throughbroadband access or through a set-shy‐top box which removes the need for a computer in thehome to access particular websites or to use e-shy‐mail services
A second age-shy‐related benefit13 available in the UK is the winter fuel subsidy People whoreceive certain benefits receive the payments automatically while others must13 make aclaim Those who are not13 eligible for benefit13 due to a lack of an address for example missout13 on these payments and also on Cold Weather payments of pound25 for each seven dayperiod of very cold weather between 1 November and 31 March
The development13 of new warm home initiatives plus the complex of subsidies that13 theelectricity supply industry and government13 offer to people with solar cells further changesthe economic arguments Global warming may lead to greater variations in weatherextremes but13 might13 also increase the amount13 of electricity that13 can be generated byalternative (green) sources such as wind and solar cells It is estimated that13 energyconsumption in the UK increased by 17 between Christmas and Easter 2013 compared toprevious years as a result13 of cold weather but13 the above subsidy scheme did not13 benefit13 older people because two of the seven day cold periods were after 31st March It must13 beassumed that13 there will be more people living in fuel poverty in the future and this will leadto more cases of cold related illness including influenza13 and stroke
32 Management of long term conditions
The management13 of long term conditions will be improved for patients who are compliant13 with their medication regime so it13 is possible that13 there may be compulsion to adhere tothe prescription Such compulsion may be monitored using technology Indeed the remotemonitoring of vital signs using telehealthcare will become commonplace as the old boxesand sensors are replaced by devices that13 can be worn continuously or which can beembedded into the fabric of homes (including furniture and bedding) or can be worn asvests or patches They will wirelessly transmit13 data13 to smartphones or tablets and mobile
28
transmission and cloud technology will enable real-shy‐time data13 collection analysis andfeedback
One of the diseases which is projected to increase most13 significantly over the comingdecade is Type 2 diabetes Whilst13 there is a hereditary susceptibility to this condition formany people including those from the Middle East13 and the Asian sub-shy‐continent it13 is also adisease which tends to affect13 those people who are overweight13 andor have a sedentarylifestyle If untreated diabetes can lead to dizziness and collapse at any time but13 can alsohave more devastating long term consequences which include kidney failure strokeblindness and in extreme cases lower limb amputations Management13 therefore includesdaily monitoring of blood glucose levels and major dietary changes such as a significant13 reduction in the consumption of carbohydrates as well as a rigid exercise regime
Many newly diagnosed diabetics follow this advice closely and can lead normal lives for 40years or more but13 some struggle to accept13 the change in lifestyle required as well asremembering which foods are allowed and how much exercise they need to takeIndividual support13 plans are now forthcoming and over the next13 ten years best13 practicewill emerge in the form of smartphone apps that13 are personalised and which can becomean individualrsquos health coach This level of support13 will be fine for some people but13 otherswill need incentives so it13 is likely that13 gaming technologies will be introduced perhapsoffering rewards for good compliance There will be a temptation for some people tocheat perhaps allowing others to perform exercise for them or changing theirconsumption details
Many of these opportunities for cheating will be removed through the use of a uniquebiometric identifier a technology that13 will be mature enough to use in place of passwordson smartphones However the biggest13 challenge may be in encouraging older people to usethe technology Many older people have multiple morbidities Indeed a survey of Scottishpatients implied that13 42 of people aged over 80 will suffer from three long termconditions It will be essential for those people to comply with treatment13 regimes if they arenot13 to have the functional deficits that13 follow
33 Finding people who13 donrsquot fit
People who have low social capital are likely to have few relatives and friends with whomthey regularly communicate and are also unlikely to be part13 of community or faithorganisations such as clubs societies and church groups They also die several yearsyounger than most13 of the population often because they donrsquot13 engage with public healthinitiatives such as vaccinations against13 flu regular checks on their blood pressure bloodsugar levels or in the case of women smear tests or mammography The most13 likelyreason for disappearing beneath the radar of such initiatives is their mobility which leadsalmost13 inevitably to them having no fixed abode and no fixed telephone line It thenbecomes very difficult13 for them to be contacted because their mobile telephones are likelyto have Pay-shy‐As-shy‐You-shy‐Go contracts that13 donrsquot13 require validated names addresses and bankaccounts
29
It follows that13 some of the most13 vulnerable people in society including those who live onthe streets are effectively unknown to both the NHS and to social work departments untilthey are referred in a crisis This could be an emergency presentation to a hospital Accident13 and Emergency Department13 where they will come into contact13 with a social worker becausedischarge may be unsafe This often highlights the importance of the prevention agenda13 and the potential for avoiding admissions to hospital by intervening at an earlier stage
The advantages of being able to locate people who are vulnerable to specific diseases willincrease as genetic testing becomes more routine It is already possible to determine whomight13 be most13 at risk of breast13 cancer and prostate cancer as a result13 of family history Addto this the evidence that13 particular diet13 and exposure to environmental factors can furtherincrease risk then it13 is evident13 that13 individuals can be identified and offered treatmentsthat13 could save their lives many years before they become ill In the case of cancersperhaps only the individual is involved but13 for infectious diseases it13 is the whole of societythat13 is at risk if someone contracts one of the new strains of influenza or if someonechooses not13 to be vaccinated against13 rubella In Chinese airports all visitors are screenedfor fever and refused entry if they tested positive in cities the public are monitored in thesame way Similar approaches may be necessary in the UK if potential carriers cannot13 otherwise be identified
34 Volunteering
It is estimated that13 72 per cent13 of people volunteered to perform a charitable act13 at least13 once during 2012 a rise from 65 per cent13 the previous year About13 four out13 of every 10volunteers offer their services formally to one or more organisations The remaindervolunteer informally by helping out13 a friend or a neighbour Around 50 per cent13 volunteered at least13 once a month in the past13 year up from 41 per cent13 on the previous13 year Most13 have retired many of them before the statutory retirement13 age Those whodonrsquot13 feel able to offer time have offered their financial support13 at a time when the fundingavailable from sources such as the National Lottery has been decreasing Despite economicausterity donations to charities have been increasing 74 per cent13 said they had given tocharity at least13 once in the previous month up from 72 per cent13 the previous year
Strikingly 78 per cent13 of people strongly believe that13 they are part13 of their localneighbourhood an increase from 70 per cent13 10 years previously Community cohesion isstronger than ever 87 per cent13 of people believe their local area13 is a place where peoplefrom different13 backgrounds get13 on well together compared to 80 per cent13 in 2003
The role of volunteers in supporting vulnerable people is therefore likely to increase overthe next13 decade perhaps exploiting the success of the army of volunteers that13 was highlysuccessful in London during the Olympic and Paralympic games The greatest13 role for suchvolunteers may be in providing informal care for older people Already the UK has someseven million informal carers whose value in monetary terms has been calculated to be
30
more than the combined budgets of the NHS and social care Maintaining or extending thisprovision will help to support13 services in the future and may be supported by technology
Whilst13 there is ample evidence to suggest13 that13 telecare services support13 informal carers asmuch as (if not13 more than) the people that13 they are caring for it13 is the potential for utilisingthe internet13 and apps to make their role easier to coordinate and hence more effectivethat13 is likely to be most13 successful moving forward
Many of these focus on particular tasks that13 informal carers can help offer to older peoplesuch as organising their medication A pillbox program is just13 one feature of an app calledBalance It also includes sections for caregiving tips notes for the doctor and the patientsappointments plus a lsquolearning sectionrsquo with articles on aspects of Alzheimers and an RSSfeed for news about13 the disease Tyze is another multi-shy‐functional app it13 allows carers to
bull Organise appointmentsbull Plan outingsbull Share storiesbull Send updates to other family members
Another application is Rally Round which helps carers to organise someone to perform littlejobs often on a temporary basis when someone has dementia physical frailty or isrecovering from accident13 or illness Similar applications are MeMaxi and Finerday
35 The High13 Street
The shape and appearance of UK shopping centres have been changing for half a centuryPeople complain that13 centres are losing their identity with one town looking like everyother both in terms of the stores and in terms of the layout But13 there are three trendswhich are having a profound impact13 on many of the most13 vulnerable people in society
bull Centres lock their doors at 6pm or in some cases 10pm -shy‐ thus denying people whosuffer from claustrophobia13 from window shopping at times when other shoppershave left
bull Out13 of town shopping malls -shy‐ these US style centres are ideal for people in carsbecause they offer free parking which is essential for people who want13 to buy largeritems but13 difficult13 for people who have no transport13 and who must13 rely on publictransport13 that13 is often deficient
bull The rise of online shopping -shy‐ which means that13 many potential shoppers only visit13 High Street13 stores to check the prices before returning home to make a purchaseonline
It is the third of these effects that13 has the greatest13 potential for changing the High Street13 forever and it13 is making life for traditional retailers increasingly difficult13 at a time when highrents are crippling stores large and small It is difficult13 to see how this trend is likely tochange because consolidation in banking and estate agencies is already forcing the closure
31
of other High Street13 players while additional pressures on pubs has led to the closure ofthousands of pubs every year
Those figures however demonstrate that13 consumers still value what13 the high street13 canoffer -shy‐ the chance to inspect13 what13 theyrsquore thinking of buying -shy‐ as well as the new opennessof the internet Customer service makes a difference to people especially if there is aproblem and goods need to be returned One of the most13 common reasons for furniture tobe returned for example is that13 when a sofa13 or a wardrobe was delivered it13 couldnrsquot13 fit13 through the front13 door or up the stairs In the future people will be able to benefit from13 visualisation technology they will upload the floor plans of their homes enabling theretailer to inform them of the problem before they try to delivery Augmented reality viewwill similarly allow customers to see what13 a new item of furniture will look like in itsintended place so that13 they can be more informed about13 the effect13 of size and colour
In terms of improving the viability of the High Street stores will have to focus on theimportance of brand which could mean that13 individual independent13 retailers will have topartner with national suppliers to support13 a local tailored offering based on products that13 are designed for a more global market This is a lsquoconnected High Streetrsquo approach whichcould be enabled by the developments in internet13 availability and smart13 phone accessdescribed in the previous section
The overall effect13 of all these changes could mean that13 town centres become smaller but13 more vibrant13 areas They could thrive if people are attracted there in large numbers whichmeans that13 retail must13 be developed alongside restaurants pubs galleries and other leisureopportunities This is possible in new shopping centres which are already being integratedwith transport13 hubs including railway and bus stations but13 may be more of a design13 challenge for older towns and cities with large Victorian buildings To ensure that13 morepeople are welcomed into the new centres they should include attention to green spacesand areas where people can relax without13 feeling that13 they are second class citizensbecause they donrsquot13 have the same buying power
3513 Privacy
To some people privacy is their right13 to live their lives without13 interference they may seethe State as a potential lsquoBig Brotherrsquo spying on their every move and judging their actions13 and activities Other people have fewer concerns about13 the role of the State but13 great13 fearof individuals interfering with and invading their privacy Some embrace the concept13 of lsquomyspacersquo an area13 of a square metre or so into which nobody can enter without13 permissionThis allows them to avoid physical contact13 and to feel safe from any form of threateningbehaviour
Yet13 this idea13 of private space and its potential violation is merely the tip of the iceberg asfar as privacy is concerned more significant13 is the idea13 of personal (and private)information being shared with anyone and everyone This could be related to identityopinion or image for an individual who wants to remain anonymous or even secretive thisis going to become an increasing problem as technology provides the means of taking
32
photographs recording conversations and capturing environment13 with something as smalland ubiquitous as a mobile phone The fact13 that13 this information can then be shared withthe rest13 of the world using e-shy‐mail Twitter and Facebook makes the problem all the moredifficult So the threat13 is no longer solely from the long lenses of the Paparazzi but13 fromanyone (and that13 means everyone) who has even the most13 basic of mobile phones
This relates to the changing views of society on what13 information should remain privateand what13 should be shared with others The success of social media13 has been based on anattitude of lsquosharing everythingrsquo with either your friends or the world This has introduced anaiumlve idea13 in the minds of some younger people (especially those known as Millennials ieaged 18-shy‐30) that13 everyone can be their friends whilst13 perhaps failing to reinforce the bondsof genuine friendship with any form of test13 or restriction Technology could play a role indefining these friendships and allowing individuals to understand what13 makes a goodfriend but13 this approach has yet13 to be developed and may be slow to overcome the needfor some people to measure their own popularity simply as the number of people that13 theycan list13 as friends on their Facebook page
It follows that13 there may be a need for a new definition of privacy that13 is in keeping withthe web and its ability to display images and opinion in an unregulated manner This needsto embrace past13 concerns about13 the ability of an individual to live without13 the threat13 ofothers being able to watch them whilst13 offering some protection from random postingsabout13 them online Perhaps this could include a right13 to be able to edit13 or remove anythingrelating to themselves on the Web including images that13 are not13 news-shy‐worthy Theownership of image rights may be an associated issue that13 needs to be addressedespecially as modern technology can remove an individual from a group (or a background)13 view provide digital touch-shy‐up or air-shy‐brushing and then republish it13 in a different13 contextHowever there is general agreement13 that13 personal information (such as contact13 details andbank codes) should not13 have a place on the web Surprisingly few people take proactivemeasures to prevent13 tracking functions being activated
It follows that13 too much privacy could lead to younger people fearing that13 they maybecome lost13 in a digital world It is not13 surprising then that13 they are prepared to make lots13 of personal information available often with no fear of how it13 might13 be used by othersWhen Google glasses and similar technologies become available during the next13 few yearsthey will have the potential to identify a stranger walking down the street and to find manyof their secrets to present13 to the wearer in a fraction of a second They could know moreabout13 them than their genuine friends know -shy‐ so who will be their friends in the future
36 Data sharing and13 protection
By lsquodata13 sharingrsquo we mean the disclosure of data13 held by one organisation on an individualto a third party organisation(s) or the sharing of data13 between different13 parts of anorganisation Some data13 sharing doesnrsquot13 involve personal data13 because it13 has beenanonymised in such a way that13 the statistics can be used for the collective good without13 theidentification of the individual The Data13 Protection Act13 (DPA) is in place to provide a legal
33
framework that13 ensures that13 organisations that13 hold personal data13 must13 act13 responsibly atall times These principles adequately describe the position of public and government13 bodies especially social services departments who are responsible for the informationconcerning the health and well-shy‐being of individuals -shy‐ and hence by implication thesensitive data13 relating to their vulnerability
The legal framework that13 applies to private and third sector organisations differs from that13 which applies to public sector organisations which may only act13 within the defined limits oftheir statutory powers However all bodies must13 comply fully with the data13 protectionprinciples and this situation is unlikely to change within the next13 10 to 15 years In someprivate sector contexts there are legal constraints on the disclosure of personal dataHowever most13 private and third sector organisations have a general ability to shareinformation provided this does not13 breach the DPA or any other law It is advisable for acompany to check its constitutional documents such as its memorandum and articles13 ofassociation to make sure there are no restrictions that13 would prevent13 it13 from sharingpersonal data13 in a particular context The type of data13 held is therefore a subject13 ofconcern as it13 may be difficult13 for legislation to keep up with the additional layers of data13 created on-shy‐line and through the Internet13 of Things
Private and third sector organisations should have regard to any industry-shy‐specific regulationor guidance about13 handling individualsrsquo information as this may affect13 the organisationrsquosability to share information They should also be aware of the legal issues that13 can arisewhen sharing personal data13 with public sector bodies This becomes more of an issue asprivate and third sector bodies are carrying out13 a wider range of traditionally public sectorfunctions Opportunities for inappropriate sharing of sensitive data13 will therefore inevitablyincrease
Public authorities must13 comply with the Human Rights Act13 (HRA) legislation in theperformance of their functions The HRA also applies to organisations in the private sectorinsofar as they carry out13 functions of a public nature which could include delivering a socialcare activity Where the HRA applies organisations must13 not13 act13 in a way that13 would beincompatible with rights under the European Convention on Human Rights Article 8 of theConvention giving everyone the right13 to respect13 for their private and family life their homeand their correspondence is especially relevant13 to sharing personal data If personal data13 isdisclosed or shared in ways that13 comply with the DPA the sharing or disclosure of that13 information is also likely to comply with the HRA The problem may still be in policing theActs and the rights of an individual if they believe that13 their personal data13 has been sharedor accessed by an inappropriate organisation or individual
A legal industry may be born to deal with such matters but13 this is unlikely to benefit13 peoplewho cannot13 afford the fees involved They would require either legal aid or to employ13 more13 lsquono win no feersquo companies Public attitudes to such costs might13 become negative unlessthey prove successful in preventing breaches of data13 security There may need to belegislation to provide a stronger basis for forcing compliance with privacy laws
34
37 Connecting with13 people
We are social creatures most13 of us rely on our friendships and interactions with friendsand families to share our happiest13 moments and experiences Research suggests that13 thishappiness is infectious at all levels and leads to a 15 increase in the happiness of a closecontact 10 for a second degree contact13 such as the friendrsquos spouse and a 6 increase fora friend of a friend It is hardly surprising that13 the success of social media13 such as Facebookis intimately related to the ability of people to quickly share their happiest13 moments with asmany of their friends and connections as possible
All this has happened during the rise of the Internet13 and the corresponding increase inopportunities for connecting online ie this is a 21st Century phenomenon which has beenfacilitated by Information and Communications Technology But13 the Internet13 remains in itsinfancy and we are only beginning to understand and exploit13 its potential In terms ofaccessing the Internet there are now perhaps two billion people who have access with99 of them having gained this during the past13 decade This number will have doubled bythe period 2020 to 2025 It is likely that13 everyone who wants to be connected in the UK willby then be connected Turning this on its head only those who donrsquot13 want13 to be online willnot13 be on the Internet13 within a decade Connecting with the unconnected will therefore bea case of identifying those people who donrsquot13 want13 to be found unfortunately these mayinclude many people who need the support13 of social care organisations It means that13 theywill be looking for support13 only when they are in crisis unless other ways of finding andormonitoring them are found
While the number of people connected via the Internet13 has exploded this might13 bedwarfed by the number of connected lsquothingsrsquo During 2009 the number of thingsconnected to the Internet13 surpassed the number of connected people at which point13 webegan to experience what13 this report13 has described as the lsquoInternet13 of Thingsrsquo Yet 99 ofall physical objects that13 could join this network are not13 yet13 connected but13 the number couldgrow by 25 every year for the next13 decade so that13 there could be 100 billion connectedobjects by 2025 some of which will be owned or used by everyone in the UK includingthose people who donrsquot13 want13 to be connected themselves We will then have an Internet13 of Everything which will be the smart13 connection of people data events and actions
With each new person object or data13 that13 comes online the connection possibilitiesbetween all these elements grows exponentially The rise of big data mobile networkingcloud storage and data13 mining technologies will all play a critical role in the Internet13 ofEverything The result13 will be new capabilities richer experiences and unprecedentedvalue for individuals businesses communities and countries everywhere The lsquonetworkeffectrsquo of the Internet13 of Everything will be a very powerful thing the true impact13 of whichwe wonrsquot13 fully understand for several years As it13 develops however those who are not13 connected will feel even more digitally and socially excluded There will be a need to reachout13 to vulnerable people unless the process of claiming requires proof of online identityand the payments to be received can only be redeemed using a chipped card or adownloaded app onto a smartphone This is of course the way that13 welfare arrangementsare already developing thus it13 might13 prove impossible to make a successful claim without13
35
already being connected to lsquothe systemrsquo either through an online presence or through theInternet13 of Things
38 Downloading everything
Sixty years ago information was discovered by reading books often in a library wherenotes had to be made because the books or journals couldnrsquot13 be removed Then in theearly 1960s the first13 office photocopying machines were introduced into the UK theyimmediately meant13 that13 pages or articles from books could be copied and taken away to beread and summarised later Within a few years photocopying became a replacement13 forreading as researchers became less adept13 at selecting a few sentences and every deskbecame a depository for reams of printed paper Paper became the means of recordingeverything from bank statements through to music
We now appreciate that13 printing everything is a waste of both the ink (or toner) used tocreate the black print13 and of paper which requires trees to be chopped down and pulpedbefore it13 can be pressed into thin sheets Saving paper is therefore seen as green and goodfor the planet Fortunately we no longer need to print13 everything because computermemory is unlimited thanks to the cloud and we can then view pages and articles onportable or fixed screens
The internet13 has everything and it13 is all available instantly for downloading providing thereis a device available to accept13 it and there is sufficient13 communication bandwidth toperform the transfer of data13 sufficiently quickly Thus we can record all text13 articles that13 are relevant13 to us including digital records of birth certificates qualifications and passportsand the need for original printed versions will decline But13 we can also do this forphotographs Most13 handheld computing devices include at least13 one camera so they cangenerate enormous number of pictures which can be kept13 for posterity without13 having toconsume inks and special papers to print13 them
But13 the materials that13 can be downloaded donrsquot13 stop at pictures software is available that13 can grab TV shows after they air and movies as soon as theyre released In the same wayit13 is possible to schedule music comic books video games and practically anything else asa download with minimal effort People will need enormous hard drives if they want13 theirown digital copies of these files so will more than likely make use of cloud storage that13 willbe available from many organisations The location of the servers may become sensitivedue to border restrictions as will the security of the data13 and the way that13 it13 is backed up sothat13 it13 is resilient13 to failures
It may be evident13 that13 application forms for all types of welfare payment13 will be availableonly for downloading so that once digitised they can be processed by computer andrecords sent13 to various servers for subsequent13 storage and processing Some people maywant13 to keep their data13 on them once it13 has been downloaded Pen drives can already holdseveral GB of data so it13 is likely that13 people will be able to carry their downloaded data13 withthem at all times irrespective of the size and complexities of the information
36
39 Health13 and13 well-shy‐being
The general health of the population is unlikely to deteriorate noticeably within 10 to 20years Indeed expectations of the population are that13 things must13 improve as surgicaltechniques mature and as pharmaceutical interventions become more personalised andpowerful However the rising demand for health services due to an ageing population andthe increasing cost13 of providing sophisticated therapies will make delivering a free anduniversal health service difficult13 without13 substantial increases in taxation This is unlikely tohappen in the UK even though spending on health services will be protected against13 thecuts facing other services
There will have to be changes in how the NHS works For twenty years hospitals have beenclosed and replaced by fewer new facilities so that13 the bed count13 is reduced This has led toa significant13 shift13 in resources to primary care and community care supporting shorter staysin hospital and speedier transfer back home for people after surgery or illness This hasbeen13 successful but13 there remain problems with demand for GP services especially out-shy‐of-shy‐hours and at weekends Indeed despite the introduction of NHS24 and similar help-shy‐linesthe demand for GP appointments continues to increase Delays are inevitable and this willincrease system failures with more unnecessary deaths and a failure for people to access adiagnosis that13 might13 lead to early interventions and ultimately lower delivery costs Over250 more patients are added to waiting lists every day
This will lead to a new model of primary care consistent13 with existing changes which haveseen surgeries move from High Street13 locations to medical centres close to bus routes andwith more parking for patients The process of making an appointment13 is changing from atelephone-shy‐based interview process dominated by a medically-shy‐unqualified receptionist13 to achoose and book approach using an online process linked to electronic patient13 records Thiswill give patients more convenience but13 will allow priority for those who have Internet13 access at the expensive of those who are digitally excluded Making the process of bookingan appointment13 quick and easy may also increase demand from people who do not13 need tobe seen as it13 will fail to identify those in greatest13 need
A greater use of telehealth and telecare technologies will be inevitable beginning with thefirst13 contact13 as an encounter using the telephone e-shy‐mail or video conferencing -shy‐ a visit13 tothe GP surgery should be a last13 resort and should involve a nurse consultation in the first13 instance This would be consistent13 with three quarters of appointments currently involvinga chronic disease or long term condition which relates to improved self-shy‐care The support13 ofthese patients at home should be prioritised through tele-shy‐ and web-shy‐based technologies andshould involve training and coaching through a network of nurse practitioners Home visitsshould generally be unnecessary through the use of these technologies but13 could besupplemented by satellite surgeries manned by nursing in community premises or inpharmacies nurseries and Internet13 cafes
The homes13 of people who13 need13 closer monitoring can then become part13 of virtual wardswith real or electronic visits by health professionals University Hospital Southampton NHSFoundation Trust13 already looks after patients who have undergone surgery such as a hip orknee13 replacements in virtual wards with high levels of satisfaction The Royal Free London
37
NHS Foundation Trust13 offers a similar service but13 plans to add the possibility of videoconsultations between patient13 and consultant
310 Attitudes to public health issues ndash obesity smoking alcohol abuse drugs
As self-shy‐care becomes the focus of the NHS the public will increasingly understand that13 thecosts and availability of services are being harmed by the poor health behaviour ofrelatively small numbers of people The link between public health initiatives today andhealthcare needs and costs in the future will become increasingly evident13 as a result13 of theway that13 information is presented Thus the overweight13 smoker who currently attractsconcern and pity when they are diagnosed with diabetes and COPD is increasingly beingseen as the victim of their own stupidity or lack of self-shy‐discipline If they continue to neglect13 medical advice and continue with an unhealthy lifestyle then the way that13 they receivetreatment13 and consume resources will become a matter for the entire population
Obesity is seen as due to a combination of poor diet13 and a sedentary lifestyle No longer isthe idea13 that13 people are lsquobig bonedrsquo acceptable Governments will respond initially byrequiring manufacturers and food processors to provide nutritional information onpackaging and on menus in restaurants But13 people can choose not13 to read the data13 and toneglect13 both the importance of food quality content13 and quantity This will increasepressure to introduce fat13 or sugar taxes and these are likely to be in force within a decade
Although the high taxes on tobacco products has forced some smokers to reduce theirconsumption or to give up altogether the impact13 has been reduced by the smuggling ofproducts from overseas and by the availability of duty-shy‐free cigarettes for people returningfrom foreign holidays and business meetings Further measures are planned to changepackaging and to include even more graphic images and warnings on cigarette packages tomake smokers aware of the effects of smoking on their health and well-shy‐being There is asyet little evidence of how successful this might13 be More effective has been the banning ofsmoking in public places including trains and aircraft Expensive medical interventions suchas heart13 transplants will be denied to individuals until they change their lifestyle behaviourSmokers might13 therefore be increasingly ostracised leading to a loss of esteem This mayhave a particular impact13 on people who already suffer from mental health problems whoare more likely to smoke
The overuse of alcohol is being recognised as a major factor in hospital admissions withNHS figures showing an increase of over 40 in such admissions over the past13 decadeLinked to this has been a 75 increase in prescriptions to treat13 alcohol dependency Fewpeople have sympathy for those who waste their limited income on booze If they havechildren or other dependents they will be the ones who suffer and who may need thesupport13 of social care
Drug users are already significant13 users of social services as their habit13 is likely to makethem unemployable They receive little sympathy from the general public because they areseen as criminals and people who waste public resources Levels of drug abuse have been
38
slowly increasing over the years but13 this trend is slowly being reversed Indeed the numberof people using drugs during the past13 year has fallen to its lowest13 level for nearly 20 years(below 9) with cannabis being most13 likely often following excessive drinking Aselectronic noses and other technologies can detect13 traces of drugs it13 seems likely that13 success in overcoming addiction can be measured objectively This may become a two-shy‐edged sword rewarding those who can turn around their lives but13 further marginalisingthose who canrsquot13 or wont13 accept13 the lsquocold turkeyrsquo
311 Attitudes to surveillance
Issues associated with privacy confidentiality and data13 security have been discussedpreviously in the context13 of information technology the World Wide Web and the ease ofcollecting recording recalling analysing and displaying data The monitoring of individualsand their methods of using this information can be regarded as surveillance As thequantities of data13 increase along with the number of devices that13 can be used to access itthe surveillance tools will also increase in their sophistication Indeed the Big Data13 approaches described in the previous section will enable the combination of structureddata13 (such as the information held in databases) to be married with unstructured data13 fromimages in such a way that13 it13 can be mined
Whilst13 the lsquodigital surveillancersquo methods described above may cause most13 concern topeople because of its impact13 on anonymity it13 is the collection and analysis of images that13 are the major concern to people as they contemplate the ways that13 lsquoBig Brotherrsquo maydevelop to restrict13 freedom Every major UK city and town centre has an array of CCTVcameras that13 continually record activities from every angle If it13 used to be true that13 nobody in London was more than 10 yards from a rat it13 is certainly the case today that13 nobody can be more than this distance from being in view of a surveillance camera Yetthey receive so much positive publicity from TV programmes where their footage is used todetect13 vehicles close to a crime scene or to monitor the movements of suspects that13 theyare now accepted by the public as a deterrent13 in the same way as lsquobobbies on the beatrsquowere seen 25 years ago There is therefore little public reaction to the expansion in the useof video surveillance except13 for the practical observation of how so many views can beinspected and recorded
Looking to the future the tumbling cost13 of video technology will surely lead to anotherincrease in the number of devices The aerial views taken from towers will besupplemented by more local views taken by devices that13 are embedded in the fabric ofbuildings or carried by individuals either on their person (for example on clothing orspectacles) or in the bags that13 they carry The time and date-shy‐stamped images as Big Datawill be recorded to lsquothe Cloudrsquo where it13 can be added to other data It can then be usedwhen an incident13 has occurred or to provide further detail of night-shy‐time activities
It follows that13 there will be no hiding place for people who simply want13 to disappear Theymay respond by wearing clothing (such as hoodies) that13 hide their faces or which make it13 difficult13 to distinguish gait13 or mannerisms from which they might13 be identified New forms
39
of clothing may be designed to make shapes more difficult13 to analyse and these might13 become the uniforms of a class of person who wants to live in a way that13 they donrsquot13 interact13 with officials from any ministry or local government13 department If they also obstruct13 services then they will be considered to be anarchists of some form sparking protests fromother sectors of society
31213 Attitudes to driving
Motor cars have been a feature of UK roads for over a century but13 it13 is only during the past13 50 years that13 they have become a resource that13 most13 families have had access to enablingthem to travel without13 the restrictions imposed by a limited railway network and non-shy‐integrated bus transport People who have had a car throughout13 their lives often see theircars as an important13 factor in enabling them to remain independent13 and to exercise choicesrelating to where they shop and where they spend their leisure time This extends to theirspouse and to friends and neighbours that13 they might13 take with them on their variousexpeditions
Unfortunately there are incidents involving older drivers who perhaps go down amotorway in the wrong direction who are taken ill at the wheel or who are involved in anaccident13 involving no other vehicles These are small in number but13 often lead to a reactionthat13 they shouldnrsquot13 be allowed to drive lsquoat13 their agersquo Age itself is not13 an indicator ofdriving quality but13 because old age also brings more chance of having limited long termconditions and other illnesses it13 is easy to make a link between driving ability and age Thelicensing system does require continued driving to be linked with medical advice andforbids people with poor eyesight epilepsy and other conditions to hold a licence in oldage
Yet13 statistically older drivers cause far fewer accidents than younger drivers The reasonsfor this may be complex and are likely to include the fact13 that13 they drive less often covershorter distances and donrsquot13 go out13 in the dark or in poor weather However it13 does not13 wholly explain why the UKrsquos drivers aged over 70 and who represent13 some 8 of all driversare involved in only 4 of accidents that13 cause injury This compares favourably with the15 of13 drivers aged between 17 and 29 who are involved in over a third of crashes that13 result13 in injury
By 2020 the number of drivers aged over 70 on UK roads is likely to increase to over 7million This will require a new national strategy perhaps involving support13 for olderdrivers further training raising awareness of issues and making more use of adaptivetechnologies to support13 the driver in avoiding collision or forgetting to check on the statusof their vehicle Poor eyesight13 could be enhanced by camera technologies rather thanforcing people off the road if they are unable to read a licence plate
The International Longevity Centre has found that13 one in four Britons thought13 driversshould be made to switch off the ignition for good somewhere between the ages of 70 and75 The numbers may decrease as the population ages and as cars become safer Forcing
40
older people off the road may be a natural consequence of providing free bus passes andsubsidised rail fares but13 the growth in the pavement13 scooter industry demonstrates that13 older people value their independence and will do almost13 anything to get13 out13 and aboutPerhaps legislation will result13 in more regulation of electric vehicles and where they cantravel
There can be no doubt13 that13 getting out13 will be associated with better quality of life andwell-shy‐being and this is likely to be supported in the future as evidence of improvedoutcomes emerges It is to be hoped that13 positive stories will be publicised so that13 publicattitudes arenrsquot13 hardened This may be supported by more in-shy‐car monitoring of drivers andthe linking of performance with on-shy‐line driving records and licences These could throughremotely monitored ignition systems prevent13 the use of motor vehicles by people without13 a licence or without13 insurance
313 Climate change
There is a general view that13 the emissions of carbon gases are contributing to globalwarming in a manner that13 will change the UK climate in such a way that13 the climate maybecome more Mediterranean However some scientists believe that13 manrsquos impact13 on theenvironment13 may be small compared with natural variations caused for example bycyclical changes in the sunrsquos energy output13 or by the effects of volcanoes and earthquakesRecent13 evidence has suggested that13 we are going through a phase of changing extremesand that13 this is more likely to cause storms periods of excessive rainfall and unusualseasonal trends with snow and frost13 in the spring and warmer winters Considerableuncertainty remains and it13 might13 be necessary to plan for a number of different13 scenariosand for the impact13 on vulnerable people
I Colder winters UK properties are poorly insulated resulting in excess mortalitiesduring cold spells due to an increased number of people suffering from stroke aswell as bronchitis and other pulmonary diseases The cost13 of heating continues toincrease putting more households into a state of fuel poverty Any further coolingduring the winter months will result13 in more people living in unhealthy coldconditions Winter fuel payments are likely to be restricted to the poorest13 peoplebut13 this might13 exclude people who live in larger properties that13 are more difficult13 toheat
II More storms excessive winds and rain can cause flooding at any time of the yearMany UK communities are built13 close to rivers and these can surge during heavyrainfall causing houses to be filled with water and furniture and carpets lostInsurance can be problematic for properties built13 on flood plains which can blight13 properties and prevent13 owners from being able to sell and move on High winds canrip off roofs causing injury and also causing families to be left13 homeless anddependent13 on social services
III Hot13 summers Europe suffered high temperatures during the summers of 2003 and2004 leading to heat13 stroke and hypothermia The UK has not13 previously sufferedfrom such problems but13 might13 be expected to experience days of extreme
41
temperature and humidity at times Older people may not13 be prepared for suchweather Street13 dwellers may be unable to find shade and supplies of drinkingwater
Irrespective of what13 combination of weather scenarios arise it13 must13 be concluded that13 any extremes will have a major negative impact13 on vulnerable people especially if theyare not13 prepared because they havenrsquot13 received the weather warnings and advice that13 can be broadcast13 using the TV radio and online services Once again the digitallyexcluded will suffer and will pay a high cost Society will continue to pick up the bill interms of demands on social care services unless preventive actions are taken in theform of connecting these people to each other and to formal services
42
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
s13 13
13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
n13 13
13 s13
r13 n13
e13 at13
e13 y13 e13 ld13
ly13
13 e13 t13 e13
s13 er13 e13
f13
rt13 13
13 13
13
r13 13
s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
e13 g13 13
e13
13 13 ial13
13
d13
13 d13 h13 r13
d13 13
s13 y13
e13
13
rd13 r13 e13
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13
e13
e13
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13
13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
The final component13 for the DIY enthusiast13 is the treatment13 option Many people fear longterm use of medication produced by the big pharmaceutical industry and prefer morenatural remedies which are available over the counter More medical treatment13 devicesare available that13 stimulate blood flow and counter pain through the use of electrical andphysical stimulation
The evidence may be weak at present13 but13 might13 grow as more people use them and as theircost13 drops The13 impact13 of13 such technologies13 on vulnerable13 people13 is13 difficult13 to gauge
213 Telecare
Support13 provided at a distance to people in their own homes is known as telecare Thename implies remote monitoring and interaction and includes the monitoring of the homeenvironment13 and of the individual as well as the interaction of the individual with thisenvironment Definitions have become difficult13 due to some US medical devicemanufacturers introducing the term telehealth to describe medical telecare such as remotemeasurement13 and collection of vital signs data
In the UK telecare alarm services have matured quickly using the robust13 platform andinfrastructure of social alarm systems which were originally used by tenants in shelteredhousing schemes to seek help when they didnrsquot13 own a telephone The majority of telecareservice users today live in their own homes and use dispersed alarm units to link with amonitoring centre through the telephone network Improved assessments of needs andrisks to independence have resulted in combinations of sensors being used to support13 theoption of staying put13 rather than moving into residential care or having increasing levels ofdomiciliary support They support13 the policy of bringing care closer to home and ofencouraging people to become partners in their long term support13 arrangements
Telecare services developments over the past13 decade include standalone items such asautomatic lights which have achieved significant13 efficiencies especially for people who arefrail and prone to falling and to those suffering from mild cognitive impairment epilepsyand anxiety People who have long term conditions including chronic conditions such asdiabetes and hypertension can also be managed more effectively through telecare supportThe benefits of telecare services include a relief of stress for family caregivers enablingthem to continue to provide unpaid support13 while holding down a job and maintaining theirquality of life
New developments enable continuous monitoring of behaviour and smart13 devices that13 canfor example remotely control the cooker the water supply and door entry Such13 monitoring may detect13 incidents early and prevent13 emergencies arising Devices arebecoming smaller and easier to embed quickly within the home environment making themmore acceptable and less noticeable Longer battery life means less frequent13 maintenancevisits
16
The13 monitoring13 centre13 becomes13 an information hub13 offering13 both advice13 and a vehicle13 for checking that someone is coping especially following a trigger event such as a stay inhospital or the illness13 of an informal13 carer
New systems utilise web technology that13 allows family members to be more proactive inthe monitoring of their relatives This can lead to greater interaction with them especiallywhen the relatives live a considerable distance away (perhaps in another country) Thesenext13 generation systems might13 include video conferencing and the use of tablets smart13 phones or smart13 TVs but13 when an emergency response is required (perhaps to lift13 someoneup after a non-shy‐injurious fall) there remains a need for human intervention
The13 future13 of13 telecare13 might therefore13 include13 an increasing13 dependence13 on volunteersfrom13 the13 community to provide13 the13 required support Social networking may need to beused13 to support13 telecare technologies
214 Mobile healthcare
While telecare can support13 people effectively in their own homes it13 is now recognised that13 being able to go out13 to enjoy open spaces and to overcome the fear that13 the home is aprison is an important13 part13 of improving well being and supporting a higher quality of lifeExtending telecare technologies to operate outside the home is known as mobile healthcare(or mCare) and is based on mobile telephone networks rather than landlines
The simplest13 form of mCare requires only a basic mobile phone to deliver telephone callsvoice13 messages and SMS (text13 messages) The technology is mature and there are countlessapplications in use both in the UK and in developing countries such as Africa13 and India13 where mobile telephones have already achieved a saturation level and where fixedtelephone infrastructures are not13 likely to be established at any time Such telephones areuniversally available in the UK and are used by the vast13 majority of people including manyolder people especially if they have been introduced to the low cost13 (pound30) devices that13 have large buttons large displays and a separate large button for calling an emergencynumber
Smart13 phones are rapidly replacing basic phones and allow the use of a large range of lsquoappsrsquothat13 are being developed to provide information and for enhanced experiences In thehealthcare space Skype FaceTime Vidyo and GoToMeeting with HD Faces are all current13 examples of video conferencing software available on tablets and smartphones
The specific software will depend on the nature of the communication desired
bull Skype will13 manage a simple video phone callbull Where an AampE physician needs to share a CT scan of head with a Neurologist13 on call
from home GoToMeeting would be more appropriate
17
bull If the physician would rather have a dedicated online meeting room that13 patientsand colleagues can simply drop in for a virtual meeting a Vidyo virtual room may bemore appropriate
This technology can suit13 any form of lifestyle including many people with complex needswhose lifestyle is not13 consistent13 with a fixed address
Social care apps are available already to deal with problems of sensory deficit
bull Guiding a blind person through GPS navigation and reading signs through appslinked to the devicersquos camera13
bull The microphone can be used as a hearing aidbull Speech recognition software can be used either to replay speech at a slower speed
or for translation into a language of choicebull Speech can also be selected for people who have a stammer or who have a problem
with their larynxbull Apps are becoming contextually aware recognising situations and locations and are
thus becoming a personal assistant13 for people with disabilities
By 2020 it is therefore possible that a smartphone may13 be prescribed13 for people who13 need13 social13 care13 together with13 a range of apps that have been13 selected13 to meet13 theirassessed13 needs
Whilst13 smart13 phones tablet13 devices and apps may become an important13 part13 of anindividualrsquos personal support13 armoury the potential of mCare will be limited only by anindividualrsquos ability to make use of all its functions Each device could become a part13 of anindividualrsquos personality supporting them to improve behaviour take exercise avoidtemptation and manage their own health and well-shy‐being Potentially mCare could becomethe most13 important13 element13 of social care and support13 within 10 years
215 Artificial Sensing and Enhancement Devices
bull It is estimated that13 one in seven people has imperfect13 hearingbull The numbers who are born deaf are quite small and many of these people may
have some form of hearing restored through surgery or through technologybull Similarly while there may be nearly a million people registered as blind or having a
severe visual impairment the vast13 majority lose their sight13 during their lives as aresult13 of disease
bull New treatments will deliver sight13 recovery or restoration over the course of the next13 10 to 20 years
Fortunately technology can provide excellent13 sensing capabilities that13 are already providingpeople with external portable devices for enhancing their lives The simple hearing aid is anexcellent13 example of a device which has been improved through both miniaturisation
18
personalisation and enhanced performance Today digital hearing aids use sub-shy‐miniaturemicrophones that13 can be unidirectional or omnidirectional and which can be adjusted insensitivity over an extended range Tomorrowrsquos devices can be switched between modesby the user so that13 they can benefit13 from hearing perfectly in any environment Indeedthey can be used with adaptive filtering technologies (as used by helicopter pilot13 headsets)to eliminate some sounds so that13 the rich speech (or music) components alone remainFuture developments will be on optimising control so that13 the user can switch seamlesslybetween different13 amplification applications without13 appearing to be distracted A smart13 phone or mp3 music player may be used as either a processing unit13 or as a ubiquitousoutput13 device that13 looks cool and natural
These same technologies will also be developed for use within the home environment13 fortimes when a deaf user isnrsquot13 present13 or is asleep Acoustic signatures associated withadverse events and incidents such as the hiss of a gas leak the crackle of a fire the sound ofa smoke detector the drip or a water leak or the sound of breaking glass can be directlyassociated with programmed actions Speech will be recognised interpreted translatedsimplified or displayed so that13 an individual knows what13 is said and can be provided withclear instructions on how to respond
Video cameras have become smaller and cheaper and capable of producing high definitionimages The problem of storing and editing these large image files is being solved by thearrival of cloud computing
Electronic noses are already capable of detecting the quality of wine and fresh fruit Similartechnology will be based in smart13 phones and will be able to analyse the air to warn of13 foodthat is no longer fresh and of other indicators of danger including gases that13 have13 little13 natural13 smell These13 devices13 could support13 people with13 cognitive impairment13 -shy‐ whose13 sense of smell13 tends13 to deteriorate -shy‐ to live independently
Many older and vulnerable people are at risk of hypothermia during the winter Sensordevices can provide warnings of low temperature In the same way heat13 stress can be adanger during the summer months so sensors can alert13 people of the need to openwindows or to operate a fanFinally people who have damaged13 their fingers13 or hands will be able to wear sensorsembedded in artificial skin or in gloves that13 will enable them to identify textures and shapesand be able to dress and undress without13 the assistance of carers
216 Robotics
We may recoil at the idea13 of personal care being delivered by robotic devices but13 it13 is likelythat13 within a decade personal assistants will exist13 to assist13 with household tasks These areunlikely to be humanoid and are more likely to be machines dedicated to helping frailpeople to support13 their own weight13 and to carry trays of food around the home
19
There are four broad classes of robot13 under development13 that13 are likely to mature within 10to 12 years
1 Miniature industrial robots that13 have been programmed to perform specific taskswith precision They are likely to be relatively heavy enabling them to bear weight13 but13 still have the necessary flexibility to carry an individual over short13 distancesplacing them in a chair or on a bed They will have sensors and cameras to provideimmediate feedback and to adjust13 rapidly in response to verbal commands or cues13 from the user Some designs may build on existing assistive devices such as abathroom hoist13 or a bathing aid to become intelligent13 extensions of productsalready on the market A stair lift13 with intelligence is already being designed by a UKcompany and is aimed at providing the user with more control of the journeybetween floors of a house
2 The second group of devices might13 be described as intelligent13 furniture Beds andchairs are already available that13 adjust13 to make the user more comfortable and also13 to help them get13 into or out13 of bed The control units are fairly cumbersome andare suited to operation by a carer Voice activated controls and built-shy‐in intelligencewill give the user more control and independence Other items of furniture to whichintelligence might13 be added would be tables whose height13 can adjust13 and whichhold items of food and medicine securely The table would recognise these objectsand could provide prompts or reminders
3 Mobile robots form the third group These could be goffers that13 can either fetchand carry items such as newspapers drinks or trays or which can accompany theuser when they move between rooms providing them with support13 or prompts Thistype of robot13 could be an intelligent13 walking frame with wheels which13 could13 doubleup as a smart13 wheelchair when necessary
4 Finally there are companion robots These might13 be in the form of an electronicpet typically a cat13 or a dog though the Japanese Paro robot13 is a seal Pets canrespond to stroking and being patted they can also remind their owners that13 theyneed to take exercise and to eat drink and take their medication Various designsare already available which provide feedback but13 future models would includecameras and a screen to provide a mobile means of information and interactionwith other people over the Internet Intelligence within the device could allow themto have a personality of their own and gain knowledge by scraping data13 fromwebsites so that13 they can generate speech and have conversations about13 the newsthe weather or sports results
217 Transport and transfer technologies
Walking is good exercise and is a no-shy‐cost13 form of transport13 that13 is encouraged because of itsimpact13 on well-shy‐being For an individual with a chronic disability or suffering from theeffects of an accident13 or an injury this becomes impractical without13 an assistive technology(AT) A walking stick is the simplest13 example of AT
20
Within the home the stair lift13 has enabled people who live in conventional properties that13 are on two or more floors to continue to use facilities on different13 floors when climbing thestairs has become too difficult This is often the case for people who have arthritis a lowerlimb amputation a long term condition such as Chronic Obstructive Pulmonary Disease orpeople approaching the end of life and who have chosen to die in their own homes
Designs have improved so that13 a curved staircase is no longer an issue and the reliabilityhas reached a level where breakdown is a rare occurrence13 Through-shy‐floor lifts have been analternative proposition but13 they remain too large for most13 properties Alternativeapproaches may emerge using air pressure or water pressure as the driving force ABrazilian design already utilises a plastic tube in which a pod is moved effortlessly up anddown
Electronic wheelchairs are now available that13 allow the individual to become moreindependent13 as they allow the user to control both propulsion and steering Some modelshave the capability of mounting a pavement13 or a step or even a flight13 of stairs Personalmuscle amplification devices have been developed originally with the intention of helpingpeople who are confined to a wheelchair due to a neurological disorder to perform sometasks from a standing position Indeed the Rex walkerrsquos manufacturers claim that13 anyonewho can propel themselves in a wheelchair could walk by using Rex
Other approaches have focused on the rehabilitation of people after major accidents that13 have caused partial paralysis They quickly extend into exoskeleton designs that13 enableanyone to gain a mechanical advantage and thus to tackle physical tasks that13 would not13 otherwise be possible These suits are the focus of major research projects across theworld Some13 products such as the system developed by Honda are being tested inAssisted Living facilities and are likely to become more and more enabling over the next13 decade
Similar benefits are also occurring outside the home with a number of novel carryingsystems appearing over the past13 few years They are generally termed lsquoscootersrsquo but13 thiscovers a wide range of systems and devices ranging from the Segway a device that13 is amobile platform on which the user stands and navigates through to conventional electricvehicles that13 have been developed from golf buggies There remain a number of issuesconcerning their use on roads or on pavements but13 similar problems will need to beresolved for bicycles to play their full part13 in enabling people to get13 more exercise13 Thepotential for hybrid scooters remains
218 Smart domestic appliances and personal hygiene
The bathroom is a dangerous place and one where many older and disabled people slip andsuffer a fall Many older people recall taking a bath in a tin tub in front13 of an open fireToday the options tend to be a level access shower (ie a type of wet13 room) for anyoneunable to get13 into a bath There are various aids to help people get13 into and out13 of thebath most13 involving a seat13 that13 can be raised or lower with some bath-shy‐tubs having a door
21
There has been some research into alternative methods of keeping the body clean Sanyointroduced a machine in 1970 modelled on a clothes or dish washing machines the personsits on a seat13 inside the machine where13 they are cleaned by a set13 of water jets These havenot13 proved popular and furthermore require the individual to be transported to themachine Thus the technology may find application in nursing homes but13 are unlikely to beattractive to people living independently in the community
The washing needs of people change over time Over the past13 20 years body piercingshave appeared which have demanded additional attention to avoid the problemsassociated with poor hygiene and metals Similarly hair may be permed and dyed usingchemicals which are much stronger and which might13 damage the hair Add to this thepainting of finger and toe nails and the washing needs are rather different13 to what13 theymight13 have been even ten years ago Finally tattoos were once popular only with sailorsToday they are likely to be found on the arms backs and legs of both men and womenNew ways of cleaning these tattoos will be needed especially if they become infected orare sites at which pressure sores develop
Even if a personrsquos body is clean if their clothes are dirty they may become socially isolatedBut13 the washing of clothes can be strenuous even if a launderette is used The need toconserve water has driven research into ultrasound techniques to beat13 the dirt13 out13 ofclothing while some companies are experimenting with polymer chips These13 ldquogreenrdquo13 technologies are quickly maturing and are likely to be standard in the next 10 years
Other smart13 household appliances are already appearing on the market13 and may soonbecome common13 in UK homes13
bull Robovac devices have sensors to enable them to detect13 dirt13 on carpets and to adjust13 their operation accordingly
bull Refrigerators can read bar codes or RFID tags to identify their contents and theirldquouse byrdquo13 dates enabling them to inform the owner that13 they should use theproducts before they are out13 of date They can be linked to the Internet13 to reorderitems as they are consumed or to suggest13 menu options for the individual based ontheir preferences or according to the diet13 required to manage a condition
bull Ovens will automatically switch off if they are left13 without13 attention for too longand drying machines will set13 times automatically
Devices may be linked so that13 they are more efficient and report13 maintenance issues sothat13 they can be repaired (perhaps remotely) before they suffer a catastrophic breakdown
219 Personal and home13 security
It might13 appear perverse but13 people with very little personal wealth and property are morelikely to be the victims of crime than those who have expensive items This may be due towhere poorer people tend to live or because people who have valuable assets take greater
22
steps to protect13 them There can be no doubt13 that13 crime has a very negative effect13 onindividuals and on their families creating a fear factor that13 may be difficult13 to remove Theimpact13 on quality of life is therefore very considerable especially if it13 forces people to stayat home behind locked doors effectively isolating themselves from society
Modern policing places increasing reliance on the use of closed circuit13 television (CCTV)Town centres are covered by cameras used increasingly in the fight13 against13 crime by bothdetecting anti-shy‐social incidents and identifying the people involved They are also used tomonitor the movement13 of cars that13 may be involved in incidents of burglary and violenceand are fast13 becoming the primary mechanism of law enforcement13 agencies to solve crime
CCTV has moved into the home to record movement but13 monitoring the footage is timeconsuming and often not13 practical Cameras are now available which provide an instant13 video feed to a smart13 phone when movement13 is detected These may have intercomcapability allowing someone to remotely speak to an intruder sometimes before they havegained access to a building This may serve as a deterrent13 and when fitted alongside simpledevices that13 switch lights on randomly around the home may force burglars to goelsewhere
As the price of cameras continues to fall the option of carrying a camera13 on the body that13 continuously monitors personal space is becoming more useful Using wireless networksthe data13 collected can be sent13 continuously to the cloud for safe storage It cansubsequently be retrieved to provide evidence (video and audio) of confrontations enablingsuccessful prosecutions to be made The smart13 phone itself is becoming a valuable itemthat13 is attractive to criminals These can be tethered to personal attack buttons usingwireless technology allowing the device to be activated by the pressing of a button if theowner is being attacked The phones can then be tracked and located by the police whilebeing rendered useless to the assailant
Bogus callers are a perennial problem for vulnerable people Video door bells can beconfigured to display images and record the words of visitors before they are admittedallowing remote monitoring centres to oversee the situations and use image recognitionsoftware to confirm the bona13 fide of visitors Such13 arrangements may become13 commonplace13 over13 the13 next five13 or13 six years13 significantly13 improving the safety of peopleliving independently
220 Personal safety
The biggest13 risks to personal safety stem from fires and falls Most13 fires are the result13 ofpoor cooking practices resulting in burns or scalds Floods and gas emissions are caused bya failure to remember to close taps
The current13 approach involves detection of an emergency situation as soon as possible but13 always after a problem has already occurred This responsive approach can minimise therisks provided that13 there is a protocol in place for intervening This could increasingly be an
23
automated response such as the switching off of the gas of water or the switching on of asprinkler system or a water mist13 system
In the future monitoring systems will be more sophisticated and will have sensors and localintelligence to identify activities In this way reminders can be issued before an emergencyoccurs13 This lsquosmart kitchenrsquo approach may become13 an integral part of13 homes of13 vulnerable13 people
A prototype system has been developed at the Culture Lab in Newcastle Sensors havebeen embedded into cooking utensils enabling the kitchen to identify what13 the person istrying to cook or prepare It can provide interventions as messages on an instructionscreen
Accidents also occur out13 of doors People with dementia13 might13 become lost13 and may havepoor road safety awareness Location devices based on GPS have advanced from large andheavy receivers that13 were used on ships and boats to small battery-shy‐operated devices that13 can be carried in the hand or in a handbag The current13 generation of locators has limitedbattery life and are rather too large to be secreted about13 a personrsquos clothing while devicesthat13 are integrated into a wrist-shy‐watch are rather clunky and unattractive
Within 10 years the13 technologies13 will have13 matured and will be13 much smaller13 so that theycan be embedded in shoes in walking sticks hats or any other item of clothing Powerrequirements will have reduced so that13 energy harvesting from the movements of theindividual will be sufficient13 to keep these products working for several weeks without13 theneed for recharging The devices will not13 simply indicate to others where the individualhappens to be but13 will provide subtle guidance cues to direct13 them home
Cameras might13 also form part13 of the personal security systems that13 will protect13 people fromaccidents Data13 may be sent13 to the cloud and analysed in real time if the person is in adangerous location and can provide prompts either to the individual or broadcast13 advice toothers to clear the danger These systems may be embedded in items of clothing (such as ahat) or they may be attached to spectacles
221 Energy and13 portable power supplies
The demands of developing economies for more power will inevitably lead to higherdomestic fuel charges in the UK especially as oil and gas reserves dwindle
By 2018 UK homes should be fitted with new smart13 meters The specifications for these13 devices have yet13 to be finalised but13 will include a means of identifying wasteful use ofenergy including TV sets that13 are left13 on and unattended fridges and freezers that13 are set13 attoo low temperatures and dryers that13 are used for too long or when the weather is suitablefor using a washing line They could be an enabling factor that13 supports changes inbehaviour driven by a need to use less power but13 it13 is unlikely that13 they will offer a bigreduction in costs that13 are already a problem for many vulnerable families
24
More generally the need for power conservation will include devices that13 are moreefficient and a significant13 emphasis on heat13 retention in buildings through betterinsulation
The energy crisis may force many people to spend more time in community settingsincluding shops and public buildings where they can benefit13 from the warmth Increasingreliance on mobile communication devices will lead to increasing demand for batterycharging facilities
Greater use may be made of portable devices for generating power based on solar cellswind or hand motion
222 Smart cities and homes
The Digital City initiatives have been based on information and how it13 can be used most13 effectively to make people aware of what13 is going on around them This means bettercoordination of resources more rapid access to advice and a battery of sensors measuringevery conceivable parameter from sound and light13 levels through to air quality andtemperature fluctuations There are several Digital or Smart13 City initiatives currently beingimplemented both in the UK and across the world They may significantly impact13 the livesof the millions of people living in them but13 the timeframe for outcome benefits to influenceplanning and design elsewhere is likely to be at least13 20 years and therefore outside thetimeframe of the current13 project
Housing plays a big role in the lives of most13 people both through their aspirations to moveup in the world (usually to a bigger property with a garden) and as the heart13 of the familylife which is associated with good quality of life UK properties have a life span approaching100 years which is about13 double that13 of their European counterparts (and certainly longerthan the wooden-shy‐frame buildings built13 in North America13 for example) A shortage ofhouses has plagued improvements in social welfare for the past13 30 years There is anargument13 that13 there are enough houses but13 the wrong size and in the wrong places andthis has some basis in fact13 as demography changes lead to more people (and more olderpeople) living alone However if there are two million homes in Scotland each with alifespan of 100 years then the renewal rate needs only to be 20000 per annum to maintainthe status quo However it13 must13 be clear that13 the impact13 of smart13 house development13 willbe small The focus should therefore be on adapting existing properties to render themmore appropriate for vulnerable people
Housing adaptations are a branch of assistive technologies The technologies for providingdifferent13 forms of accessible bath and level access shower are well-shy‐established with littleresearch considering anything other than alternative building materials and methods formaintaining the temperature of the bathwater Different13 technologies for bathing will beconsidered separately
25
Thus housing technologies are not likely to impact on social work13 within the next 20years13 though13 the use of information13 technology13 to ensure that people are aware of what13 is available is likely to be commonplace well before then
26
3 BEHAVIOUR AND ATTITUDE CHANGES DUE TO TECHNOLOGICALADVANCES
Technology is only one factor that13 will affect13 the way society changes in the next13 10 or 15years This chapter will consider the context13 in which the technological developmentsoutlined in the previous chapter will be supported (or held back) by societal factors
When the impact13 of such factors has been considered we can then apply theseassumptions to a number of case studies listed in Appendix13 A13
The headings selected for this chapter are not13 arbitrary as they reflect13 the context13 in whichtechnological changes must13 be considered They must13 include consideration of factors suchas demography and long-shy‐term conditions already addressed in the introduction to thesepapers together with the aspects of workforce and citizenship considered in the parallelpapers The additional elements here focus on trends that13 are already occurring and whichmay leave people struggling with the changes that13 occur
Finally there is a need to consider the attitudes of people to technology generally andespecially to the issues of privacy and social responsibility that13 could be radically changedby technology In some cases public opinion will prevent13 some forms of technology beingdeveloped if not13 commercialised In other cases some technologies will be fast-shy‐trackedeither at the request13 of government13 or because of a clear public demand for theopportunities that13 it13 can bring
Predictions13 about the13 future13 must inevitably be13 subject to considerable13 uncertainty butthat is no reason to stop thinking what might happen
31 The Welfare State
The UK can be rightly proud of the way that13 its welfare state has developed during the past13 100 years to provide a safety net13 of financial support13 to people and to their families whenthey are unemployed destitute homeless or challenged by crises and emergencies Therange of benefits received is considerable some are complex and many people struggle tounderstand their entitlements Some are universal some are discretionary some apply onlyto parents others to anyone
The total cost13 of providing these benefits continues to rise and when the economy isstagnating there is inevitably both political pressure often supported by popular publicopinion to introduce welfare reform so that13 people who do not13 work cannot13 be better offthan they would be if they were in full-shy‐time employment This strategy requires a universalbenefit13 to be introduced so that13 it13 is easier for claimants to access support13 but13 also easierfor agencies to identify the total benefits received The idea13 of a benefits cap then becomes
27
more practical to introduce especially if all the processes involved in making a claim arehandled electronically Indeed this encourages government13 to insist13 on applications forbenefits to be made on-shy‐line Unfortunately this will marginalise those people who haveneither a computer nor access to the internet thus emphasising the digital divide in amanner which works against13 some of the most13 disadvantaged people in society
There are currently few tangible links between digital technology and welfare provisionThe most13 obvious are universal benefits such as a free television licence (worth pound14550)13 for13 everyone aged 75 or older with blind and visually impaired people entitled to a 50discount13 irrespective of their age The significance of this position is that13 6 of revenuesgenerated through licence fees are to fund BBC on-shy‐line services13 such13 as websites and i-shy‐player In Scotland the BBCrsquos Alba Gaelic language television service is predominantlyfunded13 by MG Alba an organisation funded by the Scottish Government It is thereforeconceivable that13 in the future licence fees may be used to directly subsidise access toinformation and advice through the Internet13 for vulnerable people whether it13 is throughbroadband access or through a set-shy‐top box which removes the need for a computer in thehome to access particular websites or to use e-shy‐mail services
A second age-shy‐related benefit13 available in the UK is the winter fuel subsidy People whoreceive certain benefits receive the payments automatically while others must13 make aclaim Those who are not13 eligible for benefit13 due to a lack of an address for example missout13 on these payments and also on Cold Weather payments of pound25 for each seven dayperiod of very cold weather between 1 November and 31 March
The development13 of new warm home initiatives plus the complex of subsidies that13 theelectricity supply industry and government13 offer to people with solar cells further changesthe economic arguments Global warming may lead to greater variations in weatherextremes but13 might13 also increase the amount13 of electricity that13 can be generated byalternative (green) sources such as wind and solar cells It is estimated that13 energyconsumption in the UK increased by 17 between Christmas and Easter 2013 compared toprevious years as a result13 of cold weather but13 the above subsidy scheme did not13 benefit13 older people because two of the seven day cold periods were after 31st March It must13 beassumed that13 there will be more people living in fuel poverty in the future and this will leadto more cases of cold related illness including influenza13 and stroke
32 Management of long term conditions
The management13 of long term conditions will be improved for patients who are compliant13 with their medication regime so it13 is possible that13 there may be compulsion to adhere tothe prescription Such compulsion may be monitored using technology Indeed the remotemonitoring of vital signs using telehealthcare will become commonplace as the old boxesand sensors are replaced by devices that13 can be worn continuously or which can beembedded into the fabric of homes (including furniture and bedding) or can be worn asvests or patches They will wirelessly transmit13 data13 to smartphones or tablets and mobile
28
transmission and cloud technology will enable real-shy‐time data13 collection analysis andfeedback
One of the diseases which is projected to increase most13 significantly over the comingdecade is Type 2 diabetes Whilst13 there is a hereditary susceptibility to this condition formany people including those from the Middle East13 and the Asian sub-shy‐continent it13 is also adisease which tends to affect13 those people who are overweight13 andor have a sedentarylifestyle If untreated diabetes can lead to dizziness and collapse at any time but13 can alsohave more devastating long term consequences which include kidney failure strokeblindness and in extreme cases lower limb amputations Management13 therefore includesdaily monitoring of blood glucose levels and major dietary changes such as a significant13 reduction in the consumption of carbohydrates as well as a rigid exercise regime
Many newly diagnosed diabetics follow this advice closely and can lead normal lives for 40years or more but13 some struggle to accept13 the change in lifestyle required as well asremembering which foods are allowed and how much exercise they need to takeIndividual support13 plans are now forthcoming and over the next13 ten years best13 practicewill emerge in the form of smartphone apps that13 are personalised and which can becomean individualrsquos health coach This level of support13 will be fine for some people but13 otherswill need incentives so it13 is likely that13 gaming technologies will be introduced perhapsoffering rewards for good compliance There will be a temptation for some people tocheat perhaps allowing others to perform exercise for them or changing theirconsumption details
Many of these opportunities for cheating will be removed through the use of a uniquebiometric identifier a technology that13 will be mature enough to use in place of passwordson smartphones However the biggest13 challenge may be in encouraging older people to usethe technology Many older people have multiple morbidities Indeed a survey of Scottishpatients implied that13 42 of people aged over 80 will suffer from three long termconditions It will be essential for those people to comply with treatment13 regimes if they arenot13 to have the functional deficits that13 follow
33 Finding people who13 donrsquot fit
People who have low social capital are likely to have few relatives and friends with whomthey regularly communicate and are also unlikely to be part13 of community or faithorganisations such as clubs societies and church groups They also die several yearsyounger than most13 of the population often because they donrsquot13 engage with public healthinitiatives such as vaccinations against13 flu regular checks on their blood pressure bloodsugar levels or in the case of women smear tests or mammography The most13 likelyreason for disappearing beneath the radar of such initiatives is their mobility which leadsalmost13 inevitably to them having no fixed abode and no fixed telephone line It thenbecomes very difficult13 for them to be contacted because their mobile telephones are likelyto have Pay-shy‐As-shy‐You-shy‐Go contracts that13 donrsquot13 require validated names addresses and bankaccounts
29
It follows that13 some of the most13 vulnerable people in society including those who live onthe streets are effectively unknown to both the NHS and to social work departments untilthey are referred in a crisis This could be an emergency presentation to a hospital Accident13 and Emergency Department13 where they will come into contact13 with a social worker becausedischarge may be unsafe This often highlights the importance of the prevention agenda13 and the potential for avoiding admissions to hospital by intervening at an earlier stage
The advantages of being able to locate people who are vulnerable to specific diseases willincrease as genetic testing becomes more routine It is already possible to determine whomight13 be most13 at risk of breast13 cancer and prostate cancer as a result13 of family history Addto this the evidence that13 particular diet13 and exposure to environmental factors can furtherincrease risk then it13 is evident13 that13 individuals can be identified and offered treatmentsthat13 could save their lives many years before they become ill In the case of cancersperhaps only the individual is involved but13 for infectious diseases it13 is the whole of societythat13 is at risk if someone contracts one of the new strains of influenza or if someonechooses not13 to be vaccinated against13 rubella In Chinese airports all visitors are screenedfor fever and refused entry if they tested positive in cities the public are monitored in thesame way Similar approaches may be necessary in the UK if potential carriers cannot13 otherwise be identified
34 Volunteering
It is estimated that13 72 per cent13 of people volunteered to perform a charitable act13 at least13 once during 2012 a rise from 65 per cent13 the previous year About13 four out13 of every 10volunteers offer their services formally to one or more organisations The remaindervolunteer informally by helping out13 a friend or a neighbour Around 50 per cent13 volunteered at least13 once a month in the past13 year up from 41 per cent13 on the previous13 year Most13 have retired many of them before the statutory retirement13 age Those whodonrsquot13 feel able to offer time have offered their financial support13 at a time when the fundingavailable from sources such as the National Lottery has been decreasing Despite economicausterity donations to charities have been increasing 74 per cent13 said they had given tocharity at least13 once in the previous month up from 72 per cent13 the previous year
Strikingly 78 per cent13 of people strongly believe that13 they are part13 of their localneighbourhood an increase from 70 per cent13 10 years previously Community cohesion isstronger than ever 87 per cent13 of people believe their local area13 is a place where peoplefrom different13 backgrounds get13 on well together compared to 80 per cent13 in 2003
The role of volunteers in supporting vulnerable people is therefore likely to increase overthe next13 decade perhaps exploiting the success of the army of volunteers that13 was highlysuccessful in London during the Olympic and Paralympic games The greatest13 role for suchvolunteers may be in providing informal care for older people Already the UK has someseven million informal carers whose value in monetary terms has been calculated to be
30
more than the combined budgets of the NHS and social care Maintaining or extending thisprovision will help to support13 services in the future and may be supported by technology
Whilst13 there is ample evidence to suggest13 that13 telecare services support13 informal carers asmuch as (if not13 more than) the people that13 they are caring for it13 is the potential for utilisingthe internet13 and apps to make their role easier to coordinate and hence more effectivethat13 is likely to be most13 successful moving forward
Many of these focus on particular tasks that13 informal carers can help offer to older peoplesuch as organising their medication A pillbox program is just13 one feature of an app calledBalance It also includes sections for caregiving tips notes for the doctor and the patientsappointments plus a lsquolearning sectionrsquo with articles on aspects of Alzheimers and an RSSfeed for news about13 the disease Tyze is another multi-shy‐functional app it13 allows carers to
bull Organise appointmentsbull Plan outingsbull Share storiesbull Send updates to other family members
Another application is Rally Round which helps carers to organise someone to perform littlejobs often on a temporary basis when someone has dementia physical frailty or isrecovering from accident13 or illness Similar applications are MeMaxi and Finerday
35 The High13 Street
The shape and appearance of UK shopping centres have been changing for half a centuryPeople complain that13 centres are losing their identity with one town looking like everyother both in terms of the stores and in terms of the layout But13 there are three trendswhich are having a profound impact13 on many of the most13 vulnerable people in society
bull Centres lock their doors at 6pm or in some cases 10pm -shy‐ thus denying people whosuffer from claustrophobia13 from window shopping at times when other shoppershave left
bull Out13 of town shopping malls -shy‐ these US style centres are ideal for people in carsbecause they offer free parking which is essential for people who want13 to buy largeritems but13 difficult13 for people who have no transport13 and who must13 rely on publictransport13 that13 is often deficient
bull The rise of online shopping -shy‐ which means that13 many potential shoppers only visit13 High Street13 stores to check the prices before returning home to make a purchaseonline
It is the third of these effects that13 has the greatest13 potential for changing the High Street13 forever and it13 is making life for traditional retailers increasingly difficult13 at a time when highrents are crippling stores large and small It is difficult13 to see how this trend is likely tochange because consolidation in banking and estate agencies is already forcing the closure
31
of other High Street13 players while additional pressures on pubs has led to the closure ofthousands of pubs every year
Those figures however demonstrate that13 consumers still value what13 the high street13 canoffer -shy‐ the chance to inspect13 what13 theyrsquore thinking of buying -shy‐ as well as the new opennessof the internet Customer service makes a difference to people especially if there is aproblem and goods need to be returned One of the most13 common reasons for furniture tobe returned for example is that13 when a sofa13 or a wardrobe was delivered it13 couldnrsquot13 fit13 through the front13 door or up the stairs In the future people will be able to benefit from13 visualisation technology they will upload the floor plans of their homes enabling theretailer to inform them of the problem before they try to delivery Augmented reality viewwill similarly allow customers to see what13 a new item of furniture will look like in itsintended place so that13 they can be more informed about13 the effect13 of size and colour
In terms of improving the viability of the High Street stores will have to focus on theimportance of brand which could mean that13 individual independent13 retailers will have topartner with national suppliers to support13 a local tailored offering based on products that13 are designed for a more global market This is a lsquoconnected High Streetrsquo approach whichcould be enabled by the developments in internet13 availability and smart13 phone accessdescribed in the previous section
The overall effect13 of all these changes could mean that13 town centres become smaller but13 more vibrant13 areas They could thrive if people are attracted there in large numbers whichmeans that13 retail must13 be developed alongside restaurants pubs galleries and other leisureopportunities This is possible in new shopping centres which are already being integratedwith transport13 hubs including railway and bus stations but13 may be more of a design13 challenge for older towns and cities with large Victorian buildings To ensure that13 morepeople are welcomed into the new centres they should include attention to green spacesand areas where people can relax without13 feeling that13 they are second class citizensbecause they donrsquot13 have the same buying power
3513 Privacy
To some people privacy is their right13 to live their lives without13 interference they may seethe State as a potential lsquoBig Brotherrsquo spying on their every move and judging their actions13 and activities Other people have fewer concerns about13 the role of the State but13 great13 fearof individuals interfering with and invading their privacy Some embrace the concept13 of lsquomyspacersquo an area13 of a square metre or so into which nobody can enter without13 permissionThis allows them to avoid physical contact13 and to feel safe from any form of threateningbehaviour
Yet13 this idea13 of private space and its potential violation is merely the tip of the iceberg asfar as privacy is concerned more significant13 is the idea13 of personal (and private)information being shared with anyone and everyone This could be related to identityopinion or image for an individual who wants to remain anonymous or even secretive thisis going to become an increasing problem as technology provides the means of taking
32
photographs recording conversations and capturing environment13 with something as smalland ubiquitous as a mobile phone The fact13 that13 this information can then be shared withthe rest13 of the world using e-shy‐mail Twitter and Facebook makes the problem all the moredifficult So the threat13 is no longer solely from the long lenses of the Paparazzi but13 fromanyone (and that13 means everyone) who has even the most13 basic of mobile phones
This relates to the changing views of society on what13 information should remain privateand what13 should be shared with others The success of social media13 has been based on anattitude of lsquosharing everythingrsquo with either your friends or the world This has introduced anaiumlve idea13 in the minds of some younger people (especially those known as Millennials ieaged 18-shy‐30) that13 everyone can be their friends whilst13 perhaps failing to reinforce the bondsof genuine friendship with any form of test13 or restriction Technology could play a role indefining these friendships and allowing individuals to understand what13 makes a goodfriend but13 this approach has yet13 to be developed and may be slow to overcome the needfor some people to measure their own popularity simply as the number of people that13 theycan list13 as friends on their Facebook page
It follows that13 there may be a need for a new definition of privacy that13 is in keeping withthe web and its ability to display images and opinion in an unregulated manner This needsto embrace past13 concerns about13 the ability of an individual to live without13 the threat13 ofothers being able to watch them whilst13 offering some protection from random postingsabout13 them online Perhaps this could include a right13 to be able to edit13 or remove anythingrelating to themselves on the Web including images that13 are not13 news-shy‐worthy Theownership of image rights may be an associated issue that13 needs to be addressedespecially as modern technology can remove an individual from a group (or a background)13 view provide digital touch-shy‐up or air-shy‐brushing and then republish it13 in a different13 contextHowever there is general agreement13 that13 personal information (such as contact13 details andbank codes) should not13 have a place on the web Surprisingly few people take proactivemeasures to prevent13 tracking functions being activated
It follows that13 too much privacy could lead to younger people fearing that13 they maybecome lost13 in a digital world It is not13 surprising then that13 they are prepared to make lots13 of personal information available often with no fear of how it13 might13 be used by othersWhen Google glasses and similar technologies become available during the next13 few yearsthey will have the potential to identify a stranger walking down the street and to find manyof their secrets to present13 to the wearer in a fraction of a second They could know moreabout13 them than their genuine friends know -shy‐ so who will be their friends in the future
36 Data sharing and13 protection
By lsquodata13 sharingrsquo we mean the disclosure of data13 held by one organisation on an individualto a third party organisation(s) or the sharing of data13 between different13 parts of anorganisation Some data13 sharing doesnrsquot13 involve personal data13 because it13 has beenanonymised in such a way that13 the statistics can be used for the collective good without13 theidentification of the individual The Data13 Protection Act13 (DPA) is in place to provide a legal
33
framework that13 ensures that13 organisations that13 hold personal data13 must13 act13 responsibly atall times These principles adequately describe the position of public and government13 bodies especially social services departments who are responsible for the informationconcerning the health and well-shy‐being of individuals -shy‐ and hence by implication thesensitive data13 relating to their vulnerability
The legal framework that13 applies to private and third sector organisations differs from that13 which applies to public sector organisations which may only act13 within the defined limits oftheir statutory powers However all bodies must13 comply fully with the data13 protectionprinciples and this situation is unlikely to change within the next13 10 to 15 years In someprivate sector contexts there are legal constraints on the disclosure of personal dataHowever most13 private and third sector organisations have a general ability to shareinformation provided this does not13 breach the DPA or any other law It is advisable for acompany to check its constitutional documents such as its memorandum and articles13 ofassociation to make sure there are no restrictions that13 would prevent13 it13 from sharingpersonal data13 in a particular context The type of data13 held is therefore a subject13 ofconcern as it13 may be difficult13 for legislation to keep up with the additional layers of data13 created on-shy‐line and through the Internet13 of Things
Private and third sector organisations should have regard to any industry-shy‐specific regulationor guidance about13 handling individualsrsquo information as this may affect13 the organisationrsquosability to share information They should also be aware of the legal issues that13 can arisewhen sharing personal data13 with public sector bodies This becomes more of an issue asprivate and third sector bodies are carrying out13 a wider range of traditionally public sectorfunctions Opportunities for inappropriate sharing of sensitive data13 will therefore inevitablyincrease
Public authorities must13 comply with the Human Rights Act13 (HRA) legislation in theperformance of their functions The HRA also applies to organisations in the private sectorinsofar as they carry out13 functions of a public nature which could include delivering a socialcare activity Where the HRA applies organisations must13 not13 act13 in a way that13 would beincompatible with rights under the European Convention on Human Rights Article 8 of theConvention giving everyone the right13 to respect13 for their private and family life their homeand their correspondence is especially relevant13 to sharing personal data If personal data13 isdisclosed or shared in ways that13 comply with the DPA the sharing or disclosure of that13 information is also likely to comply with the HRA The problem may still be in policing theActs and the rights of an individual if they believe that13 their personal data13 has been sharedor accessed by an inappropriate organisation or individual
A legal industry may be born to deal with such matters but13 this is unlikely to benefit13 peoplewho cannot13 afford the fees involved They would require either legal aid or to employ13 more13 lsquono win no feersquo companies Public attitudes to such costs might13 become negative unlessthey prove successful in preventing breaches of data13 security There may need to belegislation to provide a stronger basis for forcing compliance with privacy laws
34
37 Connecting with13 people
We are social creatures most13 of us rely on our friendships and interactions with friendsand families to share our happiest13 moments and experiences Research suggests that13 thishappiness is infectious at all levels and leads to a 15 increase in the happiness of a closecontact 10 for a second degree contact13 such as the friendrsquos spouse and a 6 increase fora friend of a friend It is hardly surprising that13 the success of social media13 such as Facebookis intimately related to the ability of people to quickly share their happiest13 moments with asmany of their friends and connections as possible
All this has happened during the rise of the Internet13 and the corresponding increase inopportunities for connecting online ie this is a 21st Century phenomenon which has beenfacilitated by Information and Communications Technology But13 the Internet13 remains in itsinfancy and we are only beginning to understand and exploit13 its potential In terms ofaccessing the Internet there are now perhaps two billion people who have access with99 of them having gained this during the past13 decade This number will have doubled bythe period 2020 to 2025 It is likely that13 everyone who wants to be connected in the UK willby then be connected Turning this on its head only those who donrsquot13 want13 to be online willnot13 be on the Internet13 within a decade Connecting with the unconnected will therefore bea case of identifying those people who donrsquot13 want13 to be found unfortunately these mayinclude many people who need the support13 of social care organisations It means that13 theywill be looking for support13 only when they are in crisis unless other ways of finding andormonitoring them are found
While the number of people connected via the Internet13 has exploded this might13 bedwarfed by the number of connected lsquothingsrsquo During 2009 the number of thingsconnected to the Internet13 surpassed the number of connected people at which point13 webegan to experience what13 this report13 has described as the lsquoInternet13 of Thingsrsquo Yet 99 ofall physical objects that13 could join this network are not13 yet13 connected but13 the number couldgrow by 25 every year for the next13 decade so that13 there could be 100 billion connectedobjects by 2025 some of which will be owned or used by everyone in the UK includingthose people who donrsquot13 want13 to be connected themselves We will then have an Internet13 of Everything which will be the smart13 connection of people data events and actions
With each new person object or data13 that13 comes online the connection possibilitiesbetween all these elements grows exponentially The rise of big data mobile networkingcloud storage and data13 mining technologies will all play a critical role in the Internet13 ofEverything The result13 will be new capabilities richer experiences and unprecedentedvalue for individuals businesses communities and countries everywhere The lsquonetworkeffectrsquo of the Internet13 of Everything will be a very powerful thing the true impact13 of whichwe wonrsquot13 fully understand for several years As it13 develops however those who are not13 connected will feel even more digitally and socially excluded There will be a need to reachout13 to vulnerable people unless the process of claiming requires proof of online identityand the payments to be received can only be redeemed using a chipped card or adownloaded app onto a smartphone This is of course the way that13 welfare arrangementsare already developing thus it13 might13 prove impossible to make a successful claim without13
35
already being connected to lsquothe systemrsquo either through an online presence or through theInternet13 of Things
38 Downloading everything
Sixty years ago information was discovered by reading books often in a library wherenotes had to be made because the books or journals couldnrsquot13 be removed Then in theearly 1960s the first13 office photocopying machines were introduced into the UK theyimmediately meant13 that13 pages or articles from books could be copied and taken away to beread and summarised later Within a few years photocopying became a replacement13 forreading as researchers became less adept13 at selecting a few sentences and every deskbecame a depository for reams of printed paper Paper became the means of recordingeverything from bank statements through to music
We now appreciate that13 printing everything is a waste of both the ink (or toner) used tocreate the black print13 and of paper which requires trees to be chopped down and pulpedbefore it13 can be pressed into thin sheets Saving paper is therefore seen as green and goodfor the planet Fortunately we no longer need to print13 everything because computermemory is unlimited thanks to the cloud and we can then view pages and articles onportable or fixed screens
The internet13 has everything and it13 is all available instantly for downloading providing thereis a device available to accept13 it and there is sufficient13 communication bandwidth toperform the transfer of data13 sufficiently quickly Thus we can record all text13 articles that13 are relevant13 to us including digital records of birth certificates qualifications and passportsand the need for original printed versions will decline But13 we can also do this forphotographs Most13 handheld computing devices include at least13 one camera so they cangenerate enormous number of pictures which can be kept13 for posterity without13 having toconsume inks and special papers to print13 them
But13 the materials that13 can be downloaded donrsquot13 stop at pictures software is available that13 can grab TV shows after they air and movies as soon as theyre released In the same wayit13 is possible to schedule music comic books video games and practically anything else asa download with minimal effort People will need enormous hard drives if they want13 theirown digital copies of these files so will more than likely make use of cloud storage that13 willbe available from many organisations The location of the servers may become sensitivedue to border restrictions as will the security of the data13 and the way that13 it13 is backed up sothat13 it13 is resilient13 to failures
It may be evident13 that13 application forms for all types of welfare payment13 will be availableonly for downloading so that once digitised they can be processed by computer andrecords sent13 to various servers for subsequent13 storage and processing Some people maywant13 to keep their data13 on them once it13 has been downloaded Pen drives can already holdseveral GB of data so it13 is likely that13 people will be able to carry their downloaded data13 withthem at all times irrespective of the size and complexities of the information
36
39 Health13 and13 well-shy‐being
The general health of the population is unlikely to deteriorate noticeably within 10 to 20years Indeed expectations of the population are that13 things must13 improve as surgicaltechniques mature and as pharmaceutical interventions become more personalised andpowerful However the rising demand for health services due to an ageing population andthe increasing cost13 of providing sophisticated therapies will make delivering a free anduniversal health service difficult13 without13 substantial increases in taxation This is unlikely tohappen in the UK even though spending on health services will be protected against13 thecuts facing other services
There will have to be changes in how the NHS works For twenty years hospitals have beenclosed and replaced by fewer new facilities so that13 the bed count13 is reduced This has led toa significant13 shift13 in resources to primary care and community care supporting shorter staysin hospital and speedier transfer back home for people after surgery or illness This hasbeen13 successful but13 there remain problems with demand for GP services especially out-shy‐of-shy‐hours and at weekends Indeed despite the introduction of NHS24 and similar help-shy‐linesthe demand for GP appointments continues to increase Delays are inevitable and this willincrease system failures with more unnecessary deaths and a failure for people to access adiagnosis that13 might13 lead to early interventions and ultimately lower delivery costs Over250 more patients are added to waiting lists every day
This will lead to a new model of primary care consistent13 with existing changes which haveseen surgeries move from High Street13 locations to medical centres close to bus routes andwith more parking for patients The process of making an appointment13 is changing from atelephone-shy‐based interview process dominated by a medically-shy‐unqualified receptionist13 to achoose and book approach using an online process linked to electronic patient13 records Thiswill give patients more convenience but13 will allow priority for those who have Internet13 access at the expensive of those who are digitally excluded Making the process of bookingan appointment13 quick and easy may also increase demand from people who do not13 need tobe seen as it13 will fail to identify those in greatest13 need
A greater use of telehealth and telecare technologies will be inevitable beginning with thefirst13 contact13 as an encounter using the telephone e-shy‐mail or video conferencing -shy‐ a visit13 tothe GP surgery should be a last13 resort and should involve a nurse consultation in the first13 instance This would be consistent13 with three quarters of appointments currently involvinga chronic disease or long term condition which relates to improved self-shy‐care The support13 ofthese patients at home should be prioritised through tele-shy‐ and web-shy‐based technologies andshould involve training and coaching through a network of nurse practitioners Home visitsshould generally be unnecessary through the use of these technologies but13 could besupplemented by satellite surgeries manned by nursing in community premises or inpharmacies nurseries and Internet13 cafes
The homes13 of people who13 need13 closer monitoring can then become part13 of virtual wardswith real or electronic visits by health professionals University Hospital Southampton NHSFoundation Trust13 already looks after patients who have undergone surgery such as a hip orknee13 replacements in virtual wards with high levels of satisfaction The Royal Free London
37
NHS Foundation Trust13 offers a similar service but13 plans to add the possibility of videoconsultations between patient13 and consultant
310 Attitudes to public health issues ndash obesity smoking alcohol abuse drugs
As self-shy‐care becomes the focus of the NHS the public will increasingly understand that13 thecosts and availability of services are being harmed by the poor health behaviour ofrelatively small numbers of people The link between public health initiatives today andhealthcare needs and costs in the future will become increasingly evident13 as a result13 of theway that13 information is presented Thus the overweight13 smoker who currently attractsconcern and pity when they are diagnosed with diabetes and COPD is increasingly beingseen as the victim of their own stupidity or lack of self-shy‐discipline If they continue to neglect13 medical advice and continue with an unhealthy lifestyle then the way that13 they receivetreatment13 and consume resources will become a matter for the entire population
Obesity is seen as due to a combination of poor diet13 and a sedentary lifestyle No longer isthe idea13 that13 people are lsquobig bonedrsquo acceptable Governments will respond initially byrequiring manufacturers and food processors to provide nutritional information onpackaging and on menus in restaurants But13 people can choose not13 to read the data13 and toneglect13 both the importance of food quality content13 and quantity This will increasepressure to introduce fat13 or sugar taxes and these are likely to be in force within a decade
Although the high taxes on tobacco products has forced some smokers to reduce theirconsumption or to give up altogether the impact13 has been reduced by the smuggling ofproducts from overseas and by the availability of duty-shy‐free cigarettes for people returningfrom foreign holidays and business meetings Further measures are planned to changepackaging and to include even more graphic images and warnings on cigarette packages tomake smokers aware of the effects of smoking on their health and well-shy‐being There is asyet little evidence of how successful this might13 be More effective has been the banning ofsmoking in public places including trains and aircraft Expensive medical interventions suchas heart13 transplants will be denied to individuals until they change their lifestyle behaviourSmokers might13 therefore be increasingly ostracised leading to a loss of esteem This mayhave a particular impact13 on people who already suffer from mental health problems whoare more likely to smoke
The overuse of alcohol is being recognised as a major factor in hospital admissions withNHS figures showing an increase of over 40 in such admissions over the past13 decadeLinked to this has been a 75 increase in prescriptions to treat13 alcohol dependency Fewpeople have sympathy for those who waste their limited income on booze If they havechildren or other dependents they will be the ones who suffer and who may need thesupport13 of social care
Drug users are already significant13 users of social services as their habit13 is likely to makethem unemployable They receive little sympathy from the general public because they areseen as criminals and people who waste public resources Levels of drug abuse have been
38
slowly increasing over the years but13 this trend is slowly being reversed Indeed the numberof people using drugs during the past13 year has fallen to its lowest13 level for nearly 20 years(below 9) with cannabis being most13 likely often following excessive drinking Aselectronic noses and other technologies can detect13 traces of drugs it13 seems likely that13 success in overcoming addiction can be measured objectively This may become a two-shy‐edged sword rewarding those who can turn around their lives but13 further marginalisingthose who canrsquot13 or wont13 accept13 the lsquocold turkeyrsquo
311 Attitudes to surveillance
Issues associated with privacy confidentiality and data13 security have been discussedpreviously in the context13 of information technology the World Wide Web and the ease ofcollecting recording recalling analysing and displaying data The monitoring of individualsand their methods of using this information can be regarded as surveillance As thequantities of data13 increase along with the number of devices that13 can be used to access itthe surveillance tools will also increase in their sophistication Indeed the Big Data13 approaches described in the previous section will enable the combination of structureddata13 (such as the information held in databases) to be married with unstructured data13 fromimages in such a way that13 it13 can be mined
Whilst13 the lsquodigital surveillancersquo methods described above may cause most13 concern topeople because of its impact13 on anonymity it13 is the collection and analysis of images that13 are the major concern to people as they contemplate the ways that13 lsquoBig Brotherrsquo maydevelop to restrict13 freedom Every major UK city and town centre has an array of CCTVcameras that13 continually record activities from every angle If it13 used to be true that13 nobody in London was more than 10 yards from a rat it13 is certainly the case today that13 nobody can be more than this distance from being in view of a surveillance camera Yetthey receive so much positive publicity from TV programmes where their footage is used todetect13 vehicles close to a crime scene or to monitor the movements of suspects that13 theyare now accepted by the public as a deterrent13 in the same way as lsquobobbies on the beatrsquowere seen 25 years ago There is therefore little public reaction to the expansion in the useof video surveillance except13 for the practical observation of how so many views can beinspected and recorded
Looking to the future the tumbling cost13 of video technology will surely lead to anotherincrease in the number of devices The aerial views taken from towers will besupplemented by more local views taken by devices that13 are embedded in the fabric ofbuildings or carried by individuals either on their person (for example on clothing orspectacles) or in the bags that13 they carry The time and date-shy‐stamped images as Big Datawill be recorded to lsquothe Cloudrsquo where it13 can be added to other data It can then be usedwhen an incident13 has occurred or to provide further detail of night-shy‐time activities
It follows that13 there will be no hiding place for people who simply want13 to disappear Theymay respond by wearing clothing (such as hoodies) that13 hide their faces or which make it13 difficult13 to distinguish gait13 or mannerisms from which they might13 be identified New forms
39
of clothing may be designed to make shapes more difficult13 to analyse and these might13 become the uniforms of a class of person who wants to live in a way that13 they donrsquot13 interact13 with officials from any ministry or local government13 department If they also obstruct13 services then they will be considered to be anarchists of some form sparking protests fromother sectors of society
31213 Attitudes to driving
Motor cars have been a feature of UK roads for over a century but13 it13 is only during the past13 50 years that13 they have become a resource that13 most13 families have had access to enablingthem to travel without13 the restrictions imposed by a limited railway network and non-shy‐integrated bus transport People who have had a car throughout13 their lives often see theircars as an important13 factor in enabling them to remain independent13 and to exercise choicesrelating to where they shop and where they spend their leisure time This extends to theirspouse and to friends and neighbours that13 they might13 take with them on their variousexpeditions
Unfortunately there are incidents involving older drivers who perhaps go down amotorway in the wrong direction who are taken ill at the wheel or who are involved in anaccident13 involving no other vehicles These are small in number but13 often lead to a reactionthat13 they shouldnrsquot13 be allowed to drive lsquoat13 their agersquo Age itself is not13 an indicator ofdriving quality but13 because old age also brings more chance of having limited long termconditions and other illnesses it13 is easy to make a link between driving ability and age Thelicensing system does require continued driving to be linked with medical advice andforbids people with poor eyesight epilepsy and other conditions to hold a licence in oldage
Yet13 statistically older drivers cause far fewer accidents than younger drivers The reasonsfor this may be complex and are likely to include the fact13 that13 they drive less often covershorter distances and donrsquot13 go out13 in the dark or in poor weather However it13 does not13 wholly explain why the UKrsquos drivers aged over 70 and who represent13 some 8 of all driversare involved in only 4 of accidents that13 cause injury This compares favourably with the15 of13 drivers aged between 17 and 29 who are involved in over a third of crashes that13 result13 in injury
By 2020 the number of drivers aged over 70 on UK roads is likely to increase to over 7million This will require a new national strategy perhaps involving support13 for olderdrivers further training raising awareness of issues and making more use of adaptivetechnologies to support13 the driver in avoiding collision or forgetting to check on the statusof their vehicle Poor eyesight13 could be enhanced by camera technologies rather thanforcing people off the road if they are unable to read a licence plate
The International Longevity Centre has found that13 one in four Britons thought13 driversshould be made to switch off the ignition for good somewhere between the ages of 70 and75 The numbers may decrease as the population ages and as cars become safer Forcing
40
older people off the road may be a natural consequence of providing free bus passes andsubsidised rail fares but13 the growth in the pavement13 scooter industry demonstrates that13 older people value their independence and will do almost13 anything to get13 out13 and aboutPerhaps legislation will result13 in more regulation of electric vehicles and where they cantravel
There can be no doubt13 that13 getting out13 will be associated with better quality of life andwell-shy‐being and this is likely to be supported in the future as evidence of improvedoutcomes emerges It is to be hoped that13 positive stories will be publicised so that13 publicattitudes arenrsquot13 hardened This may be supported by more in-shy‐car monitoring of drivers andthe linking of performance with on-shy‐line driving records and licences These could throughremotely monitored ignition systems prevent13 the use of motor vehicles by people without13 a licence or without13 insurance
313 Climate change
There is a general view that13 the emissions of carbon gases are contributing to globalwarming in a manner that13 will change the UK climate in such a way that13 the climate maybecome more Mediterranean However some scientists believe that13 manrsquos impact13 on theenvironment13 may be small compared with natural variations caused for example bycyclical changes in the sunrsquos energy output13 or by the effects of volcanoes and earthquakesRecent13 evidence has suggested that13 we are going through a phase of changing extremesand that13 this is more likely to cause storms periods of excessive rainfall and unusualseasonal trends with snow and frost13 in the spring and warmer winters Considerableuncertainty remains and it13 might13 be necessary to plan for a number of different13 scenariosand for the impact13 on vulnerable people
I Colder winters UK properties are poorly insulated resulting in excess mortalitiesduring cold spells due to an increased number of people suffering from stroke aswell as bronchitis and other pulmonary diseases The cost13 of heating continues toincrease putting more households into a state of fuel poverty Any further coolingduring the winter months will result13 in more people living in unhealthy coldconditions Winter fuel payments are likely to be restricted to the poorest13 peoplebut13 this might13 exclude people who live in larger properties that13 are more difficult13 toheat
II More storms excessive winds and rain can cause flooding at any time of the yearMany UK communities are built13 close to rivers and these can surge during heavyrainfall causing houses to be filled with water and furniture and carpets lostInsurance can be problematic for properties built13 on flood plains which can blight13 properties and prevent13 owners from being able to sell and move on High winds canrip off roofs causing injury and also causing families to be left13 homeless anddependent13 on social services
III Hot13 summers Europe suffered high temperatures during the summers of 2003 and2004 leading to heat13 stroke and hypothermia The UK has not13 previously sufferedfrom such problems but13 might13 be expected to experience days of extreme
41
temperature and humidity at times Older people may not13 be prepared for suchweather Street13 dwellers may be unable to find shade and supplies of drinkingwater
Irrespective of what13 combination of weather scenarios arise it13 must13 be concluded that13 any extremes will have a major negative impact13 on vulnerable people especially if theyare not13 prepared because they havenrsquot13 received the weather warnings and advice that13 can be broadcast13 using the TV radio and online services Once again the digitallyexcluded will suffer and will pay a high cost Society will continue to pick up the bill interms of demands on social care services unless preventive actions are taken in theform of connecting these people to each other and to formal services
42
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
s13 13
13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
n13 13
13 s13
r13 n13
e13 at13
e13 y13 e13 ld13
ly13
13 e13 t13 e13
s13 er13 e13
f13
rt13 13
13 13
13
r13 13
s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
e13 g13 13
e13
13 13 ial13
13
d13
13 d13 h13 r13
d13 13
s13 y13
e13
13
rd13 r13 e13
13
13
13
e13
e13
d13 13
13
13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
The13 monitoring13 centre13 becomes13 an information hub13 offering13 both advice13 and a vehicle13 for checking that someone is coping especially following a trigger event such as a stay inhospital or the illness13 of an informal13 carer
New systems utilise web technology that13 allows family members to be more proactive inthe monitoring of their relatives This can lead to greater interaction with them especiallywhen the relatives live a considerable distance away (perhaps in another country) Thesenext13 generation systems might13 include video conferencing and the use of tablets smart13 phones or smart13 TVs but13 when an emergency response is required (perhaps to lift13 someoneup after a non-shy‐injurious fall) there remains a need for human intervention
The13 future13 of13 telecare13 might therefore13 include13 an increasing13 dependence13 on volunteersfrom13 the13 community to provide13 the13 required support Social networking may need to beused13 to support13 telecare technologies
214 Mobile healthcare
While telecare can support13 people effectively in their own homes it13 is now recognised that13 being able to go out13 to enjoy open spaces and to overcome the fear that13 the home is aprison is an important13 part13 of improving well being and supporting a higher quality of lifeExtending telecare technologies to operate outside the home is known as mobile healthcare(or mCare) and is based on mobile telephone networks rather than landlines
The simplest13 form of mCare requires only a basic mobile phone to deliver telephone callsvoice13 messages and SMS (text13 messages) The technology is mature and there are countlessapplications in use both in the UK and in developing countries such as Africa13 and India13 where mobile telephones have already achieved a saturation level and where fixedtelephone infrastructures are not13 likely to be established at any time Such telephones areuniversally available in the UK and are used by the vast13 majority of people including manyolder people especially if they have been introduced to the low cost13 (pound30) devices that13 have large buttons large displays and a separate large button for calling an emergencynumber
Smart13 phones are rapidly replacing basic phones and allow the use of a large range of lsquoappsrsquothat13 are being developed to provide information and for enhanced experiences In thehealthcare space Skype FaceTime Vidyo and GoToMeeting with HD Faces are all current13 examples of video conferencing software available on tablets and smartphones
The specific software will depend on the nature of the communication desired
bull Skype will13 manage a simple video phone callbull Where an AampE physician needs to share a CT scan of head with a Neurologist13 on call
from home GoToMeeting would be more appropriate
17
bull If the physician would rather have a dedicated online meeting room that13 patientsand colleagues can simply drop in for a virtual meeting a Vidyo virtual room may bemore appropriate
This technology can suit13 any form of lifestyle including many people with complex needswhose lifestyle is not13 consistent13 with a fixed address
Social care apps are available already to deal with problems of sensory deficit
bull Guiding a blind person through GPS navigation and reading signs through appslinked to the devicersquos camera13
bull The microphone can be used as a hearing aidbull Speech recognition software can be used either to replay speech at a slower speed
or for translation into a language of choicebull Speech can also be selected for people who have a stammer or who have a problem
with their larynxbull Apps are becoming contextually aware recognising situations and locations and are
thus becoming a personal assistant13 for people with disabilities
By 2020 it is therefore possible that a smartphone may13 be prescribed13 for people who13 need13 social13 care13 together with13 a range of apps that have been13 selected13 to meet13 theirassessed13 needs
Whilst13 smart13 phones tablet13 devices and apps may become an important13 part13 of anindividualrsquos personal support13 armoury the potential of mCare will be limited only by anindividualrsquos ability to make use of all its functions Each device could become a part13 of anindividualrsquos personality supporting them to improve behaviour take exercise avoidtemptation and manage their own health and well-shy‐being Potentially mCare could becomethe most13 important13 element13 of social care and support13 within 10 years
215 Artificial Sensing and Enhancement Devices
bull It is estimated that13 one in seven people has imperfect13 hearingbull The numbers who are born deaf are quite small and many of these people may
have some form of hearing restored through surgery or through technologybull Similarly while there may be nearly a million people registered as blind or having a
severe visual impairment the vast13 majority lose their sight13 during their lives as aresult13 of disease
bull New treatments will deliver sight13 recovery or restoration over the course of the next13 10 to 20 years
Fortunately technology can provide excellent13 sensing capabilities that13 are already providingpeople with external portable devices for enhancing their lives The simple hearing aid is anexcellent13 example of a device which has been improved through both miniaturisation
18
personalisation and enhanced performance Today digital hearing aids use sub-shy‐miniaturemicrophones that13 can be unidirectional or omnidirectional and which can be adjusted insensitivity over an extended range Tomorrowrsquos devices can be switched between modesby the user so that13 they can benefit13 from hearing perfectly in any environment Indeedthey can be used with adaptive filtering technologies (as used by helicopter pilot13 headsets)to eliminate some sounds so that13 the rich speech (or music) components alone remainFuture developments will be on optimising control so that13 the user can switch seamlesslybetween different13 amplification applications without13 appearing to be distracted A smart13 phone or mp3 music player may be used as either a processing unit13 or as a ubiquitousoutput13 device that13 looks cool and natural
These same technologies will also be developed for use within the home environment13 fortimes when a deaf user isnrsquot13 present13 or is asleep Acoustic signatures associated withadverse events and incidents such as the hiss of a gas leak the crackle of a fire the sound ofa smoke detector the drip or a water leak or the sound of breaking glass can be directlyassociated with programmed actions Speech will be recognised interpreted translatedsimplified or displayed so that13 an individual knows what13 is said and can be provided withclear instructions on how to respond
Video cameras have become smaller and cheaper and capable of producing high definitionimages The problem of storing and editing these large image files is being solved by thearrival of cloud computing
Electronic noses are already capable of detecting the quality of wine and fresh fruit Similartechnology will be based in smart13 phones and will be able to analyse the air to warn of13 foodthat is no longer fresh and of other indicators of danger including gases that13 have13 little13 natural13 smell These13 devices13 could support13 people with13 cognitive impairment13 -shy‐ whose13 sense of smell13 tends13 to deteriorate -shy‐ to live independently
Many older and vulnerable people are at risk of hypothermia during the winter Sensordevices can provide warnings of low temperature In the same way heat13 stress can be adanger during the summer months so sensors can alert13 people of the need to openwindows or to operate a fanFinally people who have damaged13 their fingers13 or hands will be able to wear sensorsembedded in artificial skin or in gloves that13 will enable them to identify textures and shapesand be able to dress and undress without13 the assistance of carers
216 Robotics
We may recoil at the idea13 of personal care being delivered by robotic devices but13 it13 is likelythat13 within a decade personal assistants will exist13 to assist13 with household tasks These areunlikely to be humanoid and are more likely to be machines dedicated to helping frailpeople to support13 their own weight13 and to carry trays of food around the home
19
There are four broad classes of robot13 under development13 that13 are likely to mature within 10to 12 years
1 Miniature industrial robots that13 have been programmed to perform specific taskswith precision They are likely to be relatively heavy enabling them to bear weight13 but13 still have the necessary flexibility to carry an individual over short13 distancesplacing them in a chair or on a bed They will have sensors and cameras to provideimmediate feedback and to adjust13 rapidly in response to verbal commands or cues13 from the user Some designs may build on existing assistive devices such as abathroom hoist13 or a bathing aid to become intelligent13 extensions of productsalready on the market A stair lift13 with intelligence is already being designed by a UKcompany and is aimed at providing the user with more control of the journeybetween floors of a house
2 The second group of devices might13 be described as intelligent13 furniture Beds andchairs are already available that13 adjust13 to make the user more comfortable and also13 to help them get13 into or out13 of bed The control units are fairly cumbersome andare suited to operation by a carer Voice activated controls and built-shy‐in intelligencewill give the user more control and independence Other items of furniture to whichintelligence might13 be added would be tables whose height13 can adjust13 and whichhold items of food and medicine securely The table would recognise these objectsand could provide prompts or reminders
3 Mobile robots form the third group These could be goffers that13 can either fetchand carry items such as newspapers drinks or trays or which can accompany theuser when they move between rooms providing them with support13 or prompts Thistype of robot13 could be an intelligent13 walking frame with wheels which13 could13 doubleup as a smart13 wheelchair when necessary
4 Finally there are companion robots These might13 be in the form of an electronicpet typically a cat13 or a dog though the Japanese Paro robot13 is a seal Pets canrespond to stroking and being patted they can also remind their owners that13 theyneed to take exercise and to eat drink and take their medication Various designsare already available which provide feedback but13 future models would includecameras and a screen to provide a mobile means of information and interactionwith other people over the Internet Intelligence within the device could allow themto have a personality of their own and gain knowledge by scraping data13 fromwebsites so that13 they can generate speech and have conversations about13 the newsthe weather or sports results
217 Transport and transfer technologies
Walking is good exercise and is a no-shy‐cost13 form of transport13 that13 is encouraged because of itsimpact13 on well-shy‐being For an individual with a chronic disability or suffering from theeffects of an accident13 or an injury this becomes impractical without13 an assistive technology(AT) A walking stick is the simplest13 example of AT
20
Within the home the stair lift13 has enabled people who live in conventional properties that13 are on two or more floors to continue to use facilities on different13 floors when climbing thestairs has become too difficult This is often the case for people who have arthritis a lowerlimb amputation a long term condition such as Chronic Obstructive Pulmonary Disease orpeople approaching the end of life and who have chosen to die in their own homes
Designs have improved so that13 a curved staircase is no longer an issue and the reliabilityhas reached a level where breakdown is a rare occurrence13 Through-shy‐floor lifts have been analternative proposition but13 they remain too large for most13 properties Alternativeapproaches may emerge using air pressure or water pressure as the driving force ABrazilian design already utilises a plastic tube in which a pod is moved effortlessly up anddown
Electronic wheelchairs are now available that13 allow the individual to become moreindependent13 as they allow the user to control both propulsion and steering Some modelshave the capability of mounting a pavement13 or a step or even a flight13 of stairs Personalmuscle amplification devices have been developed originally with the intention of helpingpeople who are confined to a wheelchair due to a neurological disorder to perform sometasks from a standing position Indeed the Rex walkerrsquos manufacturers claim that13 anyonewho can propel themselves in a wheelchair could walk by using Rex
Other approaches have focused on the rehabilitation of people after major accidents that13 have caused partial paralysis They quickly extend into exoskeleton designs that13 enableanyone to gain a mechanical advantage and thus to tackle physical tasks that13 would not13 otherwise be possible These suits are the focus of major research projects across theworld Some13 products such as the system developed by Honda are being tested inAssisted Living facilities and are likely to become more and more enabling over the next13 decade
Similar benefits are also occurring outside the home with a number of novel carryingsystems appearing over the past13 few years They are generally termed lsquoscootersrsquo but13 thiscovers a wide range of systems and devices ranging from the Segway a device that13 is amobile platform on which the user stands and navigates through to conventional electricvehicles that13 have been developed from golf buggies There remain a number of issuesconcerning their use on roads or on pavements but13 similar problems will need to beresolved for bicycles to play their full part13 in enabling people to get13 more exercise13 Thepotential for hybrid scooters remains
218 Smart domestic appliances and personal hygiene
The bathroom is a dangerous place and one where many older and disabled people slip andsuffer a fall Many older people recall taking a bath in a tin tub in front13 of an open fireToday the options tend to be a level access shower (ie a type of wet13 room) for anyoneunable to get13 into a bath There are various aids to help people get13 into and out13 of thebath most13 involving a seat13 that13 can be raised or lower with some bath-shy‐tubs having a door
21
There has been some research into alternative methods of keeping the body clean Sanyointroduced a machine in 1970 modelled on a clothes or dish washing machines the personsits on a seat13 inside the machine where13 they are cleaned by a set13 of water jets These havenot13 proved popular and furthermore require the individual to be transported to themachine Thus the technology may find application in nursing homes but13 are unlikely to beattractive to people living independently in the community
The washing needs of people change over time Over the past13 20 years body piercingshave appeared which have demanded additional attention to avoid the problemsassociated with poor hygiene and metals Similarly hair may be permed and dyed usingchemicals which are much stronger and which might13 damage the hair Add to this thepainting of finger and toe nails and the washing needs are rather different13 to what13 theymight13 have been even ten years ago Finally tattoos were once popular only with sailorsToday they are likely to be found on the arms backs and legs of both men and womenNew ways of cleaning these tattoos will be needed especially if they become infected orare sites at which pressure sores develop
Even if a personrsquos body is clean if their clothes are dirty they may become socially isolatedBut13 the washing of clothes can be strenuous even if a launderette is used The need toconserve water has driven research into ultrasound techniques to beat13 the dirt13 out13 ofclothing while some companies are experimenting with polymer chips These13 ldquogreenrdquo13 technologies are quickly maturing and are likely to be standard in the next 10 years
Other smart13 household appliances are already appearing on the market13 and may soonbecome common13 in UK homes13
bull Robovac devices have sensors to enable them to detect13 dirt13 on carpets and to adjust13 their operation accordingly
bull Refrigerators can read bar codes or RFID tags to identify their contents and theirldquouse byrdquo13 dates enabling them to inform the owner that13 they should use theproducts before they are out13 of date They can be linked to the Internet13 to reorderitems as they are consumed or to suggest13 menu options for the individual based ontheir preferences or according to the diet13 required to manage a condition
bull Ovens will automatically switch off if they are left13 without13 attention for too longand drying machines will set13 times automatically
Devices may be linked so that13 they are more efficient and report13 maintenance issues sothat13 they can be repaired (perhaps remotely) before they suffer a catastrophic breakdown
219 Personal and home13 security
It might13 appear perverse but13 people with very little personal wealth and property are morelikely to be the victims of crime than those who have expensive items This may be due towhere poorer people tend to live or because people who have valuable assets take greater
22
steps to protect13 them There can be no doubt13 that13 crime has a very negative effect13 onindividuals and on their families creating a fear factor that13 may be difficult13 to remove Theimpact13 on quality of life is therefore very considerable especially if it13 forces people to stayat home behind locked doors effectively isolating themselves from society
Modern policing places increasing reliance on the use of closed circuit13 television (CCTV)Town centres are covered by cameras used increasingly in the fight13 against13 crime by bothdetecting anti-shy‐social incidents and identifying the people involved They are also used tomonitor the movement13 of cars that13 may be involved in incidents of burglary and violenceand are fast13 becoming the primary mechanism of law enforcement13 agencies to solve crime
CCTV has moved into the home to record movement but13 monitoring the footage is timeconsuming and often not13 practical Cameras are now available which provide an instant13 video feed to a smart13 phone when movement13 is detected These may have intercomcapability allowing someone to remotely speak to an intruder sometimes before they havegained access to a building This may serve as a deterrent13 and when fitted alongside simpledevices that13 switch lights on randomly around the home may force burglars to goelsewhere
As the price of cameras continues to fall the option of carrying a camera13 on the body that13 continuously monitors personal space is becoming more useful Using wireless networksthe data13 collected can be sent13 continuously to the cloud for safe storage It cansubsequently be retrieved to provide evidence (video and audio) of confrontations enablingsuccessful prosecutions to be made The smart13 phone itself is becoming a valuable itemthat13 is attractive to criminals These can be tethered to personal attack buttons usingwireless technology allowing the device to be activated by the pressing of a button if theowner is being attacked The phones can then be tracked and located by the police whilebeing rendered useless to the assailant
Bogus callers are a perennial problem for vulnerable people Video door bells can beconfigured to display images and record the words of visitors before they are admittedallowing remote monitoring centres to oversee the situations and use image recognitionsoftware to confirm the bona13 fide of visitors Such13 arrangements may become13 commonplace13 over13 the13 next five13 or13 six years13 significantly13 improving the safety of peopleliving independently
220 Personal safety
The biggest13 risks to personal safety stem from fires and falls Most13 fires are the result13 ofpoor cooking practices resulting in burns or scalds Floods and gas emissions are caused bya failure to remember to close taps
The current13 approach involves detection of an emergency situation as soon as possible but13 always after a problem has already occurred This responsive approach can minimise therisks provided that13 there is a protocol in place for intervening This could increasingly be an
23
automated response such as the switching off of the gas of water or the switching on of asprinkler system or a water mist13 system
In the future monitoring systems will be more sophisticated and will have sensors and localintelligence to identify activities In this way reminders can be issued before an emergencyoccurs13 This lsquosmart kitchenrsquo approach may become13 an integral part of13 homes of13 vulnerable13 people
A prototype system has been developed at the Culture Lab in Newcastle Sensors havebeen embedded into cooking utensils enabling the kitchen to identify what13 the person istrying to cook or prepare It can provide interventions as messages on an instructionscreen
Accidents also occur out13 of doors People with dementia13 might13 become lost13 and may havepoor road safety awareness Location devices based on GPS have advanced from large andheavy receivers that13 were used on ships and boats to small battery-shy‐operated devices that13 can be carried in the hand or in a handbag The current13 generation of locators has limitedbattery life and are rather too large to be secreted about13 a personrsquos clothing while devicesthat13 are integrated into a wrist-shy‐watch are rather clunky and unattractive
Within 10 years the13 technologies13 will have13 matured and will be13 much smaller13 so that theycan be embedded in shoes in walking sticks hats or any other item of clothing Powerrequirements will have reduced so that13 energy harvesting from the movements of theindividual will be sufficient13 to keep these products working for several weeks without13 theneed for recharging The devices will not13 simply indicate to others where the individualhappens to be but13 will provide subtle guidance cues to direct13 them home
Cameras might13 also form part13 of the personal security systems that13 will protect13 people fromaccidents Data13 may be sent13 to the cloud and analysed in real time if the person is in adangerous location and can provide prompts either to the individual or broadcast13 advice toothers to clear the danger These systems may be embedded in items of clothing (such as ahat) or they may be attached to spectacles
221 Energy and13 portable power supplies
The demands of developing economies for more power will inevitably lead to higherdomestic fuel charges in the UK especially as oil and gas reserves dwindle
By 2018 UK homes should be fitted with new smart13 meters The specifications for these13 devices have yet13 to be finalised but13 will include a means of identifying wasteful use ofenergy including TV sets that13 are left13 on and unattended fridges and freezers that13 are set13 attoo low temperatures and dryers that13 are used for too long or when the weather is suitablefor using a washing line They could be an enabling factor that13 supports changes inbehaviour driven by a need to use less power but13 it13 is unlikely that13 they will offer a bigreduction in costs that13 are already a problem for many vulnerable families
24
More generally the need for power conservation will include devices that13 are moreefficient and a significant13 emphasis on heat13 retention in buildings through betterinsulation
The energy crisis may force many people to spend more time in community settingsincluding shops and public buildings where they can benefit13 from the warmth Increasingreliance on mobile communication devices will lead to increasing demand for batterycharging facilities
Greater use may be made of portable devices for generating power based on solar cellswind or hand motion
222 Smart cities and homes
The Digital City initiatives have been based on information and how it13 can be used most13 effectively to make people aware of what13 is going on around them This means bettercoordination of resources more rapid access to advice and a battery of sensors measuringevery conceivable parameter from sound and light13 levels through to air quality andtemperature fluctuations There are several Digital or Smart13 City initiatives currently beingimplemented both in the UK and across the world They may significantly impact13 the livesof the millions of people living in them but13 the timeframe for outcome benefits to influenceplanning and design elsewhere is likely to be at least13 20 years and therefore outside thetimeframe of the current13 project
Housing plays a big role in the lives of most13 people both through their aspirations to moveup in the world (usually to a bigger property with a garden) and as the heart13 of the familylife which is associated with good quality of life UK properties have a life span approaching100 years which is about13 double that13 of their European counterparts (and certainly longerthan the wooden-shy‐frame buildings built13 in North America13 for example) A shortage ofhouses has plagued improvements in social welfare for the past13 30 years There is anargument13 that13 there are enough houses but13 the wrong size and in the wrong places andthis has some basis in fact13 as demography changes lead to more people (and more olderpeople) living alone However if there are two million homes in Scotland each with alifespan of 100 years then the renewal rate needs only to be 20000 per annum to maintainthe status quo However it13 must13 be clear that13 the impact13 of smart13 house development13 willbe small The focus should therefore be on adapting existing properties to render themmore appropriate for vulnerable people
Housing adaptations are a branch of assistive technologies The technologies for providingdifferent13 forms of accessible bath and level access shower are well-shy‐established with littleresearch considering anything other than alternative building materials and methods formaintaining the temperature of the bathwater Different13 technologies for bathing will beconsidered separately
25
Thus housing technologies are not likely to impact on social work13 within the next 20years13 though13 the use of information13 technology13 to ensure that people are aware of what13 is available is likely to be commonplace well before then
26
3 BEHAVIOUR AND ATTITUDE CHANGES DUE TO TECHNOLOGICALADVANCES
Technology is only one factor that13 will affect13 the way society changes in the next13 10 or 15years This chapter will consider the context13 in which the technological developmentsoutlined in the previous chapter will be supported (or held back) by societal factors
When the impact13 of such factors has been considered we can then apply theseassumptions to a number of case studies listed in Appendix13 A13
The headings selected for this chapter are not13 arbitrary as they reflect13 the context13 in whichtechnological changes must13 be considered They must13 include consideration of factors suchas demography and long-shy‐term conditions already addressed in the introduction to thesepapers together with the aspects of workforce and citizenship considered in the parallelpapers The additional elements here focus on trends that13 are already occurring and whichmay leave people struggling with the changes that13 occur
Finally there is a need to consider the attitudes of people to technology generally andespecially to the issues of privacy and social responsibility that13 could be radically changedby technology In some cases public opinion will prevent13 some forms of technology beingdeveloped if not13 commercialised In other cases some technologies will be fast-shy‐trackedeither at the request13 of government13 or because of a clear public demand for theopportunities that13 it13 can bring
Predictions13 about the13 future13 must inevitably be13 subject to considerable13 uncertainty butthat is no reason to stop thinking what might happen
31 The Welfare State
The UK can be rightly proud of the way that13 its welfare state has developed during the past13 100 years to provide a safety net13 of financial support13 to people and to their families whenthey are unemployed destitute homeless or challenged by crises and emergencies Therange of benefits received is considerable some are complex and many people struggle tounderstand their entitlements Some are universal some are discretionary some apply onlyto parents others to anyone
The total cost13 of providing these benefits continues to rise and when the economy isstagnating there is inevitably both political pressure often supported by popular publicopinion to introduce welfare reform so that13 people who do not13 work cannot13 be better offthan they would be if they were in full-shy‐time employment This strategy requires a universalbenefit13 to be introduced so that13 it13 is easier for claimants to access support13 but13 also easierfor agencies to identify the total benefits received The idea13 of a benefits cap then becomes
27
more practical to introduce especially if all the processes involved in making a claim arehandled electronically Indeed this encourages government13 to insist13 on applications forbenefits to be made on-shy‐line Unfortunately this will marginalise those people who haveneither a computer nor access to the internet thus emphasising the digital divide in amanner which works against13 some of the most13 disadvantaged people in society
There are currently few tangible links between digital technology and welfare provisionThe most13 obvious are universal benefits such as a free television licence (worth pound14550)13 for13 everyone aged 75 or older with blind and visually impaired people entitled to a 50discount13 irrespective of their age The significance of this position is that13 6 of revenuesgenerated through licence fees are to fund BBC on-shy‐line services13 such13 as websites and i-shy‐player In Scotland the BBCrsquos Alba Gaelic language television service is predominantlyfunded13 by MG Alba an organisation funded by the Scottish Government It is thereforeconceivable that13 in the future licence fees may be used to directly subsidise access toinformation and advice through the Internet13 for vulnerable people whether it13 is throughbroadband access or through a set-shy‐top box which removes the need for a computer in thehome to access particular websites or to use e-shy‐mail services
A second age-shy‐related benefit13 available in the UK is the winter fuel subsidy People whoreceive certain benefits receive the payments automatically while others must13 make aclaim Those who are not13 eligible for benefit13 due to a lack of an address for example missout13 on these payments and also on Cold Weather payments of pound25 for each seven dayperiod of very cold weather between 1 November and 31 March
The development13 of new warm home initiatives plus the complex of subsidies that13 theelectricity supply industry and government13 offer to people with solar cells further changesthe economic arguments Global warming may lead to greater variations in weatherextremes but13 might13 also increase the amount13 of electricity that13 can be generated byalternative (green) sources such as wind and solar cells It is estimated that13 energyconsumption in the UK increased by 17 between Christmas and Easter 2013 compared toprevious years as a result13 of cold weather but13 the above subsidy scheme did not13 benefit13 older people because two of the seven day cold periods were after 31st March It must13 beassumed that13 there will be more people living in fuel poverty in the future and this will leadto more cases of cold related illness including influenza13 and stroke
32 Management of long term conditions
The management13 of long term conditions will be improved for patients who are compliant13 with their medication regime so it13 is possible that13 there may be compulsion to adhere tothe prescription Such compulsion may be monitored using technology Indeed the remotemonitoring of vital signs using telehealthcare will become commonplace as the old boxesand sensors are replaced by devices that13 can be worn continuously or which can beembedded into the fabric of homes (including furniture and bedding) or can be worn asvests or patches They will wirelessly transmit13 data13 to smartphones or tablets and mobile
28
transmission and cloud technology will enable real-shy‐time data13 collection analysis andfeedback
One of the diseases which is projected to increase most13 significantly over the comingdecade is Type 2 diabetes Whilst13 there is a hereditary susceptibility to this condition formany people including those from the Middle East13 and the Asian sub-shy‐continent it13 is also adisease which tends to affect13 those people who are overweight13 andor have a sedentarylifestyle If untreated diabetes can lead to dizziness and collapse at any time but13 can alsohave more devastating long term consequences which include kidney failure strokeblindness and in extreme cases lower limb amputations Management13 therefore includesdaily monitoring of blood glucose levels and major dietary changes such as a significant13 reduction in the consumption of carbohydrates as well as a rigid exercise regime
Many newly diagnosed diabetics follow this advice closely and can lead normal lives for 40years or more but13 some struggle to accept13 the change in lifestyle required as well asremembering which foods are allowed and how much exercise they need to takeIndividual support13 plans are now forthcoming and over the next13 ten years best13 practicewill emerge in the form of smartphone apps that13 are personalised and which can becomean individualrsquos health coach This level of support13 will be fine for some people but13 otherswill need incentives so it13 is likely that13 gaming technologies will be introduced perhapsoffering rewards for good compliance There will be a temptation for some people tocheat perhaps allowing others to perform exercise for them or changing theirconsumption details
Many of these opportunities for cheating will be removed through the use of a uniquebiometric identifier a technology that13 will be mature enough to use in place of passwordson smartphones However the biggest13 challenge may be in encouraging older people to usethe technology Many older people have multiple morbidities Indeed a survey of Scottishpatients implied that13 42 of people aged over 80 will suffer from three long termconditions It will be essential for those people to comply with treatment13 regimes if they arenot13 to have the functional deficits that13 follow
33 Finding people who13 donrsquot fit
People who have low social capital are likely to have few relatives and friends with whomthey regularly communicate and are also unlikely to be part13 of community or faithorganisations such as clubs societies and church groups They also die several yearsyounger than most13 of the population often because they donrsquot13 engage with public healthinitiatives such as vaccinations against13 flu regular checks on their blood pressure bloodsugar levels or in the case of women smear tests or mammography The most13 likelyreason for disappearing beneath the radar of such initiatives is their mobility which leadsalmost13 inevitably to them having no fixed abode and no fixed telephone line It thenbecomes very difficult13 for them to be contacted because their mobile telephones are likelyto have Pay-shy‐As-shy‐You-shy‐Go contracts that13 donrsquot13 require validated names addresses and bankaccounts
29
It follows that13 some of the most13 vulnerable people in society including those who live onthe streets are effectively unknown to both the NHS and to social work departments untilthey are referred in a crisis This could be an emergency presentation to a hospital Accident13 and Emergency Department13 where they will come into contact13 with a social worker becausedischarge may be unsafe This often highlights the importance of the prevention agenda13 and the potential for avoiding admissions to hospital by intervening at an earlier stage
The advantages of being able to locate people who are vulnerable to specific diseases willincrease as genetic testing becomes more routine It is already possible to determine whomight13 be most13 at risk of breast13 cancer and prostate cancer as a result13 of family history Addto this the evidence that13 particular diet13 and exposure to environmental factors can furtherincrease risk then it13 is evident13 that13 individuals can be identified and offered treatmentsthat13 could save their lives many years before they become ill In the case of cancersperhaps only the individual is involved but13 for infectious diseases it13 is the whole of societythat13 is at risk if someone contracts one of the new strains of influenza or if someonechooses not13 to be vaccinated against13 rubella In Chinese airports all visitors are screenedfor fever and refused entry if they tested positive in cities the public are monitored in thesame way Similar approaches may be necessary in the UK if potential carriers cannot13 otherwise be identified
34 Volunteering
It is estimated that13 72 per cent13 of people volunteered to perform a charitable act13 at least13 once during 2012 a rise from 65 per cent13 the previous year About13 four out13 of every 10volunteers offer their services formally to one or more organisations The remaindervolunteer informally by helping out13 a friend or a neighbour Around 50 per cent13 volunteered at least13 once a month in the past13 year up from 41 per cent13 on the previous13 year Most13 have retired many of them before the statutory retirement13 age Those whodonrsquot13 feel able to offer time have offered their financial support13 at a time when the fundingavailable from sources such as the National Lottery has been decreasing Despite economicausterity donations to charities have been increasing 74 per cent13 said they had given tocharity at least13 once in the previous month up from 72 per cent13 the previous year
Strikingly 78 per cent13 of people strongly believe that13 they are part13 of their localneighbourhood an increase from 70 per cent13 10 years previously Community cohesion isstronger than ever 87 per cent13 of people believe their local area13 is a place where peoplefrom different13 backgrounds get13 on well together compared to 80 per cent13 in 2003
The role of volunteers in supporting vulnerable people is therefore likely to increase overthe next13 decade perhaps exploiting the success of the army of volunteers that13 was highlysuccessful in London during the Olympic and Paralympic games The greatest13 role for suchvolunteers may be in providing informal care for older people Already the UK has someseven million informal carers whose value in monetary terms has been calculated to be
30
more than the combined budgets of the NHS and social care Maintaining or extending thisprovision will help to support13 services in the future and may be supported by technology
Whilst13 there is ample evidence to suggest13 that13 telecare services support13 informal carers asmuch as (if not13 more than) the people that13 they are caring for it13 is the potential for utilisingthe internet13 and apps to make their role easier to coordinate and hence more effectivethat13 is likely to be most13 successful moving forward
Many of these focus on particular tasks that13 informal carers can help offer to older peoplesuch as organising their medication A pillbox program is just13 one feature of an app calledBalance It also includes sections for caregiving tips notes for the doctor and the patientsappointments plus a lsquolearning sectionrsquo with articles on aspects of Alzheimers and an RSSfeed for news about13 the disease Tyze is another multi-shy‐functional app it13 allows carers to
bull Organise appointmentsbull Plan outingsbull Share storiesbull Send updates to other family members
Another application is Rally Round which helps carers to organise someone to perform littlejobs often on a temporary basis when someone has dementia physical frailty or isrecovering from accident13 or illness Similar applications are MeMaxi and Finerday
35 The High13 Street
The shape and appearance of UK shopping centres have been changing for half a centuryPeople complain that13 centres are losing their identity with one town looking like everyother both in terms of the stores and in terms of the layout But13 there are three trendswhich are having a profound impact13 on many of the most13 vulnerable people in society
bull Centres lock their doors at 6pm or in some cases 10pm -shy‐ thus denying people whosuffer from claustrophobia13 from window shopping at times when other shoppershave left
bull Out13 of town shopping malls -shy‐ these US style centres are ideal for people in carsbecause they offer free parking which is essential for people who want13 to buy largeritems but13 difficult13 for people who have no transport13 and who must13 rely on publictransport13 that13 is often deficient
bull The rise of online shopping -shy‐ which means that13 many potential shoppers only visit13 High Street13 stores to check the prices before returning home to make a purchaseonline
It is the third of these effects that13 has the greatest13 potential for changing the High Street13 forever and it13 is making life for traditional retailers increasingly difficult13 at a time when highrents are crippling stores large and small It is difficult13 to see how this trend is likely tochange because consolidation in banking and estate agencies is already forcing the closure
31
of other High Street13 players while additional pressures on pubs has led to the closure ofthousands of pubs every year
Those figures however demonstrate that13 consumers still value what13 the high street13 canoffer -shy‐ the chance to inspect13 what13 theyrsquore thinking of buying -shy‐ as well as the new opennessof the internet Customer service makes a difference to people especially if there is aproblem and goods need to be returned One of the most13 common reasons for furniture tobe returned for example is that13 when a sofa13 or a wardrobe was delivered it13 couldnrsquot13 fit13 through the front13 door or up the stairs In the future people will be able to benefit from13 visualisation technology they will upload the floor plans of their homes enabling theretailer to inform them of the problem before they try to delivery Augmented reality viewwill similarly allow customers to see what13 a new item of furniture will look like in itsintended place so that13 they can be more informed about13 the effect13 of size and colour
In terms of improving the viability of the High Street stores will have to focus on theimportance of brand which could mean that13 individual independent13 retailers will have topartner with national suppliers to support13 a local tailored offering based on products that13 are designed for a more global market This is a lsquoconnected High Streetrsquo approach whichcould be enabled by the developments in internet13 availability and smart13 phone accessdescribed in the previous section
The overall effect13 of all these changes could mean that13 town centres become smaller but13 more vibrant13 areas They could thrive if people are attracted there in large numbers whichmeans that13 retail must13 be developed alongside restaurants pubs galleries and other leisureopportunities This is possible in new shopping centres which are already being integratedwith transport13 hubs including railway and bus stations but13 may be more of a design13 challenge for older towns and cities with large Victorian buildings To ensure that13 morepeople are welcomed into the new centres they should include attention to green spacesand areas where people can relax without13 feeling that13 they are second class citizensbecause they donrsquot13 have the same buying power
3513 Privacy
To some people privacy is their right13 to live their lives without13 interference they may seethe State as a potential lsquoBig Brotherrsquo spying on their every move and judging their actions13 and activities Other people have fewer concerns about13 the role of the State but13 great13 fearof individuals interfering with and invading their privacy Some embrace the concept13 of lsquomyspacersquo an area13 of a square metre or so into which nobody can enter without13 permissionThis allows them to avoid physical contact13 and to feel safe from any form of threateningbehaviour
Yet13 this idea13 of private space and its potential violation is merely the tip of the iceberg asfar as privacy is concerned more significant13 is the idea13 of personal (and private)information being shared with anyone and everyone This could be related to identityopinion or image for an individual who wants to remain anonymous or even secretive thisis going to become an increasing problem as technology provides the means of taking
32
photographs recording conversations and capturing environment13 with something as smalland ubiquitous as a mobile phone The fact13 that13 this information can then be shared withthe rest13 of the world using e-shy‐mail Twitter and Facebook makes the problem all the moredifficult So the threat13 is no longer solely from the long lenses of the Paparazzi but13 fromanyone (and that13 means everyone) who has even the most13 basic of mobile phones
This relates to the changing views of society on what13 information should remain privateand what13 should be shared with others The success of social media13 has been based on anattitude of lsquosharing everythingrsquo with either your friends or the world This has introduced anaiumlve idea13 in the minds of some younger people (especially those known as Millennials ieaged 18-shy‐30) that13 everyone can be their friends whilst13 perhaps failing to reinforce the bondsof genuine friendship with any form of test13 or restriction Technology could play a role indefining these friendships and allowing individuals to understand what13 makes a goodfriend but13 this approach has yet13 to be developed and may be slow to overcome the needfor some people to measure their own popularity simply as the number of people that13 theycan list13 as friends on their Facebook page
It follows that13 there may be a need for a new definition of privacy that13 is in keeping withthe web and its ability to display images and opinion in an unregulated manner This needsto embrace past13 concerns about13 the ability of an individual to live without13 the threat13 ofothers being able to watch them whilst13 offering some protection from random postingsabout13 them online Perhaps this could include a right13 to be able to edit13 or remove anythingrelating to themselves on the Web including images that13 are not13 news-shy‐worthy Theownership of image rights may be an associated issue that13 needs to be addressedespecially as modern technology can remove an individual from a group (or a background)13 view provide digital touch-shy‐up or air-shy‐brushing and then republish it13 in a different13 contextHowever there is general agreement13 that13 personal information (such as contact13 details andbank codes) should not13 have a place on the web Surprisingly few people take proactivemeasures to prevent13 tracking functions being activated
It follows that13 too much privacy could lead to younger people fearing that13 they maybecome lost13 in a digital world It is not13 surprising then that13 they are prepared to make lots13 of personal information available often with no fear of how it13 might13 be used by othersWhen Google glasses and similar technologies become available during the next13 few yearsthey will have the potential to identify a stranger walking down the street and to find manyof their secrets to present13 to the wearer in a fraction of a second They could know moreabout13 them than their genuine friends know -shy‐ so who will be their friends in the future
36 Data sharing and13 protection
By lsquodata13 sharingrsquo we mean the disclosure of data13 held by one organisation on an individualto a third party organisation(s) or the sharing of data13 between different13 parts of anorganisation Some data13 sharing doesnrsquot13 involve personal data13 because it13 has beenanonymised in such a way that13 the statistics can be used for the collective good without13 theidentification of the individual The Data13 Protection Act13 (DPA) is in place to provide a legal
33
framework that13 ensures that13 organisations that13 hold personal data13 must13 act13 responsibly atall times These principles adequately describe the position of public and government13 bodies especially social services departments who are responsible for the informationconcerning the health and well-shy‐being of individuals -shy‐ and hence by implication thesensitive data13 relating to their vulnerability
The legal framework that13 applies to private and third sector organisations differs from that13 which applies to public sector organisations which may only act13 within the defined limits oftheir statutory powers However all bodies must13 comply fully with the data13 protectionprinciples and this situation is unlikely to change within the next13 10 to 15 years In someprivate sector contexts there are legal constraints on the disclosure of personal dataHowever most13 private and third sector organisations have a general ability to shareinformation provided this does not13 breach the DPA or any other law It is advisable for acompany to check its constitutional documents such as its memorandum and articles13 ofassociation to make sure there are no restrictions that13 would prevent13 it13 from sharingpersonal data13 in a particular context The type of data13 held is therefore a subject13 ofconcern as it13 may be difficult13 for legislation to keep up with the additional layers of data13 created on-shy‐line and through the Internet13 of Things
Private and third sector organisations should have regard to any industry-shy‐specific regulationor guidance about13 handling individualsrsquo information as this may affect13 the organisationrsquosability to share information They should also be aware of the legal issues that13 can arisewhen sharing personal data13 with public sector bodies This becomes more of an issue asprivate and third sector bodies are carrying out13 a wider range of traditionally public sectorfunctions Opportunities for inappropriate sharing of sensitive data13 will therefore inevitablyincrease
Public authorities must13 comply with the Human Rights Act13 (HRA) legislation in theperformance of their functions The HRA also applies to organisations in the private sectorinsofar as they carry out13 functions of a public nature which could include delivering a socialcare activity Where the HRA applies organisations must13 not13 act13 in a way that13 would beincompatible with rights under the European Convention on Human Rights Article 8 of theConvention giving everyone the right13 to respect13 for their private and family life their homeand their correspondence is especially relevant13 to sharing personal data If personal data13 isdisclosed or shared in ways that13 comply with the DPA the sharing or disclosure of that13 information is also likely to comply with the HRA The problem may still be in policing theActs and the rights of an individual if they believe that13 their personal data13 has been sharedor accessed by an inappropriate organisation or individual
A legal industry may be born to deal with such matters but13 this is unlikely to benefit13 peoplewho cannot13 afford the fees involved They would require either legal aid or to employ13 more13 lsquono win no feersquo companies Public attitudes to such costs might13 become negative unlessthey prove successful in preventing breaches of data13 security There may need to belegislation to provide a stronger basis for forcing compliance with privacy laws
34
37 Connecting with13 people
We are social creatures most13 of us rely on our friendships and interactions with friendsand families to share our happiest13 moments and experiences Research suggests that13 thishappiness is infectious at all levels and leads to a 15 increase in the happiness of a closecontact 10 for a second degree contact13 such as the friendrsquos spouse and a 6 increase fora friend of a friend It is hardly surprising that13 the success of social media13 such as Facebookis intimately related to the ability of people to quickly share their happiest13 moments with asmany of their friends and connections as possible
All this has happened during the rise of the Internet13 and the corresponding increase inopportunities for connecting online ie this is a 21st Century phenomenon which has beenfacilitated by Information and Communications Technology But13 the Internet13 remains in itsinfancy and we are only beginning to understand and exploit13 its potential In terms ofaccessing the Internet there are now perhaps two billion people who have access with99 of them having gained this during the past13 decade This number will have doubled bythe period 2020 to 2025 It is likely that13 everyone who wants to be connected in the UK willby then be connected Turning this on its head only those who donrsquot13 want13 to be online willnot13 be on the Internet13 within a decade Connecting with the unconnected will therefore bea case of identifying those people who donrsquot13 want13 to be found unfortunately these mayinclude many people who need the support13 of social care organisations It means that13 theywill be looking for support13 only when they are in crisis unless other ways of finding andormonitoring them are found
While the number of people connected via the Internet13 has exploded this might13 bedwarfed by the number of connected lsquothingsrsquo During 2009 the number of thingsconnected to the Internet13 surpassed the number of connected people at which point13 webegan to experience what13 this report13 has described as the lsquoInternet13 of Thingsrsquo Yet 99 ofall physical objects that13 could join this network are not13 yet13 connected but13 the number couldgrow by 25 every year for the next13 decade so that13 there could be 100 billion connectedobjects by 2025 some of which will be owned or used by everyone in the UK includingthose people who donrsquot13 want13 to be connected themselves We will then have an Internet13 of Everything which will be the smart13 connection of people data events and actions
With each new person object or data13 that13 comes online the connection possibilitiesbetween all these elements grows exponentially The rise of big data mobile networkingcloud storage and data13 mining technologies will all play a critical role in the Internet13 ofEverything The result13 will be new capabilities richer experiences and unprecedentedvalue for individuals businesses communities and countries everywhere The lsquonetworkeffectrsquo of the Internet13 of Everything will be a very powerful thing the true impact13 of whichwe wonrsquot13 fully understand for several years As it13 develops however those who are not13 connected will feel even more digitally and socially excluded There will be a need to reachout13 to vulnerable people unless the process of claiming requires proof of online identityand the payments to be received can only be redeemed using a chipped card or adownloaded app onto a smartphone This is of course the way that13 welfare arrangementsare already developing thus it13 might13 prove impossible to make a successful claim without13
35
already being connected to lsquothe systemrsquo either through an online presence or through theInternet13 of Things
38 Downloading everything
Sixty years ago information was discovered by reading books often in a library wherenotes had to be made because the books or journals couldnrsquot13 be removed Then in theearly 1960s the first13 office photocopying machines were introduced into the UK theyimmediately meant13 that13 pages or articles from books could be copied and taken away to beread and summarised later Within a few years photocopying became a replacement13 forreading as researchers became less adept13 at selecting a few sentences and every deskbecame a depository for reams of printed paper Paper became the means of recordingeverything from bank statements through to music
We now appreciate that13 printing everything is a waste of both the ink (or toner) used tocreate the black print13 and of paper which requires trees to be chopped down and pulpedbefore it13 can be pressed into thin sheets Saving paper is therefore seen as green and goodfor the planet Fortunately we no longer need to print13 everything because computermemory is unlimited thanks to the cloud and we can then view pages and articles onportable or fixed screens
The internet13 has everything and it13 is all available instantly for downloading providing thereis a device available to accept13 it and there is sufficient13 communication bandwidth toperform the transfer of data13 sufficiently quickly Thus we can record all text13 articles that13 are relevant13 to us including digital records of birth certificates qualifications and passportsand the need for original printed versions will decline But13 we can also do this forphotographs Most13 handheld computing devices include at least13 one camera so they cangenerate enormous number of pictures which can be kept13 for posterity without13 having toconsume inks and special papers to print13 them
But13 the materials that13 can be downloaded donrsquot13 stop at pictures software is available that13 can grab TV shows after they air and movies as soon as theyre released In the same wayit13 is possible to schedule music comic books video games and practically anything else asa download with minimal effort People will need enormous hard drives if they want13 theirown digital copies of these files so will more than likely make use of cloud storage that13 willbe available from many organisations The location of the servers may become sensitivedue to border restrictions as will the security of the data13 and the way that13 it13 is backed up sothat13 it13 is resilient13 to failures
It may be evident13 that13 application forms for all types of welfare payment13 will be availableonly for downloading so that once digitised they can be processed by computer andrecords sent13 to various servers for subsequent13 storage and processing Some people maywant13 to keep their data13 on them once it13 has been downloaded Pen drives can already holdseveral GB of data so it13 is likely that13 people will be able to carry their downloaded data13 withthem at all times irrespective of the size and complexities of the information
36
39 Health13 and13 well-shy‐being
The general health of the population is unlikely to deteriorate noticeably within 10 to 20years Indeed expectations of the population are that13 things must13 improve as surgicaltechniques mature and as pharmaceutical interventions become more personalised andpowerful However the rising demand for health services due to an ageing population andthe increasing cost13 of providing sophisticated therapies will make delivering a free anduniversal health service difficult13 without13 substantial increases in taxation This is unlikely tohappen in the UK even though spending on health services will be protected against13 thecuts facing other services
There will have to be changes in how the NHS works For twenty years hospitals have beenclosed and replaced by fewer new facilities so that13 the bed count13 is reduced This has led toa significant13 shift13 in resources to primary care and community care supporting shorter staysin hospital and speedier transfer back home for people after surgery or illness This hasbeen13 successful but13 there remain problems with demand for GP services especially out-shy‐of-shy‐hours and at weekends Indeed despite the introduction of NHS24 and similar help-shy‐linesthe demand for GP appointments continues to increase Delays are inevitable and this willincrease system failures with more unnecessary deaths and a failure for people to access adiagnosis that13 might13 lead to early interventions and ultimately lower delivery costs Over250 more patients are added to waiting lists every day
This will lead to a new model of primary care consistent13 with existing changes which haveseen surgeries move from High Street13 locations to medical centres close to bus routes andwith more parking for patients The process of making an appointment13 is changing from atelephone-shy‐based interview process dominated by a medically-shy‐unqualified receptionist13 to achoose and book approach using an online process linked to electronic patient13 records Thiswill give patients more convenience but13 will allow priority for those who have Internet13 access at the expensive of those who are digitally excluded Making the process of bookingan appointment13 quick and easy may also increase demand from people who do not13 need tobe seen as it13 will fail to identify those in greatest13 need
A greater use of telehealth and telecare technologies will be inevitable beginning with thefirst13 contact13 as an encounter using the telephone e-shy‐mail or video conferencing -shy‐ a visit13 tothe GP surgery should be a last13 resort and should involve a nurse consultation in the first13 instance This would be consistent13 with three quarters of appointments currently involvinga chronic disease or long term condition which relates to improved self-shy‐care The support13 ofthese patients at home should be prioritised through tele-shy‐ and web-shy‐based technologies andshould involve training and coaching through a network of nurse practitioners Home visitsshould generally be unnecessary through the use of these technologies but13 could besupplemented by satellite surgeries manned by nursing in community premises or inpharmacies nurseries and Internet13 cafes
The homes13 of people who13 need13 closer monitoring can then become part13 of virtual wardswith real or electronic visits by health professionals University Hospital Southampton NHSFoundation Trust13 already looks after patients who have undergone surgery such as a hip orknee13 replacements in virtual wards with high levels of satisfaction The Royal Free London
37
NHS Foundation Trust13 offers a similar service but13 plans to add the possibility of videoconsultations between patient13 and consultant
310 Attitudes to public health issues ndash obesity smoking alcohol abuse drugs
As self-shy‐care becomes the focus of the NHS the public will increasingly understand that13 thecosts and availability of services are being harmed by the poor health behaviour ofrelatively small numbers of people The link between public health initiatives today andhealthcare needs and costs in the future will become increasingly evident13 as a result13 of theway that13 information is presented Thus the overweight13 smoker who currently attractsconcern and pity when they are diagnosed with diabetes and COPD is increasingly beingseen as the victim of their own stupidity or lack of self-shy‐discipline If they continue to neglect13 medical advice and continue with an unhealthy lifestyle then the way that13 they receivetreatment13 and consume resources will become a matter for the entire population
Obesity is seen as due to a combination of poor diet13 and a sedentary lifestyle No longer isthe idea13 that13 people are lsquobig bonedrsquo acceptable Governments will respond initially byrequiring manufacturers and food processors to provide nutritional information onpackaging and on menus in restaurants But13 people can choose not13 to read the data13 and toneglect13 both the importance of food quality content13 and quantity This will increasepressure to introduce fat13 or sugar taxes and these are likely to be in force within a decade
Although the high taxes on tobacco products has forced some smokers to reduce theirconsumption or to give up altogether the impact13 has been reduced by the smuggling ofproducts from overseas and by the availability of duty-shy‐free cigarettes for people returningfrom foreign holidays and business meetings Further measures are planned to changepackaging and to include even more graphic images and warnings on cigarette packages tomake smokers aware of the effects of smoking on their health and well-shy‐being There is asyet little evidence of how successful this might13 be More effective has been the banning ofsmoking in public places including trains and aircraft Expensive medical interventions suchas heart13 transplants will be denied to individuals until they change their lifestyle behaviourSmokers might13 therefore be increasingly ostracised leading to a loss of esteem This mayhave a particular impact13 on people who already suffer from mental health problems whoare more likely to smoke
The overuse of alcohol is being recognised as a major factor in hospital admissions withNHS figures showing an increase of over 40 in such admissions over the past13 decadeLinked to this has been a 75 increase in prescriptions to treat13 alcohol dependency Fewpeople have sympathy for those who waste their limited income on booze If they havechildren or other dependents they will be the ones who suffer and who may need thesupport13 of social care
Drug users are already significant13 users of social services as their habit13 is likely to makethem unemployable They receive little sympathy from the general public because they areseen as criminals and people who waste public resources Levels of drug abuse have been
38
slowly increasing over the years but13 this trend is slowly being reversed Indeed the numberof people using drugs during the past13 year has fallen to its lowest13 level for nearly 20 years(below 9) with cannabis being most13 likely often following excessive drinking Aselectronic noses and other technologies can detect13 traces of drugs it13 seems likely that13 success in overcoming addiction can be measured objectively This may become a two-shy‐edged sword rewarding those who can turn around their lives but13 further marginalisingthose who canrsquot13 or wont13 accept13 the lsquocold turkeyrsquo
311 Attitudes to surveillance
Issues associated with privacy confidentiality and data13 security have been discussedpreviously in the context13 of information technology the World Wide Web and the ease ofcollecting recording recalling analysing and displaying data The monitoring of individualsand their methods of using this information can be regarded as surveillance As thequantities of data13 increase along with the number of devices that13 can be used to access itthe surveillance tools will also increase in their sophistication Indeed the Big Data13 approaches described in the previous section will enable the combination of structureddata13 (such as the information held in databases) to be married with unstructured data13 fromimages in such a way that13 it13 can be mined
Whilst13 the lsquodigital surveillancersquo methods described above may cause most13 concern topeople because of its impact13 on anonymity it13 is the collection and analysis of images that13 are the major concern to people as they contemplate the ways that13 lsquoBig Brotherrsquo maydevelop to restrict13 freedom Every major UK city and town centre has an array of CCTVcameras that13 continually record activities from every angle If it13 used to be true that13 nobody in London was more than 10 yards from a rat it13 is certainly the case today that13 nobody can be more than this distance from being in view of a surveillance camera Yetthey receive so much positive publicity from TV programmes where their footage is used todetect13 vehicles close to a crime scene or to monitor the movements of suspects that13 theyare now accepted by the public as a deterrent13 in the same way as lsquobobbies on the beatrsquowere seen 25 years ago There is therefore little public reaction to the expansion in the useof video surveillance except13 for the practical observation of how so many views can beinspected and recorded
Looking to the future the tumbling cost13 of video technology will surely lead to anotherincrease in the number of devices The aerial views taken from towers will besupplemented by more local views taken by devices that13 are embedded in the fabric ofbuildings or carried by individuals either on their person (for example on clothing orspectacles) or in the bags that13 they carry The time and date-shy‐stamped images as Big Datawill be recorded to lsquothe Cloudrsquo where it13 can be added to other data It can then be usedwhen an incident13 has occurred or to provide further detail of night-shy‐time activities
It follows that13 there will be no hiding place for people who simply want13 to disappear Theymay respond by wearing clothing (such as hoodies) that13 hide their faces or which make it13 difficult13 to distinguish gait13 or mannerisms from which they might13 be identified New forms
39
of clothing may be designed to make shapes more difficult13 to analyse and these might13 become the uniforms of a class of person who wants to live in a way that13 they donrsquot13 interact13 with officials from any ministry or local government13 department If they also obstruct13 services then they will be considered to be anarchists of some form sparking protests fromother sectors of society
31213 Attitudes to driving
Motor cars have been a feature of UK roads for over a century but13 it13 is only during the past13 50 years that13 they have become a resource that13 most13 families have had access to enablingthem to travel without13 the restrictions imposed by a limited railway network and non-shy‐integrated bus transport People who have had a car throughout13 their lives often see theircars as an important13 factor in enabling them to remain independent13 and to exercise choicesrelating to where they shop and where they spend their leisure time This extends to theirspouse and to friends and neighbours that13 they might13 take with them on their variousexpeditions
Unfortunately there are incidents involving older drivers who perhaps go down amotorway in the wrong direction who are taken ill at the wheel or who are involved in anaccident13 involving no other vehicles These are small in number but13 often lead to a reactionthat13 they shouldnrsquot13 be allowed to drive lsquoat13 their agersquo Age itself is not13 an indicator ofdriving quality but13 because old age also brings more chance of having limited long termconditions and other illnesses it13 is easy to make a link between driving ability and age Thelicensing system does require continued driving to be linked with medical advice andforbids people with poor eyesight epilepsy and other conditions to hold a licence in oldage
Yet13 statistically older drivers cause far fewer accidents than younger drivers The reasonsfor this may be complex and are likely to include the fact13 that13 they drive less often covershorter distances and donrsquot13 go out13 in the dark or in poor weather However it13 does not13 wholly explain why the UKrsquos drivers aged over 70 and who represent13 some 8 of all driversare involved in only 4 of accidents that13 cause injury This compares favourably with the15 of13 drivers aged between 17 and 29 who are involved in over a third of crashes that13 result13 in injury
By 2020 the number of drivers aged over 70 on UK roads is likely to increase to over 7million This will require a new national strategy perhaps involving support13 for olderdrivers further training raising awareness of issues and making more use of adaptivetechnologies to support13 the driver in avoiding collision or forgetting to check on the statusof their vehicle Poor eyesight13 could be enhanced by camera technologies rather thanforcing people off the road if they are unable to read a licence plate
The International Longevity Centre has found that13 one in four Britons thought13 driversshould be made to switch off the ignition for good somewhere between the ages of 70 and75 The numbers may decrease as the population ages and as cars become safer Forcing
40
older people off the road may be a natural consequence of providing free bus passes andsubsidised rail fares but13 the growth in the pavement13 scooter industry demonstrates that13 older people value their independence and will do almost13 anything to get13 out13 and aboutPerhaps legislation will result13 in more regulation of electric vehicles and where they cantravel
There can be no doubt13 that13 getting out13 will be associated with better quality of life andwell-shy‐being and this is likely to be supported in the future as evidence of improvedoutcomes emerges It is to be hoped that13 positive stories will be publicised so that13 publicattitudes arenrsquot13 hardened This may be supported by more in-shy‐car monitoring of drivers andthe linking of performance with on-shy‐line driving records and licences These could throughremotely monitored ignition systems prevent13 the use of motor vehicles by people without13 a licence or without13 insurance
313 Climate change
There is a general view that13 the emissions of carbon gases are contributing to globalwarming in a manner that13 will change the UK climate in such a way that13 the climate maybecome more Mediterranean However some scientists believe that13 manrsquos impact13 on theenvironment13 may be small compared with natural variations caused for example bycyclical changes in the sunrsquos energy output13 or by the effects of volcanoes and earthquakesRecent13 evidence has suggested that13 we are going through a phase of changing extremesand that13 this is more likely to cause storms periods of excessive rainfall and unusualseasonal trends with snow and frost13 in the spring and warmer winters Considerableuncertainty remains and it13 might13 be necessary to plan for a number of different13 scenariosand for the impact13 on vulnerable people
I Colder winters UK properties are poorly insulated resulting in excess mortalitiesduring cold spells due to an increased number of people suffering from stroke aswell as bronchitis and other pulmonary diseases The cost13 of heating continues toincrease putting more households into a state of fuel poverty Any further coolingduring the winter months will result13 in more people living in unhealthy coldconditions Winter fuel payments are likely to be restricted to the poorest13 peoplebut13 this might13 exclude people who live in larger properties that13 are more difficult13 toheat
II More storms excessive winds and rain can cause flooding at any time of the yearMany UK communities are built13 close to rivers and these can surge during heavyrainfall causing houses to be filled with water and furniture and carpets lostInsurance can be problematic for properties built13 on flood plains which can blight13 properties and prevent13 owners from being able to sell and move on High winds canrip off roofs causing injury and also causing families to be left13 homeless anddependent13 on social services
III Hot13 summers Europe suffered high temperatures during the summers of 2003 and2004 leading to heat13 stroke and hypothermia The UK has not13 previously sufferedfrom such problems but13 might13 be expected to experience days of extreme
41
temperature and humidity at times Older people may not13 be prepared for suchweather Street13 dwellers may be unable to find shade and supplies of drinkingwater
Irrespective of what13 combination of weather scenarios arise it13 must13 be concluded that13 any extremes will have a major negative impact13 on vulnerable people especially if theyare not13 prepared because they havenrsquot13 received the weather warnings and advice that13 can be broadcast13 using the TV radio and online services Once again the digitallyexcluded will suffer and will pay a high cost Society will continue to pick up the bill interms of demands on social care services unless preventive actions are taken in theform of connecting these people to each other and to formal services
42
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
s13 13
13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
n13 13
13 s13
r13 n13
e13 at13
e13 y13 e13 ld13
ly13
13 e13 t13 e13
s13 er13 e13
f13
rt13 13
13 13
13
r13 13
s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
e13 g13 13
e13
13 13 ial13
13
d13
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s13 y13
e13
13
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e13
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13
13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
bull If the physician would rather have a dedicated online meeting room that13 patientsand colleagues can simply drop in for a virtual meeting a Vidyo virtual room may bemore appropriate
This technology can suit13 any form of lifestyle including many people with complex needswhose lifestyle is not13 consistent13 with a fixed address
Social care apps are available already to deal with problems of sensory deficit
bull Guiding a blind person through GPS navigation and reading signs through appslinked to the devicersquos camera13
bull The microphone can be used as a hearing aidbull Speech recognition software can be used either to replay speech at a slower speed
or for translation into a language of choicebull Speech can also be selected for people who have a stammer or who have a problem
with their larynxbull Apps are becoming contextually aware recognising situations and locations and are
thus becoming a personal assistant13 for people with disabilities
By 2020 it is therefore possible that a smartphone may13 be prescribed13 for people who13 need13 social13 care13 together with13 a range of apps that have been13 selected13 to meet13 theirassessed13 needs
Whilst13 smart13 phones tablet13 devices and apps may become an important13 part13 of anindividualrsquos personal support13 armoury the potential of mCare will be limited only by anindividualrsquos ability to make use of all its functions Each device could become a part13 of anindividualrsquos personality supporting them to improve behaviour take exercise avoidtemptation and manage their own health and well-shy‐being Potentially mCare could becomethe most13 important13 element13 of social care and support13 within 10 years
215 Artificial Sensing and Enhancement Devices
bull It is estimated that13 one in seven people has imperfect13 hearingbull The numbers who are born deaf are quite small and many of these people may
have some form of hearing restored through surgery or through technologybull Similarly while there may be nearly a million people registered as blind or having a
severe visual impairment the vast13 majority lose their sight13 during their lives as aresult13 of disease
bull New treatments will deliver sight13 recovery or restoration over the course of the next13 10 to 20 years
Fortunately technology can provide excellent13 sensing capabilities that13 are already providingpeople with external portable devices for enhancing their lives The simple hearing aid is anexcellent13 example of a device which has been improved through both miniaturisation
18
personalisation and enhanced performance Today digital hearing aids use sub-shy‐miniaturemicrophones that13 can be unidirectional or omnidirectional and which can be adjusted insensitivity over an extended range Tomorrowrsquos devices can be switched between modesby the user so that13 they can benefit13 from hearing perfectly in any environment Indeedthey can be used with adaptive filtering technologies (as used by helicopter pilot13 headsets)to eliminate some sounds so that13 the rich speech (or music) components alone remainFuture developments will be on optimising control so that13 the user can switch seamlesslybetween different13 amplification applications without13 appearing to be distracted A smart13 phone or mp3 music player may be used as either a processing unit13 or as a ubiquitousoutput13 device that13 looks cool and natural
These same technologies will also be developed for use within the home environment13 fortimes when a deaf user isnrsquot13 present13 or is asleep Acoustic signatures associated withadverse events and incidents such as the hiss of a gas leak the crackle of a fire the sound ofa smoke detector the drip or a water leak or the sound of breaking glass can be directlyassociated with programmed actions Speech will be recognised interpreted translatedsimplified or displayed so that13 an individual knows what13 is said and can be provided withclear instructions on how to respond
Video cameras have become smaller and cheaper and capable of producing high definitionimages The problem of storing and editing these large image files is being solved by thearrival of cloud computing
Electronic noses are already capable of detecting the quality of wine and fresh fruit Similartechnology will be based in smart13 phones and will be able to analyse the air to warn of13 foodthat is no longer fresh and of other indicators of danger including gases that13 have13 little13 natural13 smell These13 devices13 could support13 people with13 cognitive impairment13 -shy‐ whose13 sense of smell13 tends13 to deteriorate -shy‐ to live independently
Many older and vulnerable people are at risk of hypothermia during the winter Sensordevices can provide warnings of low temperature In the same way heat13 stress can be adanger during the summer months so sensors can alert13 people of the need to openwindows or to operate a fanFinally people who have damaged13 their fingers13 or hands will be able to wear sensorsembedded in artificial skin or in gloves that13 will enable them to identify textures and shapesand be able to dress and undress without13 the assistance of carers
216 Robotics
We may recoil at the idea13 of personal care being delivered by robotic devices but13 it13 is likelythat13 within a decade personal assistants will exist13 to assist13 with household tasks These areunlikely to be humanoid and are more likely to be machines dedicated to helping frailpeople to support13 their own weight13 and to carry trays of food around the home
19
There are four broad classes of robot13 under development13 that13 are likely to mature within 10to 12 years
1 Miniature industrial robots that13 have been programmed to perform specific taskswith precision They are likely to be relatively heavy enabling them to bear weight13 but13 still have the necessary flexibility to carry an individual over short13 distancesplacing them in a chair or on a bed They will have sensors and cameras to provideimmediate feedback and to adjust13 rapidly in response to verbal commands or cues13 from the user Some designs may build on existing assistive devices such as abathroom hoist13 or a bathing aid to become intelligent13 extensions of productsalready on the market A stair lift13 with intelligence is already being designed by a UKcompany and is aimed at providing the user with more control of the journeybetween floors of a house
2 The second group of devices might13 be described as intelligent13 furniture Beds andchairs are already available that13 adjust13 to make the user more comfortable and also13 to help them get13 into or out13 of bed The control units are fairly cumbersome andare suited to operation by a carer Voice activated controls and built-shy‐in intelligencewill give the user more control and independence Other items of furniture to whichintelligence might13 be added would be tables whose height13 can adjust13 and whichhold items of food and medicine securely The table would recognise these objectsand could provide prompts or reminders
3 Mobile robots form the third group These could be goffers that13 can either fetchand carry items such as newspapers drinks or trays or which can accompany theuser when they move between rooms providing them with support13 or prompts Thistype of robot13 could be an intelligent13 walking frame with wheels which13 could13 doubleup as a smart13 wheelchair when necessary
4 Finally there are companion robots These might13 be in the form of an electronicpet typically a cat13 or a dog though the Japanese Paro robot13 is a seal Pets canrespond to stroking and being patted they can also remind their owners that13 theyneed to take exercise and to eat drink and take their medication Various designsare already available which provide feedback but13 future models would includecameras and a screen to provide a mobile means of information and interactionwith other people over the Internet Intelligence within the device could allow themto have a personality of their own and gain knowledge by scraping data13 fromwebsites so that13 they can generate speech and have conversations about13 the newsthe weather or sports results
217 Transport and transfer technologies
Walking is good exercise and is a no-shy‐cost13 form of transport13 that13 is encouraged because of itsimpact13 on well-shy‐being For an individual with a chronic disability or suffering from theeffects of an accident13 or an injury this becomes impractical without13 an assistive technology(AT) A walking stick is the simplest13 example of AT
20
Within the home the stair lift13 has enabled people who live in conventional properties that13 are on two or more floors to continue to use facilities on different13 floors when climbing thestairs has become too difficult This is often the case for people who have arthritis a lowerlimb amputation a long term condition such as Chronic Obstructive Pulmonary Disease orpeople approaching the end of life and who have chosen to die in their own homes
Designs have improved so that13 a curved staircase is no longer an issue and the reliabilityhas reached a level where breakdown is a rare occurrence13 Through-shy‐floor lifts have been analternative proposition but13 they remain too large for most13 properties Alternativeapproaches may emerge using air pressure or water pressure as the driving force ABrazilian design already utilises a plastic tube in which a pod is moved effortlessly up anddown
Electronic wheelchairs are now available that13 allow the individual to become moreindependent13 as they allow the user to control both propulsion and steering Some modelshave the capability of mounting a pavement13 or a step or even a flight13 of stairs Personalmuscle amplification devices have been developed originally with the intention of helpingpeople who are confined to a wheelchair due to a neurological disorder to perform sometasks from a standing position Indeed the Rex walkerrsquos manufacturers claim that13 anyonewho can propel themselves in a wheelchair could walk by using Rex
Other approaches have focused on the rehabilitation of people after major accidents that13 have caused partial paralysis They quickly extend into exoskeleton designs that13 enableanyone to gain a mechanical advantage and thus to tackle physical tasks that13 would not13 otherwise be possible These suits are the focus of major research projects across theworld Some13 products such as the system developed by Honda are being tested inAssisted Living facilities and are likely to become more and more enabling over the next13 decade
Similar benefits are also occurring outside the home with a number of novel carryingsystems appearing over the past13 few years They are generally termed lsquoscootersrsquo but13 thiscovers a wide range of systems and devices ranging from the Segway a device that13 is amobile platform on which the user stands and navigates through to conventional electricvehicles that13 have been developed from golf buggies There remain a number of issuesconcerning their use on roads or on pavements but13 similar problems will need to beresolved for bicycles to play their full part13 in enabling people to get13 more exercise13 Thepotential for hybrid scooters remains
218 Smart domestic appliances and personal hygiene
The bathroom is a dangerous place and one where many older and disabled people slip andsuffer a fall Many older people recall taking a bath in a tin tub in front13 of an open fireToday the options tend to be a level access shower (ie a type of wet13 room) for anyoneunable to get13 into a bath There are various aids to help people get13 into and out13 of thebath most13 involving a seat13 that13 can be raised or lower with some bath-shy‐tubs having a door
21
There has been some research into alternative methods of keeping the body clean Sanyointroduced a machine in 1970 modelled on a clothes or dish washing machines the personsits on a seat13 inside the machine where13 they are cleaned by a set13 of water jets These havenot13 proved popular and furthermore require the individual to be transported to themachine Thus the technology may find application in nursing homes but13 are unlikely to beattractive to people living independently in the community
The washing needs of people change over time Over the past13 20 years body piercingshave appeared which have demanded additional attention to avoid the problemsassociated with poor hygiene and metals Similarly hair may be permed and dyed usingchemicals which are much stronger and which might13 damage the hair Add to this thepainting of finger and toe nails and the washing needs are rather different13 to what13 theymight13 have been even ten years ago Finally tattoos were once popular only with sailorsToday they are likely to be found on the arms backs and legs of both men and womenNew ways of cleaning these tattoos will be needed especially if they become infected orare sites at which pressure sores develop
Even if a personrsquos body is clean if their clothes are dirty they may become socially isolatedBut13 the washing of clothes can be strenuous even if a launderette is used The need toconserve water has driven research into ultrasound techniques to beat13 the dirt13 out13 ofclothing while some companies are experimenting with polymer chips These13 ldquogreenrdquo13 technologies are quickly maturing and are likely to be standard in the next 10 years
Other smart13 household appliances are already appearing on the market13 and may soonbecome common13 in UK homes13
bull Robovac devices have sensors to enable them to detect13 dirt13 on carpets and to adjust13 their operation accordingly
bull Refrigerators can read bar codes or RFID tags to identify their contents and theirldquouse byrdquo13 dates enabling them to inform the owner that13 they should use theproducts before they are out13 of date They can be linked to the Internet13 to reorderitems as they are consumed or to suggest13 menu options for the individual based ontheir preferences or according to the diet13 required to manage a condition
bull Ovens will automatically switch off if they are left13 without13 attention for too longand drying machines will set13 times automatically
Devices may be linked so that13 they are more efficient and report13 maintenance issues sothat13 they can be repaired (perhaps remotely) before they suffer a catastrophic breakdown
219 Personal and home13 security
It might13 appear perverse but13 people with very little personal wealth and property are morelikely to be the victims of crime than those who have expensive items This may be due towhere poorer people tend to live or because people who have valuable assets take greater
22
steps to protect13 them There can be no doubt13 that13 crime has a very negative effect13 onindividuals and on their families creating a fear factor that13 may be difficult13 to remove Theimpact13 on quality of life is therefore very considerable especially if it13 forces people to stayat home behind locked doors effectively isolating themselves from society
Modern policing places increasing reliance on the use of closed circuit13 television (CCTV)Town centres are covered by cameras used increasingly in the fight13 against13 crime by bothdetecting anti-shy‐social incidents and identifying the people involved They are also used tomonitor the movement13 of cars that13 may be involved in incidents of burglary and violenceand are fast13 becoming the primary mechanism of law enforcement13 agencies to solve crime
CCTV has moved into the home to record movement but13 monitoring the footage is timeconsuming and often not13 practical Cameras are now available which provide an instant13 video feed to a smart13 phone when movement13 is detected These may have intercomcapability allowing someone to remotely speak to an intruder sometimes before they havegained access to a building This may serve as a deterrent13 and when fitted alongside simpledevices that13 switch lights on randomly around the home may force burglars to goelsewhere
As the price of cameras continues to fall the option of carrying a camera13 on the body that13 continuously monitors personal space is becoming more useful Using wireless networksthe data13 collected can be sent13 continuously to the cloud for safe storage It cansubsequently be retrieved to provide evidence (video and audio) of confrontations enablingsuccessful prosecutions to be made The smart13 phone itself is becoming a valuable itemthat13 is attractive to criminals These can be tethered to personal attack buttons usingwireless technology allowing the device to be activated by the pressing of a button if theowner is being attacked The phones can then be tracked and located by the police whilebeing rendered useless to the assailant
Bogus callers are a perennial problem for vulnerable people Video door bells can beconfigured to display images and record the words of visitors before they are admittedallowing remote monitoring centres to oversee the situations and use image recognitionsoftware to confirm the bona13 fide of visitors Such13 arrangements may become13 commonplace13 over13 the13 next five13 or13 six years13 significantly13 improving the safety of peopleliving independently
220 Personal safety
The biggest13 risks to personal safety stem from fires and falls Most13 fires are the result13 ofpoor cooking practices resulting in burns or scalds Floods and gas emissions are caused bya failure to remember to close taps
The current13 approach involves detection of an emergency situation as soon as possible but13 always after a problem has already occurred This responsive approach can minimise therisks provided that13 there is a protocol in place for intervening This could increasingly be an
23
automated response such as the switching off of the gas of water or the switching on of asprinkler system or a water mist13 system
In the future monitoring systems will be more sophisticated and will have sensors and localintelligence to identify activities In this way reminders can be issued before an emergencyoccurs13 This lsquosmart kitchenrsquo approach may become13 an integral part of13 homes of13 vulnerable13 people
A prototype system has been developed at the Culture Lab in Newcastle Sensors havebeen embedded into cooking utensils enabling the kitchen to identify what13 the person istrying to cook or prepare It can provide interventions as messages on an instructionscreen
Accidents also occur out13 of doors People with dementia13 might13 become lost13 and may havepoor road safety awareness Location devices based on GPS have advanced from large andheavy receivers that13 were used on ships and boats to small battery-shy‐operated devices that13 can be carried in the hand or in a handbag The current13 generation of locators has limitedbattery life and are rather too large to be secreted about13 a personrsquos clothing while devicesthat13 are integrated into a wrist-shy‐watch are rather clunky and unattractive
Within 10 years the13 technologies13 will have13 matured and will be13 much smaller13 so that theycan be embedded in shoes in walking sticks hats or any other item of clothing Powerrequirements will have reduced so that13 energy harvesting from the movements of theindividual will be sufficient13 to keep these products working for several weeks without13 theneed for recharging The devices will not13 simply indicate to others where the individualhappens to be but13 will provide subtle guidance cues to direct13 them home
Cameras might13 also form part13 of the personal security systems that13 will protect13 people fromaccidents Data13 may be sent13 to the cloud and analysed in real time if the person is in adangerous location and can provide prompts either to the individual or broadcast13 advice toothers to clear the danger These systems may be embedded in items of clothing (such as ahat) or they may be attached to spectacles
221 Energy and13 portable power supplies
The demands of developing economies for more power will inevitably lead to higherdomestic fuel charges in the UK especially as oil and gas reserves dwindle
By 2018 UK homes should be fitted with new smart13 meters The specifications for these13 devices have yet13 to be finalised but13 will include a means of identifying wasteful use ofenergy including TV sets that13 are left13 on and unattended fridges and freezers that13 are set13 attoo low temperatures and dryers that13 are used for too long or when the weather is suitablefor using a washing line They could be an enabling factor that13 supports changes inbehaviour driven by a need to use less power but13 it13 is unlikely that13 they will offer a bigreduction in costs that13 are already a problem for many vulnerable families
24
More generally the need for power conservation will include devices that13 are moreefficient and a significant13 emphasis on heat13 retention in buildings through betterinsulation
The energy crisis may force many people to spend more time in community settingsincluding shops and public buildings where they can benefit13 from the warmth Increasingreliance on mobile communication devices will lead to increasing demand for batterycharging facilities
Greater use may be made of portable devices for generating power based on solar cellswind or hand motion
222 Smart cities and homes
The Digital City initiatives have been based on information and how it13 can be used most13 effectively to make people aware of what13 is going on around them This means bettercoordination of resources more rapid access to advice and a battery of sensors measuringevery conceivable parameter from sound and light13 levels through to air quality andtemperature fluctuations There are several Digital or Smart13 City initiatives currently beingimplemented both in the UK and across the world They may significantly impact13 the livesof the millions of people living in them but13 the timeframe for outcome benefits to influenceplanning and design elsewhere is likely to be at least13 20 years and therefore outside thetimeframe of the current13 project
Housing plays a big role in the lives of most13 people both through their aspirations to moveup in the world (usually to a bigger property with a garden) and as the heart13 of the familylife which is associated with good quality of life UK properties have a life span approaching100 years which is about13 double that13 of their European counterparts (and certainly longerthan the wooden-shy‐frame buildings built13 in North America13 for example) A shortage ofhouses has plagued improvements in social welfare for the past13 30 years There is anargument13 that13 there are enough houses but13 the wrong size and in the wrong places andthis has some basis in fact13 as demography changes lead to more people (and more olderpeople) living alone However if there are two million homes in Scotland each with alifespan of 100 years then the renewal rate needs only to be 20000 per annum to maintainthe status quo However it13 must13 be clear that13 the impact13 of smart13 house development13 willbe small The focus should therefore be on adapting existing properties to render themmore appropriate for vulnerable people
Housing adaptations are a branch of assistive technologies The technologies for providingdifferent13 forms of accessible bath and level access shower are well-shy‐established with littleresearch considering anything other than alternative building materials and methods formaintaining the temperature of the bathwater Different13 technologies for bathing will beconsidered separately
25
Thus housing technologies are not likely to impact on social work13 within the next 20years13 though13 the use of information13 technology13 to ensure that people are aware of what13 is available is likely to be commonplace well before then
26
3 BEHAVIOUR AND ATTITUDE CHANGES DUE TO TECHNOLOGICALADVANCES
Technology is only one factor that13 will affect13 the way society changes in the next13 10 or 15years This chapter will consider the context13 in which the technological developmentsoutlined in the previous chapter will be supported (or held back) by societal factors
When the impact13 of such factors has been considered we can then apply theseassumptions to a number of case studies listed in Appendix13 A13
The headings selected for this chapter are not13 arbitrary as they reflect13 the context13 in whichtechnological changes must13 be considered They must13 include consideration of factors suchas demography and long-shy‐term conditions already addressed in the introduction to thesepapers together with the aspects of workforce and citizenship considered in the parallelpapers The additional elements here focus on trends that13 are already occurring and whichmay leave people struggling with the changes that13 occur
Finally there is a need to consider the attitudes of people to technology generally andespecially to the issues of privacy and social responsibility that13 could be radically changedby technology In some cases public opinion will prevent13 some forms of technology beingdeveloped if not13 commercialised In other cases some technologies will be fast-shy‐trackedeither at the request13 of government13 or because of a clear public demand for theopportunities that13 it13 can bring
Predictions13 about the13 future13 must inevitably be13 subject to considerable13 uncertainty butthat is no reason to stop thinking what might happen
31 The Welfare State
The UK can be rightly proud of the way that13 its welfare state has developed during the past13 100 years to provide a safety net13 of financial support13 to people and to their families whenthey are unemployed destitute homeless or challenged by crises and emergencies Therange of benefits received is considerable some are complex and many people struggle tounderstand their entitlements Some are universal some are discretionary some apply onlyto parents others to anyone
The total cost13 of providing these benefits continues to rise and when the economy isstagnating there is inevitably both political pressure often supported by popular publicopinion to introduce welfare reform so that13 people who do not13 work cannot13 be better offthan they would be if they were in full-shy‐time employment This strategy requires a universalbenefit13 to be introduced so that13 it13 is easier for claimants to access support13 but13 also easierfor agencies to identify the total benefits received The idea13 of a benefits cap then becomes
27
more practical to introduce especially if all the processes involved in making a claim arehandled electronically Indeed this encourages government13 to insist13 on applications forbenefits to be made on-shy‐line Unfortunately this will marginalise those people who haveneither a computer nor access to the internet thus emphasising the digital divide in amanner which works against13 some of the most13 disadvantaged people in society
There are currently few tangible links between digital technology and welfare provisionThe most13 obvious are universal benefits such as a free television licence (worth pound14550)13 for13 everyone aged 75 or older with blind and visually impaired people entitled to a 50discount13 irrespective of their age The significance of this position is that13 6 of revenuesgenerated through licence fees are to fund BBC on-shy‐line services13 such13 as websites and i-shy‐player In Scotland the BBCrsquos Alba Gaelic language television service is predominantlyfunded13 by MG Alba an organisation funded by the Scottish Government It is thereforeconceivable that13 in the future licence fees may be used to directly subsidise access toinformation and advice through the Internet13 for vulnerable people whether it13 is throughbroadband access or through a set-shy‐top box which removes the need for a computer in thehome to access particular websites or to use e-shy‐mail services
A second age-shy‐related benefit13 available in the UK is the winter fuel subsidy People whoreceive certain benefits receive the payments automatically while others must13 make aclaim Those who are not13 eligible for benefit13 due to a lack of an address for example missout13 on these payments and also on Cold Weather payments of pound25 for each seven dayperiod of very cold weather between 1 November and 31 March
The development13 of new warm home initiatives plus the complex of subsidies that13 theelectricity supply industry and government13 offer to people with solar cells further changesthe economic arguments Global warming may lead to greater variations in weatherextremes but13 might13 also increase the amount13 of electricity that13 can be generated byalternative (green) sources such as wind and solar cells It is estimated that13 energyconsumption in the UK increased by 17 between Christmas and Easter 2013 compared toprevious years as a result13 of cold weather but13 the above subsidy scheme did not13 benefit13 older people because two of the seven day cold periods were after 31st March It must13 beassumed that13 there will be more people living in fuel poverty in the future and this will leadto more cases of cold related illness including influenza13 and stroke
32 Management of long term conditions
The management13 of long term conditions will be improved for patients who are compliant13 with their medication regime so it13 is possible that13 there may be compulsion to adhere tothe prescription Such compulsion may be monitored using technology Indeed the remotemonitoring of vital signs using telehealthcare will become commonplace as the old boxesand sensors are replaced by devices that13 can be worn continuously or which can beembedded into the fabric of homes (including furniture and bedding) or can be worn asvests or patches They will wirelessly transmit13 data13 to smartphones or tablets and mobile
28
transmission and cloud technology will enable real-shy‐time data13 collection analysis andfeedback
One of the diseases which is projected to increase most13 significantly over the comingdecade is Type 2 diabetes Whilst13 there is a hereditary susceptibility to this condition formany people including those from the Middle East13 and the Asian sub-shy‐continent it13 is also adisease which tends to affect13 those people who are overweight13 andor have a sedentarylifestyle If untreated diabetes can lead to dizziness and collapse at any time but13 can alsohave more devastating long term consequences which include kidney failure strokeblindness and in extreme cases lower limb amputations Management13 therefore includesdaily monitoring of blood glucose levels and major dietary changes such as a significant13 reduction in the consumption of carbohydrates as well as a rigid exercise regime
Many newly diagnosed diabetics follow this advice closely and can lead normal lives for 40years or more but13 some struggle to accept13 the change in lifestyle required as well asremembering which foods are allowed and how much exercise they need to takeIndividual support13 plans are now forthcoming and over the next13 ten years best13 practicewill emerge in the form of smartphone apps that13 are personalised and which can becomean individualrsquos health coach This level of support13 will be fine for some people but13 otherswill need incentives so it13 is likely that13 gaming technologies will be introduced perhapsoffering rewards for good compliance There will be a temptation for some people tocheat perhaps allowing others to perform exercise for them or changing theirconsumption details
Many of these opportunities for cheating will be removed through the use of a uniquebiometric identifier a technology that13 will be mature enough to use in place of passwordson smartphones However the biggest13 challenge may be in encouraging older people to usethe technology Many older people have multiple morbidities Indeed a survey of Scottishpatients implied that13 42 of people aged over 80 will suffer from three long termconditions It will be essential for those people to comply with treatment13 regimes if they arenot13 to have the functional deficits that13 follow
33 Finding people who13 donrsquot fit
People who have low social capital are likely to have few relatives and friends with whomthey regularly communicate and are also unlikely to be part13 of community or faithorganisations such as clubs societies and church groups They also die several yearsyounger than most13 of the population often because they donrsquot13 engage with public healthinitiatives such as vaccinations against13 flu regular checks on their blood pressure bloodsugar levels or in the case of women smear tests or mammography The most13 likelyreason for disappearing beneath the radar of such initiatives is their mobility which leadsalmost13 inevitably to them having no fixed abode and no fixed telephone line It thenbecomes very difficult13 for them to be contacted because their mobile telephones are likelyto have Pay-shy‐As-shy‐You-shy‐Go contracts that13 donrsquot13 require validated names addresses and bankaccounts
29
It follows that13 some of the most13 vulnerable people in society including those who live onthe streets are effectively unknown to both the NHS and to social work departments untilthey are referred in a crisis This could be an emergency presentation to a hospital Accident13 and Emergency Department13 where they will come into contact13 with a social worker becausedischarge may be unsafe This often highlights the importance of the prevention agenda13 and the potential for avoiding admissions to hospital by intervening at an earlier stage
The advantages of being able to locate people who are vulnerable to specific diseases willincrease as genetic testing becomes more routine It is already possible to determine whomight13 be most13 at risk of breast13 cancer and prostate cancer as a result13 of family history Addto this the evidence that13 particular diet13 and exposure to environmental factors can furtherincrease risk then it13 is evident13 that13 individuals can be identified and offered treatmentsthat13 could save their lives many years before they become ill In the case of cancersperhaps only the individual is involved but13 for infectious diseases it13 is the whole of societythat13 is at risk if someone contracts one of the new strains of influenza or if someonechooses not13 to be vaccinated against13 rubella In Chinese airports all visitors are screenedfor fever and refused entry if they tested positive in cities the public are monitored in thesame way Similar approaches may be necessary in the UK if potential carriers cannot13 otherwise be identified
34 Volunteering
It is estimated that13 72 per cent13 of people volunteered to perform a charitable act13 at least13 once during 2012 a rise from 65 per cent13 the previous year About13 four out13 of every 10volunteers offer their services formally to one or more organisations The remaindervolunteer informally by helping out13 a friend or a neighbour Around 50 per cent13 volunteered at least13 once a month in the past13 year up from 41 per cent13 on the previous13 year Most13 have retired many of them before the statutory retirement13 age Those whodonrsquot13 feel able to offer time have offered their financial support13 at a time when the fundingavailable from sources such as the National Lottery has been decreasing Despite economicausterity donations to charities have been increasing 74 per cent13 said they had given tocharity at least13 once in the previous month up from 72 per cent13 the previous year
Strikingly 78 per cent13 of people strongly believe that13 they are part13 of their localneighbourhood an increase from 70 per cent13 10 years previously Community cohesion isstronger than ever 87 per cent13 of people believe their local area13 is a place where peoplefrom different13 backgrounds get13 on well together compared to 80 per cent13 in 2003
The role of volunteers in supporting vulnerable people is therefore likely to increase overthe next13 decade perhaps exploiting the success of the army of volunteers that13 was highlysuccessful in London during the Olympic and Paralympic games The greatest13 role for suchvolunteers may be in providing informal care for older people Already the UK has someseven million informal carers whose value in monetary terms has been calculated to be
30
more than the combined budgets of the NHS and social care Maintaining or extending thisprovision will help to support13 services in the future and may be supported by technology
Whilst13 there is ample evidence to suggest13 that13 telecare services support13 informal carers asmuch as (if not13 more than) the people that13 they are caring for it13 is the potential for utilisingthe internet13 and apps to make their role easier to coordinate and hence more effectivethat13 is likely to be most13 successful moving forward
Many of these focus on particular tasks that13 informal carers can help offer to older peoplesuch as organising their medication A pillbox program is just13 one feature of an app calledBalance It also includes sections for caregiving tips notes for the doctor and the patientsappointments plus a lsquolearning sectionrsquo with articles on aspects of Alzheimers and an RSSfeed for news about13 the disease Tyze is another multi-shy‐functional app it13 allows carers to
bull Organise appointmentsbull Plan outingsbull Share storiesbull Send updates to other family members
Another application is Rally Round which helps carers to organise someone to perform littlejobs often on a temporary basis when someone has dementia physical frailty or isrecovering from accident13 or illness Similar applications are MeMaxi and Finerday
35 The High13 Street
The shape and appearance of UK shopping centres have been changing for half a centuryPeople complain that13 centres are losing their identity with one town looking like everyother both in terms of the stores and in terms of the layout But13 there are three trendswhich are having a profound impact13 on many of the most13 vulnerable people in society
bull Centres lock their doors at 6pm or in some cases 10pm -shy‐ thus denying people whosuffer from claustrophobia13 from window shopping at times when other shoppershave left
bull Out13 of town shopping malls -shy‐ these US style centres are ideal for people in carsbecause they offer free parking which is essential for people who want13 to buy largeritems but13 difficult13 for people who have no transport13 and who must13 rely on publictransport13 that13 is often deficient
bull The rise of online shopping -shy‐ which means that13 many potential shoppers only visit13 High Street13 stores to check the prices before returning home to make a purchaseonline
It is the third of these effects that13 has the greatest13 potential for changing the High Street13 forever and it13 is making life for traditional retailers increasingly difficult13 at a time when highrents are crippling stores large and small It is difficult13 to see how this trend is likely tochange because consolidation in banking and estate agencies is already forcing the closure
31
of other High Street13 players while additional pressures on pubs has led to the closure ofthousands of pubs every year
Those figures however demonstrate that13 consumers still value what13 the high street13 canoffer -shy‐ the chance to inspect13 what13 theyrsquore thinking of buying -shy‐ as well as the new opennessof the internet Customer service makes a difference to people especially if there is aproblem and goods need to be returned One of the most13 common reasons for furniture tobe returned for example is that13 when a sofa13 or a wardrobe was delivered it13 couldnrsquot13 fit13 through the front13 door or up the stairs In the future people will be able to benefit from13 visualisation technology they will upload the floor plans of their homes enabling theretailer to inform them of the problem before they try to delivery Augmented reality viewwill similarly allow customers to see what13 a new item of furniture will look like in itsintended place so that13 they can be more informed about13 the effect13 of size and colour
In terms of improving the viability of the High Street stores will have to focus on theimportance of brand which could mean that13 individual independent13 retailers will have topartner with national suppliers to support13 a local tailored offering based on products that13 are designed for a more global market This is a lsquoconnected High Streetrsquo approach whichcould be enabled by the developments in internet13 availability and smart13 phone accessdescribed in the previous section
The overall effect13 of all these changes could mean that13 town centres become smaller but13 more vibrant13 areas They could thrive if people are attracted there in large numbers whichmeans that13 retail must13 be developed alongside restaurants pubs galleries and other leisureopportunities This is possible in new shopping centres which are already being integratedwith transport13 hubs including railway and bus stations but13 may be more of a design13 challenge for older towns and cities with large Victorian buildings To ensure that13 morepeople are welcomed into the new centres they should include attention to green spacesand areas where people can relax without13 feeling that13 they are second class citizensbecause they donrsquot13 have the same buying power
3513 Privacy
To some people privacy is their right13 to live their lives without13 interference they may seethe State as a potential lsquoBig Brotherrsquo spying on their every move and judging their actions13 and activities Other people have fewer concerns about13 the role of the State but13 great13 fearof individuals interfering with and invading their privacy Some embrace the concept13 of lsquomyspacersquo an area13 of a square metre or so into which nobody can enter without13 permissionThis allows them to avoid physical contact13 and to feel safe from any form of threateningbehaviour
Yet13 this idea13 of private space and its potential violation is merely the tip of the iceberg asfar as privacy is concerned more significant13 is the idea13 of personal (and private)information being shared with anyone and everyone This could be related to identityopinion or image for an individual who wants to remain anonymous or even secretive thisis going to become an increasing problem as technology provides the means of taking
32
photographs recording conversations and capturing environment13 with something as smalland ubiquitous as a mobile phone The fact13 that13 this information can then be shared withthe rest13 of the world using e-shy‐mail Twitter and Facebook makes the problem all the moredifficult So the threat13 is no longer solely from the long lenses of the Paparazzi but13 fromanyone (and that13 means everyone) who has even the most13 basic of mobile phones
This relates to the changing views of society on what13 information should remain privateand what13 should be shared with others The success of social media13 has been based on anattitude of lsquosharing everythingrsquo with either your friends or the world This has introduced anaiumlve idea13 in the minds of some younger people (especially those known as Millennials ieaged 18-shy‐30) that13 everyone can be their friends whilst13 perhaps failing to reinforce the bondsof genuine friendship with any form of test13 or restriction Technology could play a role indefining these friendships and allowing individuals to understand what13 makes a goodfriend but13 this approach has yet13 to be developed and may be slow to overcome the needfor some people to measure their own popularity simply as the number of people that13 theycan list13 as friends on their Facebook page
It follows that13 there may be a need for a new definition of privacy that13 is in keeping withthe web and its ability to display images and opinion in an unregulated manner This needsto embrace past13 concerns about13 the ability of an individual to live without13 the threat13 ofothers being able to watch them whilst13 offering some protection from random postingsabout13 them online Perhaps this could include a right13 to be able to edit13 or remove anythingrelating to themselves on the Web including images that13 are not13 news-shy‐worthy Theownership of image rights may be an associated issue that13 needs to be addressedespecially as modern technology can remove an individual from a group (or a background)13 view provide digital touch-shy‐up or air-shy‐brushing and then republish it13 in a different13 contextHowever there is general agreement13 that13 personal information (such as contact13 details andbank codes) should not13 have a place on the web Surprisingly few people take proactivemeasures to prevent13 tracking functions being activated
It follows that13 too much privacy could lead to younger people fearing that13 they maybecome lost13 in a digital world It is not13 surprising then that13 they are prepared to make lots13 of personal information available often with no fear of how it13 might13 be used by othersWhen Google glasses and similar technologies become available during the next13 few yearsthey will have the potential to identify a stranger walking down the street and to find manyof their secrets to present13 to the wearer in a fraction of a second They could know moreabout13 them than their genuine friends know -shy‐ so who will be their friends in the future
36 Data sharing and13 protection
By lsquodata13 sharingrsquo we mean the disclosure of data13 held by one organisation on an individualto a third party organisation(s) or the sharing of data13 between different13 parts of anorganisation Some data13 sharing doesnrsquot13 involve personal data13 because it13 has beenanonymised in such a way that13 the statistics can be used for the collective good without13 theidentification of the individual The Data13 Protection Act13 (DPA) is in place to provide a legal
33
framework that13 ensures that13 organisations that13 hold personal data13 must13 act13 responsibly atall times These principles adequately describe the position of public and government13 bodies especially social services departments who are responsible for the informationconcerning the health and well-shy‐being of individuals -shy‐ and hence by implication thesensitive data13 relating to their vulnerability
The legal framework that13 applies to private and third sector organisations differs from that13 which applies to public sector organisations which may only act13 within the defined limits oftheir statutory powers However all bodies must13 comply fully with the data13 protectionprinciples and this situation is unlikely to change within the next13 10 to 15 years In someprivate sector contexts there are legal constraints on the disclosure of personal dataHowever most13 private and third sector organisations have a general ability to shareinformation provided this does not13 breach the DPA or any other law It is advisable for acompany to check its constitutional documents such as its memorandum and articles13 ofassociation to make sure there are no restrictions that13 would prevent13 it13 from sharingpersonal data13 in a particular context The type of data13 held is therefore a subject13 ofconcern as it13 may be difficult13 for legislation to keep up with the additional layers of data13 created on-shy‐line and through the Internet13 of Things
Private and third sector organisations should have regard to any industry-shy‐specific regulationor guidance about13 handling individualsrsquo information as this may affect13 the organisationrsquosability to share information They should also be aware of the legal issues that13 can arisewhen sharing personal data13 with public sector bodies This becomes more of an issue asprivate and third sector bodies are carrying out13 a wider range of traditionally public sectorfunctions Opportunities for inappropriate sharing of sensitive data13 will therefore inevitablyincrease
Public authorities must13 comply with the Human Rights Act13 (HRA) legislation in theperformance of their functions The HRA also applies to organisations in the private sectorinsofar as they carry out13 functions of a public nature which could include delivering a socialcare activity Where the HRA applies organisations must13 not13 act13 in a way that13 would beincompatible with rights under the European Convention on Human Rights Article 8 of theConvention giving everyone the right13 to respect13 for their private and family life their homeand their correspondence is especially relevant13 to sharing personal data If personal data13 isdisclosed or shared in ways that13 comply with the DPA the sharing or disclosure of that13 information is also likely to comply with the HRA The problem may still be in policing theActs and the rights of an individual if they believe that13 their personal data13 has been sharedor accessed by an inappropriate organisation or individual
A legal industry may be born to deal with such matters but13 this is unlikely to benefit13 peoplewho cannot13 afford the fees involved They would require either legal aid or to employ13 more13 lsquono win no feersquo companies Public attitudes to such costs might13 become negative unlessthey prove successful in preventing breaches of data13 security There may need to belegislation to provide a stronger basis for forcing compliance with privacy laws
34
37 Connecting with13 people
We are social creatures most13 of us rely on our friendships and interactions with friendsand families to share our happiest13 moments and experiences Research suggests that13 thishappiness is infectious at all levels and leads to a 15 increase in the happiness of a closecontact 10 for a second degree contact13 such as the friendrsquos spouse and a 6 increase fora friend of a friend It is hardly surprising that13 the success of social media13 such as Facebookis intimately related to the ability of people to quickly share their happiest13 moments with asmany of their friends and connections as possible
All this has happened during the rise of the Internet13 and the corresponding increase inopportunities for connecting online ie this is a 21st Century phenomenon which has beenfacilitated by Information and Communications Technology But13 the Internet13 remains in itsinfancy and we are only beginning to understand and exploit13 its potential In terms ofaccessing the Internet there are now perhaps two billion people who have access with99 of them having gained this during the past13 decade This number will have doubled bythe period 2020 to 2025 It is likely that13 everyone who wants to be connected in the UK willby then be connected Turning this on its head only those who donrsquot13 want13 to be online willnot13 be on the Internet13 within a decade Connecting with the unconnected will therefore bea case of identifying those people who donrsquot13 want13 to be found unfortunately these mayinclude many people who need the support13 of social care organisations It means that13 theywill be looking for support13 only when they are in crisis unless other ways of finding andormonitoring them are found
While the number of people connected via the Internet13 has exploded this might13 bedwarfed by the number of connected lsquothingsrsquo During 2009 the number of thingsconnected to the Internet13 surpassed the number of connected people at which point13 webegan to experience what13 this report13 has described as the lsquoInternet13 of Thingsrsquo Yet 99 ofall physical objects that13 could join this network are not13 yet13 connected but13 the number couldgrow by 25 every year for the next13 decade so that13 there could be 100 billion connectedobjects by 2025 some of which will be owned or used by everyone in the UK includingthose people who donrsquot13 want13 to be connected themselves We will then have an Internet13 of Everything which will be the smart13 connection of people data events and actions
With each new person object or data13 that13 comes online the connection possibilitiesbetween all these elements grows exponentially The rise of big data mobile networkingcloud storage and data13 mining technologies will all play a critical role in the Internet13 ofEverything The result13 will be new capabilities richer experiences and unprecedentedvalue for individuals businesses communities and countries everywhere The lsquonetworkeffectrsquo of the Internet13 of Everything will be a very powerful thing the true impact13 of whichwe wonrsquot13 fully understand for several years As it13 develops however those who are not13 connected will feel even more digitally and socially excluded There will be a need to reachout13 to vulnerable people unless the process of claiming requires proof of online identityand the payments to be received can only be redeemed using a chipped card or adownloaded app onto a smartphone This is of course the way that13 welfare arrangementsare already developing thus it13 might13 prove impossible to make a successful claim without13
35
already being connected to lsquothe systemrsquo either through an online presence or through theInternet13 of Things
38 Downloading everything
Sixty years ago information was discovered by reading books often in a library wherenotes had to be made because the books or journals couldnrsquot13 be removed Then in theearly 1960s the first13 office photocopying machines were introduced into the UK theyimmediately meant13 that13 pages or articles from books could be copied and taken away to beread and summarised later Within a few years photocopying became a replacement13 forreading as researchers became less adept13 at selecting a few sentences and every deskbecame a depository for reams of printed paper Paper became the means of recordingeverything from bank statements through to music
We now appreciate that13 printing everything is a waste of both the ink (or toner) used tocreate the black print13 and of paper which requires trees to be chopped down and pulpedbefore it13 can be pressed into thin sheets Saving paper is therefore seen as green and goodfor the planet Fortunately we no longer need to print13 everything because computermemory is unlimited thanks to the cloud and we can then view pages and articles onportable or fixed screens
The internet13 has everything and it13 is all available instantly for downloading providing thereis a device available to accept13 it and there is sufficient13 communication bandwidth toperform the transfer of data13 sufficiently quickly Thus we can record all text13 articles that13 are relevant13 to us including digital records of birth certificates qualifications and passportsand the need for original printed versions will decline But13 we can also do this forphotographs Most13 handheld computing devices include at least13 one camera so they cangenerate enormous number of pictures which can be kept13 for posterity without13 having toconsume inks and special papers to print13 them
But13 the materials that13 can be downloaded donrsquot13 stop at pictures software is available that13 can grab TV shows after they air and movies as soon as theyre released In the same wayit13 is possible to schedule music comic books video games and practically anything else asa download with minimal effort People will need enormous hard drives if they want13 theirown digital copies of these files so will more than likely make use of cloud storage that13 willbe available from many organisations The location of the servers may become sensitivedue to border restrictions as will the security of the data13 and the way that13 it13 is backed up sothat13 it13 is resilient13 to failures
It may be evident13 that13 application forms for all types of welfare payment13 will be availableonly for downloading so that once digitised they can be processed by computer andrecords sent13 to various servers for subsequent13 storage and processing Some people maywant13 to keep their data13 on them once it13 has been downloaded Pen drives can already holdseveral GB of data so it13 is likely that13 people will be able to carry their downloaded data13 withthem at all times irrespective of the size and complexities of the information
36
39 Health13 and13 well-shy‐being
The general health of the population is unlikely to deteriorate noticeably within 10 to 20years Indeed expectations of the population are that13 things must13 improve as surgicaltechniques mature and as pharmaceutical interventions become more personalised andpowerful However the rising demand for health services due to an ageing population andthe increasing cost13 of providing sophisticated therapies will make delivering a free anduniversal health service difficult13 without13 substantial increases in taxation This is unlikely tohappen in the UK even though spending on health services will be protected against13 thecuts facing other services
There will have to be changes in how the NHS works For twenty years hospitals have beenclosed and replaced by fewer new facilities so that13 the bed count13 is reduced This has led toa significant13 shift13 in resources to primary care and community care supporting shorter staysin hospital and speedier transfer back home for people after surgery or illness This hasbeen13 successful but13 there remain problems with demand for GP services especially out-shy‐of-shy‐hours and at weekends Indeed despite the introduction of NHS24 and similar help-shy‐linesthe demand for GP appointments continues to increase Delays are inevitable and this willincrease system failures with more unnecessary deaths and a failure for people to access adiagnosis that13 might13 lead to early interventions and ultimately lower delivery costs Over250 more patients are added to waiting lists every day
This will lead to a new model of primary care consistent13 with existing changes which haveseen surgeries move from High Street13 locations to medical centres close to bus routes andwith more parking for patients The process of making an appointment13 is changing from atelephone-shy‐based interview process dominated by a medically-shy‐unqualified receptionist13 to achoose and book approach using an online process linked to electronic patient13 records Thiswill give patients more convenience but13 will allow priority for those who have Internet13 access at the expensive of those who are digitally excluded Making the process of bookingan appointment13 quick and easy may also increase demand from people who do not13 need tobe seen as it13 will fail to identify those in greatest13 need
A greater use of telehealth and telecare technologies will be inevitable beginning with thefirst13 contact13 as an encounter using the telephone e-shy‐mail or video conferencing -shy‐ a visit13 tothe GP surgery should be a last13 resort and should involve a nurse consultation in the first13 instance This would be consistent13 with three quarters of appointments currently involvinga chronic disease or long term condition which relates to improved self-shy‐care The support13 ofthese patients at home should be prioritised through tele-shy‐ and web-shy‐based technologies andshould involve training and coaching through a network of nurse practitioners Home visitsshould generally be unnecessary through the use of these technologies but13 could besupplemented by satellite surgeries manned by nursing in community premises or inpharmacies nurseries and Internet13 cafes
The homes13 of people who13 need13 closer monitoring can then become part13 of virtual wardswith real or electronic visits by health professionals University Hospital Southampton NHSFoundation Trust13 already looks after patients who have undergone surgery such as a hip orknee13 replacements in virtual wards with high levels of satisfaction The Royal Free London
37
NHS Foundation Trust13 offers a similar service but13 plans to add the possibility of videoconsultations between patient13 and consultant
310 Attitudes to public health issues ndash obesity smoking alcohol abuse drugs
As self-shy‐care becomes the focus of the NHS the public will increasingly understand that13 thecosts and availability of services are being harmed by the poor health behaviour ofrelatively small numbers of people The link between public health initiatives today andhealthcare needs and costs in the future will become increasingly evident13 as a result13 of theway that13 information is presented Thus the overweight13 smoker who currently attractsconcern and pity when they are diagnosed with diabetes and COPD is increasingly beingseen as the victim of their own stupidity or lack of self-shy‐discipline If they continue to neglect13 medical advice and continue with an unhealthy lifestyle then the way that13 they receivetreatment13 and consume resources will become a matter for the entire population
Obesity is seen as due to a combination of poor diet13 and a sedentary lifestyle No longer isthe idea13 that13 people are lsquobig bonedrsquo acceptable Governments will respond initially byrequiring manufacturers and food processors to provide nutritional information onpackaging and on menus in restaurants But13 people can choose not13 to read the data13 and toneglect13 both the importance of food quality content13 and quantity This will increasepressure to introduce fat13 or sugar taxes and these are likely to be in force within a decade
Although the high taxes on tobacco products has forced some smokers to reduce theirconsumption or to give up altogether the impact13 has been reduced by the smuggling ofproducts from overseas and by the availability of duty-shy‐free cigarettes for people returningfrom foreign holidays and business meetings Further measures are planned to changepackaging and to include even more graphic images and warnings on cigarette packages tomake smokers aware of the effects of smoking on their health and well-shy‐being There is asyet little evidence of how successful this might13 be More effective has been the banning ofsmoking in public places including trains and aircraft Expensive medical interventions suchas heart13 transplants will be denied to individuals until they change their lifestyle behaviourSmokers might13 therefore be increasingly ostracised leading to a loss of esteem This mayhave a particular impact13 on people who already suffer from mental health problems whoare more likely to smoke
The overuse of alcohol is being recognised as a major factor in hospital admissions withNHS figures showing an increase of over 40 in such admissions over the past13 decadeLinked to this has been a 75 increase in prescriptions to treat13 alcohol dependency Fewpeople have sympathy for those who waste their limited income on booze If they havechildren or other dependents they will be the ones who suffer and who may need thesupport13 of social care
Drug users are already significant13 users of social services as their habit13 is likely to makethem unemployable They receive little sympathy from the general public because they areseen as criminals and people who waste public resources Levels of drug abuse have been
38
slowly increasing over the years but13 this trend is slowly being reversed Indeed the numberof people using drugs during the past13 year has fallen to its lowest13 level for nearly 20 years(below 9) with cannabis being most13 likely often following excessive drinking Aselectronic noses and other technologies can detect13 traces of drugs it13 seems likely that13 success in overcoming addiction can be measured objectively This may become a two-shy‐edged sword rewarding those who can turn around their lives but13 further marginalisingthose who canrsquot13 or wont13 accept13 the lsquocold turkeyrsquo
311 Attitudes to surveillance
Issues associated with privacy confidentiality and data13 security have been discussedpreviously in the context13 of information technology the World Wide Web and the ease ofcollecting recording recalling analysing and displaying data The monitoring of individualsand their methods of using this information can be regarded as surveillance As thequantities of data13 increase along with the number of devices that13 can be used to access itthe surveillance tools will also increase in their sophistication Indeed the Big Data13 approaches described in the previous section will enable the combination of structureddata13 (such as the information held in databases) to be married with unstructured data13 fromimages in such a way that13 it13 can be mined
Whilst13 the lsquodigital surveillancersquo methods described above may cause most13 concern topeople because of its impact13 on anonymity it13 is the collection and analysis of images that13 are the major concern to people as they contemplate the ways that13 lsquoBig Brotherrsquo maydevelop to restrict13 freedom Every major UK city and town centre has an array of CCTVcameras that13 continually record activities from every angle If it13 used to be true that13 nobody in London was more than 10 yards from a rat it13 is certainly the case today that13 nobody can be more than this distance from being in view of a surveillance camera Yetthey receive so much positive publicity from TV programmes where their footage is used todetect13 vehicles close to a crime scene or to monitor the movements of suspects that13 theyare now accepted by the public as a deterrent13 in the same way as lsquobobbies on the beatrsquowere seen 25 years ago There is therefore little public reaction to the expansion in the useof video surveillance except13 for the practical observation of how so many views can beinspected and recorded
Looking to the future the tumbling cost13 of video technology will surely lead to anotherincrease in the number of devices The aerial views taken from towers will besupplemented by more local views taken by devices that13 are embedded in the fabric ofbuildings or carried by individuals either on their person (for example on clothing orspectacles) or in the bags that13 they carry The time and date-shy‐stamped images as Big Datawill be recorded to lsquothe Cloudrsquo where it13 can be added to other data It can then be usedwhen an incident13 has occurred or to provide further detail of night-shy‐time activities
It follows that13 there will be no hiding place for people who simply want13 to disappear Theymay respond by wearing clothing (such as hoodies) that13 hide their faces or which make it13 difficult13 to distinguish gait13 or mannerisms from which they might13 be identified New forms
39
of clothing may be designed to make shapes more difficult13 to analyse and these might13 become the uniforms of a class of person who wants to live in a way that13 they donrsquot13 interact13 with officials from any ministry or local government13 department If they also obstruct13 services then they will be considered to be anarchists of some form sparking protests fromother sectors of society
31213 Attitudes to driving
Motor cars have been a feature of UK roads for over a century but13 it13 is only during the past13 50 years that13 they have become a resource that13 most13 families have had access to enablingthem to travel without13 the restrictions imposed by a limited railway network and non-shy‐integrated bus transport People who have had a car throughout13 their lives often see theircars as an important13 factor in enabling them to remain independent13 and to exercise choicesrelating to where they shop and where they spend their leisure time This extends to theirspouse and to friends and neighbours that13 they might13 take with them on their variousexpeditions
Unfortunately there are incidents involving older drivers who perhaps go down amotorway in the wrong direction who are taken ill at the wheel or who are involved in anaccident13 involving no other vehicles These are small in number but13 often lead to a reactionthat13 they shouldnrsquot13 be allowed to drive lsquoat13 their agersquo Age itself is not13 an indicator ofdriving quality but13 because old age also brings more chance of having limited long termconditions and other illnesses it13 is easy to make a link between driving ability and age Thelicensing system does require continued driving to be linked with medical advice andforbids people with poor eyesight epilepsy and other conditions to hold a licence in oldage
Yet13 statistically older drivers cause far fewer accidents than younger drivers The reasonsfor this may be complex and are likely to include the fact13 that13 they drive less often covershorter distances and donrsquot13 go out13 in the dark or in poor weather However it13 does not13 wholly explain why the UKrsquos drivers aged over 70 and who represent13 some 8 of all driversare involved in only 4 of accidents that13 cause injury This compares favourably with the15 of13 drivers aged between 17 and 29 who are involved in over a third of crashes that13 result13 in injury
By 2020 the number of drivers aged over 70 on UK roads is likely to increase to over 7million This will require a new national strategy perhaps involving support13 for olderdrivers further training raising awareness of issues and making more use of adaptivetechnologies to support13 the driver in avoiding collision or forgetting to check on the statusof their vehicle Poor eyesight13 could be enhanced by camera technologies rather thanforcing people off the road if they are unable to read a licence plate
The International Longevity Centre has found that13 one in four Britons thought13 driversshould be made to switch off the ignition for good somewhere between the ages of 70 and75 The numbers may decrease as the population ages and as cars become safer Forcing
40
older people off the road may be a natural consequence of providing free bus passes andsubsidised rail fares but13 the growth in the pavement13 scooter industry demonstrates that13 older people value their independence and will do almost13 anything to get13 out13 and aboutPerhaps legislation will result13 in more regulation of electric vehicles and where they cantravel
There can be no doubt13 that13 getting out13 will be associated with better quality of life andwell-shy‐being and this is likely to be supported in the future as evidence of improvedoutcomes emerges It is to be hoped that13 positive stories will be publicised so that13 publicattitudes arenrsquot13 hardened This may be supported by more in-shy‐car monitoring of drivers andthe linking of performance with on-shy‐line driving records and licences These could throughremotely monitored ignition systems prevent13 the use of motor vehicles by people without13 a licence or without13 insurance
313 Climate change
There is a general view that13 the emissions of carbon gases are contributing to globalwarming in a manner that13 will change the UK climate in such a way that13 the climate maybecome more Mediterranean However some scientists believe that13 manrsquos impact13 on theenvironment13 may be small compared with natural variations caused for example bycyclical changes in the sunrsquos energy output13 or by the effects of volcanoes and earthquakesRecent13 evidence has suggested that13 we are going through a phase of changing extremesand that13 this is more likely to cause storms periods of excessive rainfall and unusualseasonal trends with snow and frost13 in the spring and warmer winters Considerableuncertainty remains and it13 might13 be necessary to plan for a number of different13 scenariosand for the impact13 on vulnerable people
I Colder winters UK properties are poorly insulated resulting in excess mortalitiesduring cold spells due to an increased number of people suffering from stroke aswell as bronchitis and other pulmonary diseases The cost13 of heating continues toincrease putting more households into a state of fuel poverty Any further coolingduring the winter months will result13 in more people living in unhealthy coldconditions Winter fuel payments are likely to be restricted to the poorest13 peoplebut13 this might13 exclude people who live in larger properties that13 are more difficult13 toheat
II More storms excessive winds and rain can cause flooding at any time of the yearMany UK communities are built13 close to rivers and these can surge during heavyrainfall causing houses to be filled with water and furniture and carpets lostInsurance can be problematic for properties built13 on flood plains which can blight13 properties and prevent13 owners from being able to sell and move on High winds canrip off roofs causing injury and also causing families to be left13 homeless anddependent13 on social services
III Hot13 summers Europe suffered high temperatures during the summers of 2003 and2004 leading to heat13 stroke and hypothermia The UK has not13 previously sufferedfrom such problems but13 might13 be expected to experience days of extreme
41
temperature and humidity at times Older people may not13 be prepared for suchweather Street13 dwellers may be unable to find shade and supplies of drinkingwater
Irrespective of what13 combination of weather scenarios arise it13 must13 be concluded that13 any extremes will have a major negative impact13 on vulnerable people especially if theyare not13 prepared because they havenrsquot13 received the weather warnings and advice that13 can be broadcast13 using the TV radio and online services Once again the digitallyexcluded will suffer and will pay a high cost Society will continue to pick up the bill interms of demands on social care services unless preventive actions are taken in theform of connecting these people to each other and to formal services
42
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
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13 e13
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13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
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13 13 ir13 at13
s13 13 13 lt13
at13
13
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13 is13 13
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a13 13
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13
at13
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d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
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13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
n13 13
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ly13
13 e13 t13 e13
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13 13
13
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s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
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e13
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proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
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13
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y13
o13
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ar13
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s13 13
le13 13 13
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13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
personalisation and enhanced performance Today digital hearing aids use sub-shy‐miniaturemicrophones that13 can be unidirectional or omnidirectional and which can be adjusted insensitivity over an extended range Tomorrowrsquos devices can be switched between modesby the user so that13 they can benefit13 from hearing perfectly in any environment Indeedthey can be used with adaptive filtering technologies (as used by helicopter pilot13 headsets)to eliminate some sounds so that13 the rich speech (or music) components alone remainFuture developments will be on optimising control so that13 the user can switch seamlesslybetween different13 amplification applications without13 appearing to be distracted A smart13 phone or mp3 music player may be used as either a processing unit13 or as a ubiquitousoutput13 device that13 looks cool and natural
These same technologies will also be developed for use within the home environment13 fortimes when a deaf user isnrsquot13 present13 or is asleep Acoustic signatures associated withadverse events and incidents such as the hiss of a gas leak the crackle of a fire the sound ofa smoke detector the drip or a water leak or the sound of breaking glass can be directlyassociated with programmed actions Speech will be recognised interpreted translatedsimplified or displayed so that13 an individual knows what13 is said and can be provided withclear instructions on how to respond
Video cameras have become smaller and cheaper and capable of producing high definitionimages The problem of storing and editing these large image files is being solved by thearrival of cloud computing
Electronic noses are already capable of detecting the quality of wine and fresh fruit Similartechnology will be based in smart13 phones and will be able to analyse the air to warn of13 foodthat is no longer fresh and of other indicators of danger including gases that13 have13 little13 natural13 smell These13 devices13 could support13 people with13 cognitive impairment13 -shy‐ whose13 sense of smell13 tends13 to deteriorate -shy‐ to live independently
Many older and vulnerable people are at risk of hypothermia during the winter Sensordevices can provide warnings of low temperature In the same way heat13 stress can be adanger during the summer months so sensors can alert13 people of the need to openwindows or to operate a fanFinally people who have damaged13 their fingers13 or hands will be able to wear sensorsembedded in artificial skin or in gloves that13 will enable them to identify textures and shapesand be able to dress and undress without13 the assistance of carers
216 Robotics
We may recoil at the idea13 of personal care being delivered by robotic devices but13 it13 is likelythat13 within a decade personal assistants will exist13 to assist13 with household tasks These areunlikely to be humanoid and are more likely to be machines dedicated to helping frailpeople to support13 their own weight13 and to carry trays of food around the home
19
There are four broad classes of robot13 under development13 that13 are likely to mature within 10to 12 years
1 Miniature industrial robots that13 have been programmed to perform specific taskswith precision They are likely to be relatively heavy enabling them to bear weight13 but13 still have the necessary flexibility to carry an individual over short13 distancesplacing them in a chair or on a bed They will have sensors and cameras to provideimmediate feedback and to adjust13 rapidly in response to verbal commands or cues13 from the user Some designs may build on existing assistive devices such as abathroom hoist13 or a bathing aid to become intelligent13 extensions of productsalready on the market A stair lift13 with intelligence is already being designed by a UKcompany and is aimed at providing the user with more control of the journeybetween floors of a house
2 The second group of devices might13 be described as intelligent13 furniture Beds andchairs are already available that13 adjust13 to make the user more comfortable and also13 to help them get13 into or out13 of bed The control units are fairly cumbersome andare suited to operation by a carer Voice activated controls and built-shy‐in intelligencewill give the user more control and independence Other items of furniture to whichintelligence might13 be added would be tables whose height13 can adjust13 and whichhold items of food and medicine securely The table would recognise these objectsand could provide prompts or reminders
3 Mobile robots form the third group These could be goffers that13 can either fetchand carry items such as newspapers drinks or trays or which can accompany theuser when they move between rooms providing them with support13 or prompts Thistype of robot13 could be an intelligent13 walking frame with wheels which13 could13 doubleup as a smart13 wheelchair when necessary
4 Finally there are companion robots These might13 be in the form of an electronicpet typically a cat13 or a dog though the Japanese Paro robot13 is a seal Pets canrespond to stroking and being patted they can also remind their owners that13 theyneed to take exercise and to eat drink and take their medication Various designsare already available which provide feedback but13 future models would includecameras and a screen to provide a mobile means of information and interactionwith other people over the Internet Intelligence within the device could allow themto have a personality of their own and gain knowledge by scraping data13 fromwebsites so that13 they can generate speech and have conversations about13 the newsthe weather or sports results
217 Transport and transfer technologies
Walking is good exercise and is a no-shy‐cost13 form of transport13 that13 is encouraged because of itsimpact13 on well-shy‐being For an individual with a chronic disability or suffering from theeffects of an accident13 or an injury this becomes impractical without13 an assistive technology(AT) A walking stick is the simplest13 example of AT
20
Within the home the stair lift13 has enabled people who live in conventional properties that13 are on two or more floors to continue to use facilities on different13 floors when climbing thestairs has become too difficult This is often the case for people who have arthritis a lowerlimb amputation a long term condition such as Chronic Obstructive Pulmonary Disease orpeople approaching the end of life and who have chosen to die in their own homes
Designs have improved so that13 a curved staircase is no longer an issue and the reliabilityhas reached a level where breakdown is a rare occurrence13 Through-shy‐floor lifts have been analternative proposition but13 they remain too large for most13 properties Alternativeapproaches may emerge using air pressure or water pressure as the driving force ABrazilian design already utilises a plastic tube in which a pod is moved effortlessly up anddown
Electronic wheelchairs are now available that13 allow the individual to become moreindependent13 as they allow the user to control both propulsion and steering Some modelshave the capability of mounting a pavement13 or a step or even a flight13 of stairs Personalmuscle amplification devices have been developed originally with the intention of helpingpeople who are confined to a wheelchair due to a neurological disorder to perform sometasks from a standing position Indeed the Rex walkerrsquos manufacturers claim that13 anyonewho can propel themselves in a wheelchair could walk by using Rex
Other approaches have focused on the rehabilitation of people after major accidents that13 have caused partial paralysis They quickly extend into exoskeleton designs that13 enableanyone to gain a mechanical advantage and thus to tackle physical tasks that13 would not13 otherwise be possible These suits are the focus of major research projects across theworld Some13 products such as the system developed by Honda are being tested inAssisted Living facilities and are likely to become more and more enabling over the next13 decade
Similar benefits are also occurring outside the home with a number of novel carryingsystems appearing over the past13 few years They are generally termed lsquoscootersrsquo but13 thiscovers a wide range of systems and devices ranging from the Segway a device that13 is amobile platform on which the user stands and navigates through to conventional electricvehicles that13 have been developed from golf buggies There remain a number of issuesconcerning their use on roads or on pavements but13 similar problems will need to beresolved for bicycles to play their full part13 in enabling people to get13 more exercise13 Thepotential for hybrid scooters remains
218 Smart domestic appliances and personal hygiene
The bathroom is a dangerous place and one where many older and disabled people slip andsuffer a fall Many older people recall taking a bath in a tin tub in front13 of an open fireToday the options tend to be a level access shower (ie a type of wet13 room) for anyoneunable to get13 into a bath There are various aids to help people get13 into and out13 of thebath most13 involving a seat13 that13 can be raised or lower with some bath-shy‐tubs having a door
21
There has been some research into alternative methods of keeping the body clean Sanyointroduced a machine in 1970 modelled on a clothes or dish washing machines the personsits on a seat13 inside the machine where13 they are cleaned by a set13 of water jets These havenot13 proved popular and furthermore require the individual to be transported to themachine Thus the technology may find application in nursing homes but13 are unlikely to beattractive to people living independently in the community
The washing needs of people change over time Over the past13 20 years body piercingshave appeared which have demanded additional attention to avoid the problemsassociated with poor hygiene and metals Similarly hair may be permed and dyed usingchemicals which are much stronger and which might13 damage the hair Add to this thepainting of finger and toe nails and the washing needs are rather different13 to what13 theymight13 have been even ten years ago Finally tattoos were once popular only with sailorsToday they are likely to be found on the arms backs and legs of both men and womenNew ways of cleaning these tattoos will be needed especially if they become infected orare sites at which pressure sores develop
Even if a personrsquos body is clean if their clothes are dirty they may become socially isolatedBut13 the washing of clothes can be strenuous even if a launderette is used The need toconserve water has driven research into ultrasound techniques to beat13 the dirt13 out13 ofclothing while some companies are experimenting with polymer chips These13 ldquogreenrdquo13 technologies are quickly maturing and are likely to be standard in the next 10 years
Other smart13 household appliances are already appearing on the market13 and may soonbecome common13 in UK homes13
bull Robovac devices have sensors to enable them to detect13 dirt13 on carpets and to adjust13 their operation accordingly
bull Refrigerators can read bar codes or RFID tags to identify their contents and theirldquouse byrdquo13 dates enabling them to inform the owner that13 they should use theproducts before they are out13 of date They can be linked to the Internet13 to reorderitems as they are consumed or to suggest13 menu options for the individual based ontheir preferences or according to the diet13 required to manage a condition
bull Ovens will automatically switch off if they are left13 without13 attention for too longand drying machines will set13 times automatically
Devices may be linked so that13 they are more efficient and report13 maintenance issues sothat13 they can be repaired (perhaps remotely) before they suffer a catastrophic breakdown
219 Personal and home13 security
It might13 appear perverse but13 people with very little personal wealth and property are morelikely to be the victims of crime than those who have expensive items This may be due towhere poorer people tend to live or because people who have valuable assets take greater
22
steps to protect13 them There can be no doubt13 that13 crime has a very negative effect13 onindividuals and on their families creating a fear factor that13 may be difficult13 to remove Theimpact13 on quality of life is therefore very considerable especially if it13 forces people to stayat home behind locked doors effectively isolating themselves from society
Modern policing places increasing reliance on the use of closed circuit13 television (CCTV)Town centres are covered by cameras used increasingly in the fight13 against13 crime by bothdetecting anti-shy‐social incidents and identifying the people involved They are also used tomonitor the movement13 of cars that13 may be involved in incidents of burglary and violenceand are fast13 becoming the primary mechanism of law enforcement13 agencies to solve crime
CCTV has moved into the home to record movement but13 monitoring the footage is timeconsuming and often not13 practical Cameras are now available which provide an instant13 video feed to a smart13 phone when movement13 is detected These may have intercomcapability allowing someone to remotely speak to an intruder sometimes before they havegained access to a building This may serve as a deterrent13 and when fitted alongside simpledevices that13 switch lights on randomly around the home may force burglars to goelsewhere
As the price of cameras continues to fall the option of carrying a camera13 on the body that13 continuously monitors personal space is becoming more useful Using wireless networksthe data13 collected can be sent13 continuously to the cloud for safe storage It cansubsequently be retrieved to provide evidence (video and audio) of confrontations enablingsuccessful prosecutions to be made The smart13 phone itself is becoming a valuable itemthat13 is attractive to criminals These can be tethered to personal attack buttons usingwireless technology allowing the device to be activated by the pressing of a button if theowner is being attacked The phones can then be tracked and located by the police whilebeing rendered useless to the assailant
Bogus callers are a perennial problem for vulnerable people Video door bells can beconfigured to display images and record the words of visitors before they are admittedallowing remote monitoring centres to oversee the situations and use image recognitionsoftware to confirm the bona13 fide of visitors Such13 arrangements may become13 commonplace13 over13 the13 next five13 or13 six years13 significantly13 improving the safety of peopleliving independently
220 Personal safety
The biggest13 risks to personal safety stem from fires and falls Most13 fires are the result13 ofpoor cooking practices resulting in burns or scalds Floods and gas emissions are caused bya failure to remember to close taps
The current13 approach involves detection of an emergency situation as soon as possible but13 always after a problem has already occurred This responsive approach can minimise therisks provided that13 there is a protocol in place for intervening This could increasingly be an
23
automated response such as the switching off of the gas of water or the switching on of asprinkler system or a water mist13 system
In the future monitoring systems will be more sophisticated and will have sensors and localintelligence to identify activities In this way reminders can be issued before an emergencyoccurs13 This lsquosmart kitchenrsquo approach may become13 an integral part of13 homes of13 vulnerable13 people
A prototype system has been developed at the Culture Lab in Newcastle Sensors havebeen embedded into cooking utensils enabling the kitchen to identify what13 the person istrying to cook or prepare It can provide interventions as messages on an instructionscreen
Accidents also occur out13 of doors People with dementia13 might13 become lost13 and may havepoor road safety awareness Location devices based on GPS have advanced from large andheavy receivers that13 were used on ships and boats to small battery-shy‐operated devices that13 can be carried in the hand or in a handbag The current13 generation of locators has limitedbattery life and are rather too large to be secreted about13 a personrsquos clothing while devicesthat13 are integrated into a wrist-shy‐watch are rather clunky and unattractive
Within 10 years the13 technologies13 will have13 matured and will be13 much smaller13 so that theycan be embedded in shoes in walking sticks hats or any other item of clothing Powerrequirements will have reduced so that13 energy harvesting from the movements of theindividual will be sufficient13 to keep these products working for several weeks without13 theneed for recharging The devices will not13 simply indicate to others where the individualhappens to be but13 will provide subtle guidance cues to direct13 them home
Cameras might13 also form part13 of the personal security systems that13 will protect13 people fromaccidents Data13 may be sent13 to the cloud and analysed in real time if the person is in adangerous location and can provide prompts either to the individual or broadcast13 advice toothers to clear the danger These systems may be embedded in items of clothing (such as ahat) or they may be attached to spectacles
221 Energy and13 portable power supplies
The demands of developing economies for more power will inevitably lead to higherdomestic fuel charges in the UK especially as oil and gas reserves dwindle
By 2018 UK homes should be fitted with new smart13 meters The specifications for these13 devices have yet13 to be finalised but13 will include a means of identifying wasteful use ofenergy including TV sets that13 are left13 on and unattended fridges and freezers that13 are set13 attoo low temperatures and dryers that13 are used for too long or when the weather is suitablefor using a washing line They could be an enabling factor that13 supports changes inbehaviour driven by a need to use less power but13 it13 is unlikely that13 they will offer a bigreduction in costs that13 are already a problem for many vulnerable families
24
More generally the need for power conservation will include devices that13 are moreefficient and a significant13 emphasis on heat13 retention in buildings through betterinsulation
The energy crisis may force many people to spend more time in community settingsincluding shops and public buildings where they can benefit13 from the warmth Increasingreliance on mobile communication devices will lead to increasing demand for batterycharging facilities
Greater use may be made of portable devices for generating power based on solar cellswind or hand motion
222 Smart cities and homes
The Digital City initiatives have been based on information and how it13 can be used most13 effectively to make people aware of what13 is going on around them This means bettercoordination of resources more rapid access to advice and a battery of sensors measuringevery conceivable parameter from sound and light13 levels through to air quality andtemperature fluctuations There are several Digital or Smart13 City initiatives currently beingimplemented both in the UK and across the world They may significantly impact13 the livesof the millions of people living in them but13 the timeframe for outcome benefits to influenceplanning and design elsewhere is likely to be at least13 20 years and therefore outside thetimeframe of the current13 project
Housing plays a big role in the lives of most13 people both through their aspirations to moveup in the world (usually to a bigger property with a garden) and as the heart13 of the familylife which is associated with good quality of life UK properties have a life span approaching100 years which is about13 double that13 of their European counterparts (and certainly longerthan the wooden-shy‐frame buildings built13 in North America13 for example) A shortage ofhouses has plagued improvements in social welfare for the past13 30 years There is anargument13 that13 there are enough houses but13 the wrong size and in the wrong places andthis has some basis in fact13 as demography changes lead to more people (and more olderpeople) living alone However if there are two million homes in Scotland each with alifespan of 100 years then the renewal rate needs only to be 20000 per annum to maintainthe status quo However it13 must13 be clear that13 the impact13 of smart13 house development13 willbe small The focus should therefore be on adapting existing properties to render themmore appropriate for vulnerable people
Housing adaptations are a branch of assistive technologies The technologies for providingdifferent13 forms of accessible bath and level access shower are well-shy‐established with littleresearch considering anything other than alternative building materials and methods formaintaining the temperature of the bathwater Different13 technologies for bathing will beconsidered separately
25
Thus housing technologies are not likely to impact on social work13 within the next 20years13 though13 the use of information13 technology13 to ensure that people are aware of what13 is available is likely to be commonplace well before then
26
3 BEHAVIOUR AND ATTITUDE CHANGES DUE TO TECHNOLOGICALADVANCES
Technology is only one factor that13 will affect13 the way society changes in the next13 10 or 15years This chapter will consider the context13 in which the technological developmentsoutlined in the previous chapter will be supported (or held back) by societal factors
When the impact13 of such factors has been considered we can then apply theseassumptions to a number of case studies listed in Appendix13 A13
The headings selected for this chapter are not13 arbitrary as they reflect13 the context13 in whichtechnological changes must13 be considered They must13 include consideration of factors suchas demography and long-shy‐term conditions already addressed in the introduction to thesepapers together with the aspects of workforce and citizenship considered in the parallelpapers The additional elements here focus on trends that13 are already occurring and whichmay leave people struggling with the changes that13 occur
Finally there is a need to consider the attitudes of people to technology generally andespecially to the issues of privacy and social responsibility that13 could be radically changedby technology In some cases public opinion will prevent13 some forms of technology beingdeveloped if not13 commercialised In other cases some technologies will be fast-shy‐trackedeither at the request13 of government13 or because of a clear public demand for theopportunities that13 it13 can bring
Predictions13 about the13 future13 must inevitably be13 subject to considerable13 uncertainty butthat is no reason to stop thinking what might happen
31 The Welfare State
The UK can be rightly proud of the way that13 its welfare state has developed during the past13 100 years to provide a safety net13 of financial support13 to people and to their families whenthey are unemployed destitute homeless or challenged by crises and emergencies Therange of benefits received is considerable some are complex and many people struggle tounderstand their entitlements Some are universal some are discretionary some apply onlyto parents others to anyone
The total cost13 of providing these benefits continues to rise and when the economy isstagnating there is inevitably both political pressure often supported by popular publicopinion to introduce welfare reform so that13 people who do not13 work cannot13 be better offthan they would be if they were in full-shy‐time employment This strategy requires a universalbenefit13 to be introduced so that13 it13 is easier for claimants to access support13 but13 also easierfor agencies to identify the total benefits received The idea13 of a benefits cap then becomes
27
more practical to introduce especially if all the processes involved in making a claim arehandled electronically Indeed this encourages government13 to insist13 on applications forbenefits to be made on-shy‐line Unfortunately this will marginalise those people who haveneither a computer nor access to the internet thus emphasising the digital divide in amanner which works against13 some of the most13 disadvantaged people in society
There are currently few tangible links between digital technology and welfare provisionThe most13 obvious are universal benefits such as a free television licence (worth pound14550)13 for13 everyone aged 75 or older with blind and visually impaired people entitled to a 50discount13 irrespective of their age The significance of this position is that13 6 of revenuesgenerated through licence fees are to fund BBC on-shy‐line services13 such13 as websites and i-shy‐player In Scotland the BBCrsquos Alba Gaelic language television service is predominantlyfunded13 by MG Alba an organisation funded by the Scottish Government It is thereforeconceivable that13 in the future licence fees may be used to directly subsidise access toinformation and advice through the Internet13 for vulnerable people whether it13 is throughbroadband access or through a set-shy‐top box which removes the need for a computer in thehome to access particular websites or to use e-shy‐mail services
A second age-shy‐related benefit13 available in the UK is the winter fuel subsidy People whoreceive certain benefits receive the payments automatically while others must13 make aclaim Those who are not13 eligible for benefit13 due to a lack of an address for example missout13 on these payments and also on Cold Weather payments of pound25 for each seven dayperiod of very cold weather between 1 November and 31 March
The development13 of new warm home initiatives plus the complex of subsidies that13 theelectricity supply industry and government13 offer to people with solar cells further changesthe economic arguments Global warming may lead to greater variations in weatherextremes but13 might13 also increase the amount13 of electricity that13 can be generated byalternative (green) sources such as wind and solar cells It is estimated that13 energyconsumption in the UK increased by 17 between Christmas and Easter 2013 compared toprevious years as a result13 of cold weather but13 the above subsidy scheme did not13 benefit13 older people because two of the seven day cold periods were after 31st March It must13 beassumed that13 there will be more people living in fuel poverty in the future and this will leadto more cases of cold related illness including influenza13 and stroke
32 Management of long term conditions
The management13 of long term conditions will be improved for patients who are compliant13 with their medication regime so it13 is possible that13 there may be compulsion to adhere tothe prescription Such compulsion may be monitored using technology Indeed the remotemonitoring of vital signs using telehealthcare will become commonplace as the old boxesand sensors are replaced by devices that13 can be worn continuously or which can beembedded into the fabric of homes (including furniture and bedding) or can be worn asvests or patches They will wirelessly transmit13 data13 to smartphones or tablets and mobile
28
transmission and cloud technology will enable real-shy‐time data13 collection analysis andfeedback
One of the diseases which is projected to increase most13 significantly over the comingdecade is Type 2 diabetes Whilst13 there is a hereditary susceptibility to this condition formany people including those from the Middle East13 and the Asian sub-shy‐continent it13 is also adisease which tends to affect13 those people who are overweight13 andor have a sedentarylifestyle If untreated diabetes can lead to dizziness and collapse at any time but13 can alsohave more devastating long term consequences which include kidney failure strokeblindness and in extreme cases lower limb amputations Management13 therefore includesdaily monitoring of blood glucose levels and major dietary changes such as a significant13 reduction in the consumption of carbohydrates as well as a rigid exercise regime
Many newly diagnosed diabetics follow this advice closely and can lead normal lives for 40years or more but13 some struggle to accept13 the change in lifestyle required as well asremembering which foods are allowed and how much exercise they need to takeIndividual support13 plans are now forthcoming and over the next13 ten years best13 practicewill emerge in the form of smartphone apps that13 are personalised and which can becomean individualrsquos health coach This level of support13 will be fine for some people but13 otherswill need incentives so it13 is likely that13 gaming technologies will be introduced perhapsoffering rewards for good compliance There will be a temptation for some people tocheat perhaps allowing others to perform exercise for them or changing theirconsumption details
Many of these opportunities for cheating will be removed through the use of a uniquebiometric identifier a technology that13 will be mature enough to use in place of passwordson smartphones However the biggest13 challenge may be in encouraging older people to usethe technology Many older people have multiple morbidities Indeed a survey of Scottishpatients implied that13 42 of people aged over 80 will suffer from three long termconditions It will be essential for those people to comply with treatment13 regimes if they arenot13 to have the functional deficits that13 follow
33 Finding people who13 donrsquot fit
People who have low social capital are likely to have few relatives and friends with whomthey regularly communicate and are also unlikely to be part13 of community or faithorganisations such as clubs societies and church groups They also die several yearsyounger than most13 of the population often because they donrsquot13 engage with public healthinitiatives such as vaccinations against13 flu regular checks on their blood pressure bloodsugar levels or in the case of women smear tests or mammography The most13 likelyreason for disappearing beneath the radar of such initiatives is their mobility which leadsalmost13 inevitably to them having no fixed abode and no fixed telephone line It thenbecomes very difficult13 for them to be contacted because their mobile telephones are likelyto have Pay-shy‐As-shy‐You-shy‐Go contracts that13 donrsquot13 require validated names addresses and bankaccounts
29
It follows that13 some of the most13 vulnerable people in society including those who live onthe streets are effectively unknown to both the NHS and to social work departments untilthey are referred in a crisis This could be an emergency presentation to a hospital Accident13 and Emergency Department13 where they will come into contact13 with a social worker becausedischarge may be unsafe This often highlights the importance of the prevention agenda13 and the potential for avoiding admissions to hospital by intervening at an earlier stage
The advantages of being able to locate people who are vulnerable to specific diseases willincrease as genetic testing becomes more routine It is already possible to determine whomight13 be most13 at risk of breast13 cancer and prostate cancer as a result13 of family history Addto this the evidence that13 particular diet13 and exposure to environmental factors can furtherincrease risk then it13 is evident13 that13 individuals can be identified and offered treatmentsthat13 could save their lives many years before they become ill In the case of cancersperhaps only the individual is involved but13 for infectious diseases it13 is the whole of societythat13 is at risk if someone contracts one of the new strains of influenza or if someonechooses not13 to be vaccinated against13 rubella In Chinese airports all visitors are screenedfor fever and refused entry if they tested positive in cities the public are monitored in thesame way Similar approaches may be necessary in the UK if potential carriers cannot13 otherwise be identified
34 Volunteering
It is estimated that13 72 per cent13 of people volunteered to perform a charitable act13 at least13 once during 2012 a rise from 65 per cent13 the previous year About13 four out13 of every 10volunteers offer their services formally to one or more organisations The remaindervolunteer informally by helping out13 a friend or a neighbour Around 50 per cent13 volunteered at least13 once a month in the past13 year up from 41 per cent13 on the previous13 year Most13 have retired many of them before the statutory retirement13 age Those whodonrsquot13 feel able to offer time have offered their financial support13 at a time when the fundingavailable from sources such as the National Lottery has been decreasing Despite economicausterity donations to charities have been increasing 74 per cent13 said they had given tocharity at least13 once in the previous month up from 72 per cent13 the previous year
Strikingly 78 per cent13 of people strongly believe that13 they are part13 of their localneighbourhood an increase from 70 per cent13 10 years previously Community cohesion isstronger than ever 87 per cent13 of people believe their local area13 is a place where peoplefrom different13 backgrounds get13 on well together compared to 80 per cent13 in 2003
The role of volunteers in supporting vulnerable people is therefore likely to increase overthe next13 decade perhaps exploiting the success of the army of volunteers that13 was highlysuccessful in London during the Olympic and Paralympic games The greatest13 role for suchvolunteers may be in providing informal care for older people Already the UK has someseven million informal carers whose value in monetary terms has been calculated to be
30
more than the combined budgets of the NHS and social care Maintaining or extending thisprovision will help to support13 services in the future and may be supported by technology
Whilst13 there is ample evidence to suggest13 that13 telecare services support13 informal carers asmuch as (if not13 more than) the people that13 they are caring for it13 is the potential for utilisingthe internet13 and apps to make their role easier to coordinate and hence more effectivethat13 is likely to be most13 successful moving forward
Many of these focus on particular tasks that13 informal carers can help offer to older peoplesuch as organising their medication A pillbox program is just13 one feature of an app calledBalance It also includes sections for caregiving tips notes for the doctor and the patientsappointments plus a lsquolearning sectionrsquo with articles on aspects of Alzheimers and an RSSfeed for news about13 the disease Tyze is another multi-shy‐functional app it13 allows carers to
bull Organise appointmentsbull Plan outingsbull Share storiesbull Send updates to other family members
Another application is Rally Round which helps carers to organise someone to perform littlejobs often on a temporary basis when someone has dementia physical frailty or isrecovering from accident13 or illness Similar applications are MeMaxi and Finerday
35 The High13 Street
The shape and appearance of UK shopping centres have been changing for half a centuryPeople complain that13 centres are losing their identity with one town looking like everyother both in terms of the stores and in terms of the layout But13 there are three trendswhich are having a profound impact13 on many of the most13 vulnerable people in society
bull Centres lock their doors at 6pm or in some cases 10pm -shy‐ thus denying people whosuffer from claustrophobia13 from window shopping at times when other shoppershave left
bull Out13 of town shopping malls -shy‐ these US style centres are ideal for people in carsbecause they offer free parking which is essential for people who want13 to buy largeritems but13 difficult13 for people who have no transport13 and who must13 rely on publictransport13 that13 is often deficient
bull The rise of online shopping -shy‐ which means that13 many potential shoppers only visit13 High Street13 stores to check the prices before returning home to make a purchaseonline
It is the third of these effects that13 has the greatest13 potential for changing the High Street13 forever and it13 is making life for traditional retailers increasingly difficult13 at a time when highrents are crippling stores large and small It is difficult13 to see how this trend is likely tochange because consolidation in banking and estate agencies is already forcing the closure
31
of other High Street13 players while additional pressures on pubs has led to the closure ofthousands of pubs every year
Those figures however demonstrate that13 consumers still value what13 the high street13 canoffer -shy‐ the chance to inspect13 what13 theyrsquore thinking of buying -shy‐ as well as the new opennessof the internet Customer service makes a difference to people especially if there is aproblem and goods need to be returned One of the most13 common reasons for furniture tobe returned for example is that13 when a sofa13 or a wardrobe was delivered it13 couldnrsquot13 fit13 through the front13 door or up the stairs In the future people will be able to benefit from13 visualisation technology they will upload the floor plans of their homes enabling theretailer to inform them of the problem before they try to delivery Augmented reality viewwill similarly allow customers to see what13 a new item of furniture will look like in itsintended place so that13 they can be more informed about13 the effect13 of size and colour
In terms of improving the viability of the High Street stores will have to focus on theimportance of brand which could mean that13 individual independent13 retailers will have topartner with national suppliers to support13 a local tailored offering based on products that13 are designed for a more global market This is a lsquoconnected High Streetrsquo approach whichcould be enabled by the developments in internet13 availability and smart13 phone accessdescribed in the previous section
The overall effect13 of all these changes could mean that13 town centres become smaller but13 more vibrant13 areas They could thrive if people are attracted there in large numbers whichmeans that13 retail must13 be developed alongside restaurants pubs galleries and other leisureopportunities This is possible in new shopping centres which are already being integratedwith transport13 hubs including railway and bus stations but13 may be more of a design13 challenge for older towns and cities with large Victorian buildings To ensure that13 morepeople are welcomed into the new centres they should include attention to green spacesand areas where people can relax without13 feeling that13 they are second class citizensbecause they donrsquot13 have the same buying power
3513 Privacy
To some people privacy is their right13 to live their lives without13 interference they may seethe State as a potential lsquoBig Brotherrsquo spying on their every move and judging their actions13 and activities Other people have fewer concerns about13 the role of the State but13 great13 fearof individuals interfering with and invading their privacy Some embrace the concept13 of lsquomyspacersquo an area13 of a square metre or so into which nobody can enter without13 permissionThis allows them to avoid physical contact13 and to feel safe from any form of threateningbehaviour
Yet13 this idea13 of private space and its potential violation is merely the tip of the iceberg asfar as privacy is concerned more significant13 is the idea13 of personal (and private)information being shared with anyone and everyone This could be related to identityopinion or image for an individual who wants to remain anonymous or even secretive thisis going to become an increasing problem as technology provides the means of taking
32
photographs recording conversations and capturing environment13 with something as smalland ubiquitous as a mobile phone The fact13 that13 this information can then be shared withthe rest13 of the world using e-shy‐mail Twitter and Facebook makes the problem all the moredifficult So the threat13 is no longer solely from the long lenses of the Paparazzi but13 fromanyone (and that13 means everyone) who has even the most13 basic of mobile phones
This relates to the changing views of society on what13 information should remain privateand what13 should be shared with others The success of social media13 has been based on anattitude of lsquosharing everythingrsquo with either your friends or the world This has introduced anaiumlve idea13 in the minds of some younger people (especially those known as Millennials ieaged 18-shy‐30) that13 everyone can be their friends whilst13 perhaps failing to reinforce the bondsof genuine friendship with any form of test13 or restriction Technology could play a role indefining these friendships and allowing individuals to understand what13 makes a goodfriend but13 this approach has yet13 to be developed and may be slow to overcome the needfor some people to measure their own popularity simply as the number of people that13 theycan list13 as friends on their Facebook page
It follows that13 there may be a need for a new definition of privacy that13 is in keeping withthe web and its ability to display images and opinion in an unregulated manner This needsto embrace past13 concerns about13 the ability of an individual to live without13 the threat13 ofothers being able to watch them whilst13 offering some protection from random postingsabout13 them online Perhaps this could include a right13 to be able to edit13 or remove anythingrelating to themselves on the Web including images that13 are not13 news-shy‐worthy Theownership of image rights may be an associated issue that13 needs to be addressedespecially as modern technology can remove an individual from a group (or a background)13 view provide digital touch-shy‐up or air-shy‐brushing and then republish it13 in a different13 contextHowever there is general agreement13 that13 personal information (such as contact13 details andbank codes) should not13 have a place on the web Surprisingly few people take proactivemeasures to prevent13 tracking functions being activated
It follows that13 too much privacy could lead to younger people fearing that13 they maybecome lost13 in a digital world It is not13 surprising then that13 they are prepared to make lots13 of personal information available often with no fear of how it13 might13 be used by othersWhen Google glasses and similar technologies become available during the next13 few yearsthey will have the potential to identify a stranger walking down the street and to find manyof their secrets to present13 to the wearer in a fraction of a second They could know moreabout13 them than their genuine friends know -shy‐ so who will be their friends in the future
36 Data sharing and13 protection
By lsquodata13 sharingrsquo we mean the disclosure of data13 held by one organisation on an individualto a third party organisation(s) or the sharing of data13 between different13 parts of anorganisation Some data13 sharing doesnrsquot13 involve personal data13 because it13 has beenanonymised in such a way that13 the statistics can be used for the collective good without13 theidentification of the individual The Data13 Protection Act13 (DPA) is in place to provide a legal
33
framework that13 ensures that13 organisations that13 hold personal data13 must13 act13 responsibly atall times These principles adequately describe the position of public and government13 bodies especially social services departments who are responsible for the informationconcerning the health and well-shy‐being of individuals -shy‐ and hence by implication thesensitive data13 relating to their vulnerability
The legal framework that13 applies to private and third sector organisations differs from that13 which applies to public sector organisations which may only act13 within the defined limits oftheir statutory powers However all bodies must13 comply fully with the data13 protectionprinciples and this situation is unlikely to change within the next13 10 to 15 years In someprivate sector contexts there are legal constraints on the disclosure of personal dataHowever most13 private and third sector organisations have a general ability to shareinformation provided this does not13 breach the DPA or any other law It is advisable for acompany to check its constitutional documents such as its memorandum and articles13 ofassociation to make sure there are no restrictions that13 would prevent13 it13 from sharingpersonal data13 in a particular context The type of data13 held is therefore a subject13 ofconcern as it13 may be difficult13 for legislation to keep up with the additional layers of data13 created on-shy‐line and through the Internet13 of Things
Private and third sector organisations should have regard to any industry-shy‐specific regulationor guidance about13 handling individualsrsquo information as this may affect13 the organisationrsquosability to share information They should also be aware of the legal issues that13 can arisewhen sharing personal data13 with public sector bodies This becomes more of an issue asprivate and third sector bodies are carrying out13 a wider range of traditionally public sectorfunctions Opportunities for inappropriate sharing of sensitive data13 will therefore inevitablyincrease
Public authorities must13 comply with the Human Rights Act13 (HRA) legislation in theperformance of their functions The HRA also applies to organisations in the private sectorinsofar as they carry out13 functions of a public nature which could include delivering a socialcare activity Where the HRA applies organisations must13 not13 act13 in a way that13 would beincompatible with rights under the European Convention on Human Rights Article 8 of theConvention giving everyone the right13 to respect13 for their private and family life their homeand their correspondence is especially relevant13 to sharing personal data If personal data13 isdisclosed or shared in ways that13 comply with the DPA the sharing or disclosure of that13 information is also likely to comply with the HRA The problem may still be in policing theActs and the rights of an individual if they believe that13 their personal data13 has been sharedor accessed by an inappropriate organisation or individual
A legal industry may be born to deal with such matters but13 this is unlikely to benefit13 peoplewho cannot13 afford the fees involved They would require either legal aid or to employ13 more13 lsquono win no feersquo companies Public attitudes to such costs might13 become negative unlessthey prove successful in preventing breaches of data13 security There may need to belegislation to provide a stronger basis for forcing compliance with privacy laws
34
37 Connecting with13 people
We are social creatures most13 of us rely on our friendships and interactions with friendsand families to share our happiest13 moments and experiences Research suggests that13 thishappiness is infectious at all levels and leads to a 15 increase in the happiness of a closecontact 10 for a second degree contact13 such as the friendrsquos spouse and a 6 increase fora friend of a friend It is hardly surprising that13 the success of social media13 such as Facebookis intimately related to the ability of people to quickly share their happiest13 moments with asmany of their friends and connections as possible
All this has happened during the rise of the Internet13 and the corresponding increase inopportunities for connecting online ie this is a 21st Century phenomenon which has beenfacilitated by Information and Communications Technology But13 the Internet13 remains in itsinfancy and we are only beginning to understand and exploit13 its potential In terms ofaccessing the Internet there are now perhaps two billion people who have access with99 of them having gained this during the past13 decade This number will have doubled bythe period 2020 to 2025 It is likely that13 everyone who wants to be connected in the UK willby then be connected Turning this on its head only those who donrsquot13 want13 to be online willnot13 be on the Internet13 within a decade Connecting with the unconnected will therefore bea case of identifying those people who donrsquot13 want13 to be found unfortunately these mayinclude many people who need the support13 of social care organisations It means that13 theywill be looking for support13 only when they are in crisis unless other ways of finding andormonitoring them are found
While the number of people connected via the Internet13 has exploded this might13 bedwarfed by the number of connected lsquothingsrsquo During 2009 the number of thingsconnected to the Internet13 surpassed the number of connected people at which point13 webegan to experience what13 this report13 has described as the lsquoInternet13 of Thingsrsquo Yet 99 ofall physical objects that13 could join this network are not13 yet13 connected but13 the number couldgrow by 25 every year for the next13 decade so that13 there could be 100 billion connectedobjects by 2025 some of which will be owned or used by everyone in the UK includingthose people who donrsquot13 want13 to be connected themselves We will then have an Internet13 of Everything which will be the smart13 connection of people data events and actions
With each new person object or data13 that13 comes online the connection possibilitiesbetween all these elements grows exponentially The rise of big data mobile networkingcloud storage and data13 mining technologies will all play a critical role in the Internet13 ofEverything The result13 will be new capabilities richer experiences and unprecedentedvalue for individuals businesses communities and countries everywhere The lsquonetworkeffectrsquo of the Internet13 of Everything will be a very powerful thing the true impact13 of whichwe wonrsquot13 fully understand for several years As it13 develops however those who are not13 connected will feel even more digitally and socially excluded There will be a need to reachout13 to vulnerable people unless the process of claiming requires proof of online identityand the payments to be received can only be redeemed using a chipped card or adownloaded app onto a smartphone This is of course the way that13 welfare arrangementsare already developing thus it13 might13 prove impossible to make a successful claim without13
35
already being connected to lsquothe systemrsquo either through an online presence or through theInternet13 of Things
38 Downloading everything
Sixty years ago information was discovered by reading books often in a library wherenotes had to be made because the books or journals couldnrsquot13 be removed Then in theearly 1960s the first13 office photocopying machines were introduced into the UK theyimmediately meant13 that13 pages or articles from books could be copied and taken away to beread and summarised later Within a few years photocopying became a replacement13 forreading as researchers became less adept13 at selecting a few sentences and every deskbecame a depository for reams of printed paper Paper became the means of recordingeverything from bank statements through to music
We now appreciate that13 printing everything is a waste of both the ink (or toner) used tocreate the black print13 and of paper which requires trees to be chopped down and pulpedbefore it13 can be pressed into thin sheets Saving paper is therefore seen as green and goodfor the planet Fortunately we no longer need to print13 everything because computermemory is unlimited thanks to the cloud and we can then view pages and articles onportable or fixed screens
The internet13 has everything and it13 is all available instantly for downloading providing thereis a device available to accept13 it and there is sufficient13 communication bandwidth toperform the transfer of data13 sufficiently quickly Thus we can record all text13 articles that13 are relevant13 to us including digital records of birth certificates qualifications and passportsand the need for original printed versions will decline But13 we can also do this forphotographs Most13 handheld computing devices include at least13 one camera so they cangenerate enormous number of pictures which can be kept13 for posterity without13 having toconsume inks and special papers to print13 them
But13 the materials that13 can be downloaded donrsquot13 stop at pictures software is available that13 can grab TV shows after they air and movies as soon as theyre released In the same wayit13 is possible to schedule music comic books video games and practically anything else asa download with minimal effort People will need enormous hard drives if they want13 theirown digital copies of these files so will more than likely make use of cloud storage that13 willbe available from many organisations The location of the servers may become sensitivedue to border restrictions as will the security of the data13 and the way that13 it13 is backed up sothat13 it13 is resilient13 to failures
It may be evident13 that13 application forms for all types of welfare payment13 will be availableonly for downloading so that once digitised they can be processed by computer andrecords sent13 to various servers for subsequent13 storage and processing Some people maywant13 to keep their data13 on them once it13 has been downloaded Pen drives can already holdseveral GB of data so it13 is likely that13 people will be able to carry their downloaded data13 withthem at all times irrespective of the size and complexities of the information
36
39 Health13 and13 well-shy‐being
The general health of the population is unlikely to deteriorate noticeably within 10 to 20years Indeed expectations of the population are that13 things must13 improve as surgicaltechniques mature and as pharmaceutical interventions become more personalised andpowerful However the rising demand for health services due to an ageing population andthe increasing cost13 of providing sophisticated therapies will make delivering a free anduniversal health service difficult13 without13 substantial increases in taxation This is unlikely tohappen in the UK even though spending on health services will be protected against13 thecuts facing other services
There will have to be changes in how the NHS works For twenty years hospitals have beenclosed and replaced by fewer new facilities so that13 the bed count13 is reduced This has led toa significant13 shift13 in resources to primary care and community care supporting shorter staysin hospital and speedier transfer back home for people after surgery or illness This hasbeen13 successful but13 there remain problems with demand for GP services especially out-shy‐of-shy‐hours and at weekends Indeed despite the introduction of NHS24 and similar help-shy‐linesthe demand for GP appointments continues to increase Delays are inevitable and this willincrease system failures with more unnecessary deaths and a failure for people to access adiagnosis that13 might13 lead to early interventions and ultimately lower delivery costs Over250 more patients are added to waiting lists every day
This will lead to a new model of primary care consistent13 with existing changes which haveseen surgeries move from High Street13 locations to medical centres close to bus routes andwith more parking for patients The process of making an appointment13 is changing from atelephone-shy‐based interview process dominated by a medically-shy‐unqualified receptionist13 to achoose and book approach using an online process linked to electronic patient13 records Thiswill give patients more convenience but13 will allow priority for those who have Internet13 access at the expensive of those who are digitally excluded Making the process of bookingan appointment13 quick and easy may also increase demand from people who do not13 need tobe seen as it13 will fail to identify those in greatest13 need
A greater use of telehealth and telecare technologies will be inevitable beginning with thefirst13 contact13 as an encounter using the telephone e-shy‐mail or video conferencing -shy‐ a visit13 tothe GP surgery should be a last13 resort and should involve a nurse consultation in the first13 instance This would be consistent13 with three quarters of appointments currently involvinga chronic disease or long term condition which relates to improved self-shy‐care The support13 ofthese patients at home should be prioritised through tele-shy‐ and web-shy‐based technologies andshould involve training and coaching through a network of nurse practitioners Home visitsshould generally be unnecessary through the use of these technologies but13 could besupplemented by satellite surgeries manned by nursing in community premises or inpharmacies nurseries and Internet13 cafes
The homes13 of people who13 need13 closer monitoring can then become part13 of virtual wardswith real or electronic visits by health professionals University Hospital Southampton NHSFoundation Trust13 already looks after patients who have undergone surgery such as a hip orknee13 replacements in virtual wards with high levels of satisfaction The Royal Free London
37
NHS Foundation Trust13 offers a similar service but13 plans to add the possibility of videoconsultations between patient13 and consultant
310 Attitudes to public health issues ndash obesity smoking alcohol abuse drugs
As self-shy‐care becomes the focus of the NHS the public will increasingly understand that13 thecosts and availability of services are being harmed by the poor health behaviour ofrelatively small numbers of people The link between public health initiatives today andhealthcare needs and costs in the future will become increasingly evident13 as a result13 of theway that13 information is presented Thus the overweight13 smoker who currently attractsconcern and pity when they are diagnosed with diabetes and COPD is increasingly beingseen as the victim of their own stupidity or lack of self-shy‐discipline If they continue to neglect13 medical advice and continue with an unhealthy lifestyle then the way that13 they receivetreatment13 and consume resources will become a matter for the entire population
Obesity is seen as due to a combination of poor diet13 and a sedentary lifestyle No longer isthe idea13 that13 people are lsquobig bonedrsquo acceptable Governments will respond initially byrequiring manufacturers and food processors to provide nutritional information onpackaging and on menus in restaurants But13 people can choose not13 to read the data13 and toneglect13 both the importance of food quality content13 and quantity This will increasepressure to introduce fat13 or sugar taxes and these are likely to be in force within a decade
Although the high taxes on tobacco products has forced some smokers to reduce theirconsumption or to give up altogether the impact13 has been reduced by the smuggling ofproducts from overseas and by the availability of duty-shy‐free cigarettes for people returningfrom foreign holidays and business meetings Further measures are planned to changepackaging and to include even more graphic images and warnings on cigarette packages tomake smokers aware of the effects of smoking on their health and well-shy‐being There is asyet little evidence of how successful this might13 be More effective has been the banning ofsmoking in public places including trains and aircraft Expensive medical interventions suchas heart13 transplants will be denied to individuals until they change their lifestyle behaviourSmokers might13 therefore be increasingly ostracised leading to a loss of esteem This mayhave a particular impact13 on people who already suffer from mental health problems whoare more likely to smoke
The overuse of alcohol is being recognised as a major factor in hospital admissions withNHS figures showing an increase of over 40 in such admissions over the past13 decadeLinked to this has been a 75 increase in prescriptions to treat13 alcohol dependency Fewpeople have sympathy for those who waste their limited income on booze If they havechildren or other dependents they will be the ones who suffer and who may need thesupport13 of social care
Drug users are already significant13 users of social services as their habit13 is likely to makethem unemployable They receive little sympathy from the general public because they areseen as criminals and people who waste public resources Levels of drug abuse have been
38
slowly increasing over the years but13 this trend is slowly being reversed Indeed the numberof people using drugs during the past13 year has fallen to its lowest13 level for nearly 20 years(below 9) with cannabis being most13 likely often following excessive drinking Aselectronic noses and other technologies can detect13 traces of drugs it13 seems likely that13 success in overcoming addiction can be measured objectively This may become a two-shy‐edged sword rewarding those who can turn around their lives but13 further marginalisingthose who canrsquot13 or wont13 accept13 the lsquocold turkeyrsquo
311 Attitudes to surveillance
Issues associated with privacy confidentiality and data13 security have been discussedpreviously in the context13 of information technology the World Wide Web and the ease ofcollecting recording recalling analysing and displaying data The monitoring of individualsand their methods of using this information can be regarded as surveillance As thequantities of data13 increase along with the number of devices that13 can be used to access itthe surveillance tools will also increase in their sophistication Indeed the Big Data13 approaches described in the previous section will enable the combination of structureddata13 (such as the information held in databases) to be married with unstructured data13 fromimages in such a way that13 it13 can be mined
Whilst13 the lsquodigital surveillancersquo methods described above may cause most13 concern topeople because of its impact13 on anonymity it13 is the collection and analysis of images that13 are the major concern to people as they contemplate the ways that13 lsquoBig Brotherrsquo maydevelop to restrict13 freedom Every major UK city and town centre has an array of CCTVcameras that13 continually record activities from every angle If it13 used to be true that13 nobody in London was more than 10 yards from a rat it13 is certainly the case today that13 nobody can be more than this distance from being in view of a surveillance camera Yetthey receive so much positive publicity from TV programmes where their footage is used todetect13 vehicles close to a crime scene or to monitor the movements of suspects that13 theyare now accepted by the public as a deterrent13 in the same way as lsquobobbies on the beatrsquowere seen 25 years ago There is therefore little public reaction to the expansion in the useof video surveillance except13 for the practical observation of how so many views can beinspected and recorded
Looking to the future the tumbling cost13 of video technology will surely lead to anotherincrease in the number of devices The aerial views taken from towers will besupplemented by more local views taken by devices that13 are embedded in the fabric ofbuildings or carried by individuals either on their person (for example on clothing orspectacles) or in the bags that13 they carry The time and date-shy‐stamped images as Big Datawill be recorded to lsquothe Cloudrsquo where it13 can be added to other data It can then be usedwhen an incident13 has occurred or to provide further detail of night-shy‐time activities
It follows that13 there will be no hiding place for people who simply want13 to disappear Theymay respond by wearing clothing (such as hoodies) that13 hide their faces or which make it13 difficult13 to distinguish gait13 or mannerisms from which they might13 be identified New forms
39
of clothing may be designed to make shapes more difficult13 to analyse and these might13 become the uniforms of a class of person who wants to live in a way that13 they donrsquot13 interact13 with officials from any ministry or local government13 department If they also obstruct13 services then they will be considered to be anarchists of some form sparking protests fromother sectors of society
31213 Attitudes to driving
Motor cars have been a feature of UK roads for over a century but13 it13 is only during the past13 50 years that13 they have become a resource that13 most13 families have had access to enablingthem to travel without13 the restrictions imposed by a limited railway network and non-shy‐integrated bus transport People who have had a car throughout13 their lives often see theircars as an important13 factor in enabling them to remain independent13 and to exercise choicesrelating to where they shop and where they spend their leisure time This extends to theirspouse and to friends and neighbours that13 they might13 take with them on their variousexpeditions
Unfortunately there are incidents involving older drivers who perhaps go down amotorway in the wrong direction who are taken ill at the wheel or who are involved in anaccident13 involving no other vehicles These are small in number but13 often lead to a reactionthat13 they shouldnrsquot13 be allowed to drive lsquoat13 their agersquo Age itself is not13 an indicator ofdriving quality but13 because old age also brings more chance of having limited long termconditions and other illnesses it13 is easy to make a link between driving ability and age Thelicensing system does require continued driving to be linked with medical advice andforbids people with poor eyesight epilepsy and other conditions to hold a licence in oldage
Yet13 statistically older drivers cause far fewer accidents than younger drivers The reasonsfor this may be complex and are likely to include the fact13 that13 they drive less often covershorter distances and donrsquot13 go out13 in the dark or in poor weather However it13 does not13 wholly explain why the UKrsquos drivers aged over 70 and who represent13 some 8 of all driversare involved in only 4 of accidents that13 cause injury This compares favourably with the15 of13 drivers aged between 17 and 29 who are involved in over a third of crashes that13 result13 in injury
By 2020 the number of drivers aged over 70 on UK roads is likely to increase to over 7million This will require a new national strategy perhaps involving support13 for olderdrivers further training raising awareness of issues and making more use of adaptivetechnologies to support13 the driver in avoiding collision or forgetting to check on the statusof their vehicle Poor eyesight13 could be enhanced by camera technologies rather thanforcing people off the road if they are unable to read a licence plate
The International Longevity Centre has found that13 one in four Britons thought13 driversshould be made to switch off the ignition for good somewhere between the ages of 70 and75 The numbers may decrease as the population ages and as cars become safer Forcing
40
older people off the road may be a natural consequence of providing free bus passes andsubsidised rail fares but13 the growth in the pavement13 scooter industry demonstrates that13 older people value their independence and will do almost13 anything to get13 out13 and aboutPerhaps legislation will result13 in more regulation of electric vehicles and where they cantravel
There can be no doubt13 that13 getting out13 will be associated with better quality of life andwell-shy‐being and this is likely to be supported in the future as evidence of improvedoutcomes emerges It is to be hoped that13 positive stories will be publicised so that13 publicattitudes arenrsquot13 hardened This may be supported by more in-shy‐car monitoring of drivers andthe linking of performance with on-shy‐line driving records and licences These could throughremotely monitored ignition systems prevent13 the use of motor vehicles by people without13 a licence or without13 insurance
313 Climate change
There is a general view that13 the emissions of carbon gases are contributing to globalwarming in a manner that13 will change the UK climate in such a way that13 the climate maybecome more Mediterranean However some scientists believe that13 manrsquos impact13 on theenvironment13 may be small compared with natural variations caused for example bycyclical changes in the sunrsquos energy output13 or by the effects of volcanoes and earthquakesRecent13 evidence has suggested that13 we are going through a phase of changing extremesand that13 this is more likely to cause storms periods of excessive rainfall and unusualseasonal trends with snow and frost13 in the spring and warmer winters Considerableuncertainty remains and it13 might13 be necessary to plan for a number of different13 scenariosand for the impact13 on vulnerable people
I Colder winters UK properties are poorly insulated resulting in excess mortalitiesduring cold spells due to an increased number of people suffering from stroke aswell as bronchitis and other pulmonary diseases The cost13 of heating continues toincrease putting more households into a state of fuel poverty Any further coolingduring the winter months will result13 in more people living in unhealthy coldconditions Winter fuel payments are likely to be restricted to the poorest13 peoplebut13 this might13 exclude people who live in larger properties that13 are more difficult13 toheat
II More storms excessive winds and rain can cause flooding at any time of the yearMany UK communities are built13 close to rivers and these can surge during heavyrainfall causing houses to be filled with water and furniture and carpets lostInsurance can be problematic for properties built13 on flood plains which can blight13 properties and prevent13 owners from being able to sell and move on High winds canrip off roofs causing injury and also causing families to be left13 homeless anddependent13 on social services
III Hot13 summers Europe suffered high temperatures during the summers of 2003 and2004 leading to heat13 stroke and hypothermia The UK has not13 previously sufferedfrom such problems but13 might13 be expected to experience days of extreme
41
temperature and humidity at times Older people may not13 be prepared for suchweather Street13 dwellers may be unable to find shade and supplies of drinkingwater
Irrespective of what13 combination of weather scenarios arise it13 must13 be concluded that13 any extremes will have a major negative impact13 on vulnerable people especially if theyare not13 prepared because they havenrsquot13 received the weather warnings and advice that13 can be broadcast13 using the TV radio and online services Once again the digitallyexcluded will suffer and will pay a high cost Society will continue to pick up the bill interms of demands on social care services unless preventive actions are taken in theform of connecting these people to each other and to formal services
42
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
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13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
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b13 13
n13 13
13 s13
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ly13
13 e13 t13 e13
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13 13
13
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s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
e13 g13 13
e13
13 13 ial13
13
d13
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s13 y13
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13
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13
13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
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13
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le13
y13
o13
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13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
There are four broad classes of robot13 under development13 that13 are likely to mature within 10to 12 years
1 Miniature industrial robots that13 have been programmed to perform specific taskswith precision They are likely to be relatively heavy enabling them to bear weight13 but13 still have the necessary flexibility to carry an individual over short13 distancesplacing them in a chair or on a bed They will have sensors and cameras to provideimmediate feedback and to adjust13 rapidly in response to verbal commands or cues13 from the user Some designs may build on existing assistive devices such as abathroom hoist13 or a bathing aid to become intelligent13 extensions of productsalready on the market A stair lift13 with intelligence is already being designed by a UKcompany and is aimed at providing the user with more control of the journeybetween floors of a house
2 The second group of devices might13 be described as intelligent13 furniture Beds andchairs are already available that13 adjust13 to make the user more comfortable and also13 to help them get13 into or out13 of bed The control units are fairly cumbersome andare suited to operation by a carer Voice activated controls and built-shy‐in intelligencewill give the user more control and independence Other items of furniture to whichintelligence might13 be added would be tables whose height13 can adjust13 and whichhold items of food and medicine securely The table would recognise these objectsand could provide prompts or reminders
3 Mobile robots form the third group These could be goffers that13 can either fetchand carry items such as newspapers drinks or trays or which can accompany theuser when they move between rooms providing them with support13 or prompts Thistype of robot13 could be an intelligent13 walking frame with wheels which13 could13 doubleup as a smart13 wheelchair when necessary
4 Finally there are companion robots These might13 be in the form of an electronicpet typically a cat13 or a dog though the Japanese Paro robot13 is a seal Pets canrespond to stroking and being patted they can also remind their owners that13 theyneed to take exercise and to eat drink and take their medication Various designsare already available which provide feedback but13 future models would includecameras and a screen to provide a mobile means of information and interactionwith other people over the Internet Intelligence within the device could allow themto have a personality of their own and gain knowledge by scraping data13 fromwebsites so that13 they can generate speech and have conversations about13 the newsthe weather or sports results
217 Transport and transfer technologies
Walking is good exercise and is a no-shy‐cost13 form of transport13 that13 is encouraged because of itsimpact13 on well-shy‐being For an individual with a chronic disability or suffering from theeffects of an accident13 or an injury this becomes impractical without13 an assistive technology(AT) A walking stick is the simplest13 example of AT
20
Within the home the stair lift13 has enabled people who live in conventional properties that13 are on two or more floors to continue to use facilities on different13 floors when climbing thestairs has become too difficult This is often the case for people who have arthritis a lowerlimb amputation a long term condition such as Chronic Obstructive Pulmonary Disease orpeople approaching the end of life and who have chosen to die in their own homes
Designs have improved so that13 a curved staircase is no longer an issue and the reliabilityhas reached a level where breakdown is a rare occurrence13 Through-shy‐floor lifts have been analternative proposition but13 they remain too large for most13 properties Alternativeapproaches may emerge using air pressure or water pressure as the driving force ABrazilian design already utilises a plastic tube in which a pod is moved effortlessly up anddown
Electronic wheelchairs are now available that13 allow the individual to become moreindependent13 as they allow the user to control both propulsion and steering Some modelshave the capability of mounting a pavement13 or a step or even a flight13 of stairs Personalmuscle amplification devices have been developed originally with the intention of helpingpeople who are confined to a wheelchair due to a neurological disorder to perform sometasks from a standing position Indeed the Rex walkerrsquos manufacturers claim that13 anyonewho can propel themselves in a wheelchair could walk by using Rex
Other approaches have focused on the rehabilitation of people after major accidents that13 have caused partial paralysis They quickly extend into exoskeleton designs that13 enableanyone to gain a mechanical advantage and thus to tackle physical tasks that13 would not13 otherwise be possible These suits are the focus of major research projects across theworld Some13 products such as the system developed by Honda are being tested inAssisted Living facilities and are likely to become more and more enabling over the next13 decade
Similar benefits are also occurring outside the home with a number of novel carryingsystems appearing over the past13 few years They are generally termed lsquoscootersrsquo but13 thiscovers a wide range of systems and devices ranging from the Segway a device that13 is amobile platform on which the user stands and navigates through to conventional electricvehicles that13 have been developed from golf buggies There remain a number of issuesconcerning their use on roads or on pavements but13 similar problems will need to beresolved for bicycles to play their full part13 in enabling people to get13 more exercise13 Thepotential for hybrid scooters remains
218 Smart domestic appliances and personal hygiene
The bathroom is a dangerous place and one where many older and disabled people slip andsuffer a fall Many older people recall taking a bath in a tin tub in front13 of an open fireToday the options tend to be a level access shower (ie a type of wet13 room) for anyoneunable to get13 into a bath There are various aids to help people get13 into and out13 of thebath most13 involving a seat13 that13 can be raised or lower with some bath-shy‐tubs having a door
21
There has been some research into alternative methods of keeping the body clean Sanyointroduced a machine in 1970 modelled on a clothes or dish washing machines the personsits on a seat13 inside the machine where13 they are cleaned by a set13 of water jets These havenot13 proved popular and furthermore require the individual to be transported to themachine Thus the technology may find application in nursing homes but13 are unlikely to beattractive to people living independently in the community
The washing needs of people change over time Over the past13 20 years body piercingshave appeared which have demanded additional attention to avoid the problemsassociated with poor hygiene and metals Similarly hair may be permed and dyed usingchemicals which are much stronger and which might13 damage the hair Add to this thepainting of finger and toe nails and the washing needs are rather different13 to what13 theymight13 have been even ten years ago Finally tattoos were once popular only with sailorsToday they are likely to be found on the arms backs and legs of both men and womenNew ways of cleaning these tattoos will be needed especially if they become infected orare sites at which pressure sores develop
Even if a personrsquos body is clean if their clothes are dirty they may become socially isolatedBut13 the washing of clothes can be strenuous even if a launderette is used The need toconserve water has driven research into ultrasound techniques to beat13 the dirt13 out13 ofclothing while some companies are experimenting with polymer chips These13 ldquogreenrdquo13 technologies are quickly maturing and are likely to be standard in the next 10 years
Other smart13 household appliances are already appearing on the market13 and may soonbecome common13 in UK homes13
bull Robovac devices have sensors to enable them to detect13 dirt13 on carpets and to adjust13 their operation accordingly
bull Refrigerators can read bar codes or RFID tags to identify their contents and theirldquouse byrdquo13 dates enabling them to inform the owner that13 they should use theproducts before they are out13 of date They can be linked to the Internet13 to reorderitems as they are consumed or to suggest13 menu options for the individual based ontheir preferences or according to the diet13 required to manage a condition
bull Ovens will automatically switch off if they are left13 without13 attention for too longand drying machines will set13 times automatically
Devices may be linked so that13 they are more efficient and report13 maintenance issues sothat13 they can be repaired (perhaps remotely) before they suffer a catastrophic breakdown
219 Personal and home13 security
It might13 appear perverse but13 people with very little personal wealth and property are morelikely to be the victims of crime than those who have expensive items This may be due towhere poorer people tend to live or because people who have valuable assets take greater
22
steps to protect13 them There can be no doubt13 that13 crime has a very negative effect13 onindividuals and on their families creating a fear factor that13 may be difficult13 to remove Theimpact13 on quality of life is therefore very considerable especially if it13 forces people to stayat home behind locked doors effectively isolating themselves from society
Modern policing places increasing reliance on the use of closed circuit13 television (CCTV)Town centres are covered by cameras used increasingly in the fight13 against13 crime by bothdetecting anti-shy‐social incidents and identifying the people involved They are also used tomonitor the movement13 of cars that13 may be involved in incidents of burglary and violenceand are fast13 becoming the primary mechanism of law enforcement13 agencies to solve crime
CCTV has moved into the home to record movement but13 monitoring the footage is timeconsuming and often not13 practical Cameras are now available which provide an instant13 video feed to a smart13 phone when movement13 is detected These may have intercomcapability allowing someone to remotely speak to an intruder sometimes before they havegained access to a building This may serve as a deterrent13 and when fitted alongside simpledevices that13 switch lights on randomly around the home may force burglars to goelsewhere
As the price of cameras continues to fall the option of carrying a camera13 on the body that13 continuously monitors personal space is becoming more useful Using wireless networksthe data13 collected can be sent13 continuously to the cloud for safe storage It cansubsequently be retrieved to provide evidence (video and audio) of confrontations enablingsuccessful prosecutions to be made The smart13 phone itself is becoming a valuable itemthat13 is attractive to criminals These can be tethered to personal attack buttons usingwireless technology allowing the device to be activated by the pressing of a button if theowner is being attacked The phones can then be tracked and located by the police whilebeing rendered useless to the assailant
Bogus callers are a perennial problem for vulnerable people Video door bells can beconfigured to display images and record the words of visitors before they are admittedallowing remote monitoring centres to oversee the situations and use image recognitionsoftware to confirm the bona13 fide of visitors Such13 arrangements may become13 commonplace13 over13 the13 next five13 or13 six years13 significantly13 improving the safety of peopleliving independently
220 Personal safety
The biggest13 risks to personal safety stem from fires and falls Most13 fires are the result13 ofpoor cooking practices resulting in burns or scalds Floods and gas emissions are caused bya failure to remember to close taps
The current13 approach involves detection of an emergency situation as soon as possible but13 always after a problem has already occurred This responsive approach can minimise therisks provided that13 there is a protocol in place for intervening This could increasingly be an
23
automated response such as the switching off of the gas of water or the switching on of asprinkler system or a water mist13 system
In the future monitoring systems will be more sophisticated and will have sensors and localintelligence to identify activities In this way reminders can be issued before an emergencyoccurs13 This lsquosmart kitchenrsquo approach may become13 an integral part of13 homes of13 vulnerable13 people
A prototype system has been developed at the Culture Lab in Newcastle Sensors havebeen embedded into cooking utensils enabling the kitchen to identify what13 the person istrying to cook or prepare It can provide interventions as messages on an instructionscreen
Accidents also occur out13 of doors People with dementia13 might13 become lost13 and may havepoor road safety awareness Location devices based on GPS have advanced from large andheavy receivers that13 were used on ships and boats to small battery-shy‐operated devices that13 can be carried in the hand or in a handbag The current13 generation of locators has limitedbattery life and are rather too large to be secreted about13 a personrsquos clothing while devicesthat13 are integrated into a wrist-shy‐watch are rather clunky and unattractive
Within 10 years the13 technologies13 will have13 matured and will be13 much smaller13 so that theycan be embedded in shoes in walking sticks hats or any other item of clothing Powerrequirements will have reduced so that13 energy harvesting from the movements of theindividual will be sufficient13 to keep these products working for several weeks without13 theneed for recharging The devices will not13 simply indicate to others where the individualhappens to be but13 will provide subtle guidance cues to direct13 them home
Cameras might13 also form part13 of the personal security systems that13 will protect13 people fromaccidents Data13 may be sent13 to the cloud and analysed in real time if the person is in adangerous location and can provide prompts either to the individual or broadcast13 advice toothers to clear the danger These systems may be embedded in items of clothing (such as ahat) or they may be attached to spectacles
221 Energy and13 portable power supplies
The demands of developing economies for more power will inevitably lead to higherdomestic fuel charges in the UK especially as oil and gas reserves dwindle
By 2018 UK homes should be fitted with new smart13 meters The specifications for these13 devices have yet13 to be finalised but13 will include a means of identifying wasteful use ofenergy including TV sets that13 are left13 on and unattended fridges and freezers that13 are set13 attoo low temperatures and dryers that13 are used for too long or when the weather is suitablefor using a washing line They could be an enabling factor that13 supports changes inbehaviour driven by a need to use less power but13 it13 is unlikely that13 they will offer a bigreduction in costs that13 are already a problem for many vulnerable families
24
More generally the need for power conservation will include devices that13 are moreefficient and a significant13 emphasis on heat13 retention in buildings through betterinsulation
The energy crisis may force many people to spend more time in community settingsincluding shops and public buildings where they can benefit13 from the warmth Increasingreliance on mobile communication devices will lead to increasing demand for batterycharging facilities
Greater use may be made of portable devices for generating power based on solar cellswind or hand motion
222 Smart cities and homes
The Digital City initiatives have been based on information and how it13 can be used most13 effectively to make people aware of what13 is going on around them This means bettercoordination of resources more rapid access to advice and a battery of sensors measuringevery conceivable parameter from sound and light13 levels through to air quality andtemperature fluctuations There are several Digital or Smart13 City initiatives currently beingimplemented both in the UK and across the world They may significantly impact13 the livesof the millions of people living in them but13 the timeframe for outcome benefits to influenceplanning and design elsewhere is likely to be at least13 20 years and therefore outside thetimeframe of the current13 project
Housing plays a big role in the lives of most13 people both through their aspirations to moveup in the world (usually to a bigger property with a garden) and as the heart13 of the familylife which is associated with good quality of life UK properties have a life span approaching100 years which is about13 double that13 of their European counterparts (and certainly longerthan the wooden-shy‐frame buildings built13 in North America13 for example) A shortage ofhouses has plagued improvements in social welfare for the past13 30 years There is anargument13 that13 there are enough houses but13 the wrong size and in the wrong places andthis has some basis in fact13 as demography changes lead to more people (and more olderpeople) living alone However if there are two million homes in Scotland each with alifespan of 100 years then the renewal rate needs only to be 20000 per annum to maintainthe status quo However it13 must13 be clear that13 the impact13 of smart13 house development13 willbe small The focus should therefore be on adapting existing properties to render themmore appropriate for vulnerable people
Housing adaptations are a branch of assistive technologies The technologies for providingdifferent13 forms of accessible bath and level access shower are well-shy‐established with littleresearch considering anything other than alternative building materials and methods formaintaining the temperature of the bathwater Different13 technologies for bathing will beconsidered separately
25
Thus housing technologies are not likely to impact on social work13 within the next 20years13 though13 the use of information13 technology13 to ensure that people are aware of what13 is available is likely to be commonplace well before then
26
3 BEHAVIOUR AND ATTITUDE CHANGES DUE TO TECHNOLOGICALADVANCES
Technology is only one factor that13 will affect13 the way society changes in the next13 10 or 15years This chapter will consider the context13 in which the technological developmentsoutlined in the previous chapter will be supported (or held back) by societal factors
When the impact13 of such factors has been considered we can then apply theseassumptions to a number of case studies listed in Appendix13 A13
The headings selected for this chapter are not13 arbitrary as they reflect13 the context13 in whichtechnological changes must13 be considered They must13 include consideration of factors suchas demography and long-shy‐term conditions already addressed in the introduction to thesepapers together with the aspects of workforce and citizenship considered in the parallelpapers The additional elements here focus on trends that13 are already occurring and whichmay leave people struggling with the changes that13 occur
Finally there is a need to consider the attitudes of people to technology generally andespecially to the issues of privacy and social responsibility that13 could be radically changedby technology In some cases public opinion will prevent13 some forms of technology beingdeveloped if not13 commercialised In other cases some technologies will be fast-shy‐trackedeither at the request13 of government13 or because of a clear public demand for theopportunities that13 it13 can bring
Predictions13 about the13 future13 must inevitably be13 subject to considerable13 uncertainty butthat is no reason to stop thinking what might happen
31 The Welfare State
The UK can be rightly proud of the way that13 its welfare state has developed during the past13 100 years to provide a safety net13 of financial support13 to people and to their families whenthey are unemployed destitute homeless or challenged by crises and emergencies Therange of benefits received is considerable some are complex and many people struggle tounderstand their entitlements Some are universal some are discretionary some apply onlyto parents others to anyone
The total cost13 of providing these benefits continues to rise and when the economy isstagnating there is inevitably both political pressure often supported by popular publicopinion to introduce welfare reform so that13 people who do not13 work cannot13 be better offthan they would be if they were in full-shy‐time employment This strategy requires a universalbenefit13 to be introduced so that13 it13 is easier for claimants to access support13 but13 also easierfor agencies to identify the total benefits received The idea13 of a benefits cap then becomes
27
more practical to introduce especially if all the processes involved in making a claim arehandled electronically Indeed this encourages government13 to insist13 on applications forbenefits to be made on-shy‐line Unfortunately this will marginalise those people who haveneither a computer nor access to the internet thus emphasising the digital divide in amanner which works against13 some of the most13 disadvantaged people in society
There are currently few tangible links between digital technology and welfare provisionThe most13 obvious are universal benefits such as a free television licence (worth pound14550)13 for13 everyone aged 75 or older with blind and visually impaired people entitled to a 50discount13 irrespective of their age The significance of this position is that13 6 of revenuesgenerated through licence fees are to fund BBC on-shy‐line services13 such13 as websites and i-shy‐player In Scotland the BBCrsquos Alba Gaelic language television service is predominantlyfunded13 by MG Alba an organisation funded by the Scottish Government It is thereforeconceivable that13 in the future licence fees may be used to directly subsidise access toinformation and advice through the Internet13 for vulnerable people whether it13 is throughbroadband access or through a set-shy‐top box which removes the need for a computer in thehome to access particular websites or to use e-shy‐mail services
A second age-shy‐related benefit13 available in the UK is the winter fuel subsidy People whoreceive certain benefits receive the payments automatically while others must13 make aclaim Those who are not13 eligible for benefit13 due to a lack of an address for example missout13 on these payments and also on Cold Weather payments of pound25 for each seven dayperiod of very cold weather between 1 November and 31 March
The development13 of new warm home initiatives plus the complex of subsidies that13 theelectricity supply industry and government13 offer to people with solar cells further changesthe economic arguments Global warming may lead to greater variations in weatherextremes but13 might13 also increase the amount13 of electricity that13 can be generated byalternative (green) sources such as wind and solar cells It is estimated that13 energyconsumption in the UK increased by 17 between Christmas and Easter 2013 compared toprevious years as a result13 of cold weather but13 the above subsidy scheme did not13 benefit13 older people because two of the seven day cold periods were after 31st March It must13 beassumed that13 there will be more people living in fuel poverty in the future and this will leadto more cases of cold related illness including influenza13 and stroke
32 Management of long term conditions
The management13 of long term conditions will be improved for patients who are compliant13 with their medication regime so it13 is possible that13 there may be compulsion to adhere tothe prescription Such compulsion may be monitored using technology Indeed the remotemonitoring of vital signs using telehealthcare will become commonplace as the old boxesand sensors are replaced by devices that13 can be worn continuously or which can beembedded into the fabric of homes (including furniture and bedding) or can be worn asvests or patches They will wirelessly transmit13 data13 to smartphones or tablets and mobile
28
transmission and cloud technology will enable real-shy‐time data13 collection analysis andfeedback
One of the diseases which is projected to increase most13 significantly over the comingdecade is Type 2 diabetes Whilst13 there is a hereditary susceptibility to this condition formany people including those from the Middle East13 and the Asian sub-shy‐continent it13 is also adisease which tends to affect13 those people who are overweight13 andor have a sedentarylifestyle If untreated diabetes can lead to dizziness and collapse at any time but13 can alsohave more devastating long term consequences which include kidney failure strokeblindness and in extreme cases lower limb amputations Management13 therefore includesdaily monitoring of blood glucose levels and major dietary changes such as a significant13 reduction in the consumption of carbohydrates as well as a rigid exercise regime
Many newly diagnosed diabetics follow this advice closely and can lead normal lives for 40years or more but13 some struggle to accept13 the change in lifestyle required as well asremembering which foods are allowed and how much exercise they need to takeIndividual support13 plans are now forthcoming and over the next13 ten years best13 practicewill emerge in the form of smartphone apps that13 are personalised and which can becomean individualrsquos health coach This level of support13 will be fine for some people but13 otherswill need incentives so it13 is likely that13 gaming technologies will be introduced perhapsoffering rewards for good compliance There will be a temptation for some people tocheat perhaps allowing others to perform exercise for them or changing theirconsumption details
Many of these opportunities for cheating will be removed through the use of a uniquebiometric identifier a technology that13 will be mature enough to use in place of passwordson smartphones However the biggest13 challenge may be in encouraging older people to usethe technology Many older people have multiple morbidities Indeed a survey of Scottishpatients implied that13 42 of people aged over 80 will suffer from three long termconditions It will be essential for those people to comply with treatment13 regimes if they arenot13 to have the functional deficits that13 follow
33 Finding people who13 donrsquot fit
People who have low social capital are likely to have few relatives and friends with whomthey regularly communicate and are also unlikely to be part13 of community or faithorganisations such as clubs societies and church groups They also die several yearsyounger than most13 of the population often because they donrsquot13 engage with public healthinitiatives such as vaccinations against13 flu regular checks on their blood pressure bloodsugar levels or in the case of women smear tests or mammography The most13 likelyreason for disappearing beneath the radar of such initiatives is their mobility which leadsalmost13 inevitably to them having no fixed abode and no fixed telephone line It thenbecomes very difficult13 for them to be contacted because their mobile telephones are likelyto have Pay-shy‐As-shy‐You-shy‐Go contracts that13 donrsquot13 require validated names addresses and bankaccounts
29
It follows that13 some of the most13 vulnerable people in society including those who live onthe streets are effectively unknown to both the NHS and to social work departments untilthey are referred in a crisis This could be an emergency presentation to a hospital Accident13 and Emergency Department13 where they will come into contact13 with a social worker becausedischarge may be unsafe This often highlights the importance of the prevention agenda13 and the potential for avoiding admissions to hospital by intervening at an earlier stage
The advantages of being able to locate people who are vulnerable to specific diseases willincrease as genetic testing becomes more routine It is already possible to determine whomight13 be most13 at risk of breast13 cancer and prostate cancer as a result13 of family history Addto this the evidence that13 particular diet13 and exposure to environmental factors can furtherincrease risk then it13 is evident13 that13 individuals can be identified and offered treatmentsthat13 could save their lives many years before they become ill In the case of cancersperhaps only the individual is involved but13 for infectious diseases it13 is the whole of societythat13 is at risk if someone contracts one of the new strains of influenza or if someonechooses not13 to be vaccinated against13 rubella In Chinese airports all visitors are screenedfor fever and refused entry if they tested positive in cities the public are monitored in thesame way Similar approaches may be necessary in the UK if potential carriers cannot13 otherwise be identified
34 Volunteering
It is estimated that13 72 per cent13 of people volunteered to perform a charitable act13 at least13 once during 2012 a rise from 65 per cent13 the previous year About13 four out13 of every 10volunteers offer their services formally to one or more organisations The remaindervolunteer informally by helping out13 a friend or a neighbour Around 50 per cent13 volunteered at least13 once a month in the past13 year up from 41 per cent13 on the previous13 year Most13 have retired many of them before the statutory retirement13 age Those whodonrsquot13 feel able to offer time have offered their financial support13 at a time when the fundingavailable from sources such as the National Lottery has been decreasing Despite economicausterity donations to charities have been increasing 74 per cent13 said they had given tocharity at least13 once in the previous month up from 72 per cent13 the previous year
Strikingly 78 per cent13 of people strongly believe that13 they are part13 of their localneighbourhood an increase from 70 per cent13 10 years previously Community cohesion isstronger than ever 87 per cent13 of people believe their local area13 is a place where peoplefrom different13 backgrounds get13 on well together compared to 80 per cent13 in 2003
The role of volunteers in supporting vulnerable people is therefore likely to increase overthe next13 decade perhaps exploiting the success of the army of volunteers that13 was highlysuccessful in London during the Olympic and Paralympic games The greatest13 role for suchvolunteers may be in providing informal care for older people Already the UK has someseven million informal carers whose value in monetary terms has been calculated to be
30
more than the combined budgets of the NHS and social care Maintaining or extending thisprovision will help to support13 services in the future and may be supported by technology
Whilst13 there is ample evidence to suggest13 that13 telecare services support13 informal carers asmuch as (if not13 more than) the people that13 they are caring for it13 is the potential for utilisingthe internet13 and apps to make their role easier to coordinate and hence more effectivethat13 is likely to be most13 successful moving forward
Many of these focus on particular tasks that13 informal carers can help offer to older peoplesuch as organising their medication A pillbox program is just13 one feature of an app calledBalance It also includes sections for caregiving tips notes for the doctor and the patientsappointments plus a lsquolearning sectionrsquo with articles on aspects of Alzheimers and an RSSfeed for news about13 the disease Tyze is another multi-shy‐functional app it13 allows carers to
bull Organise appointmentsbull Plan outingsbull Share storiesbull Send updates to other family members
Another application is Rally Round which helps carers to organise someone to perform littlejobs often on a temporary basis when someone has dementia physical frailty or isrecovering from accident13 or illness Similar applications are MeMaxi and Finerday
35 The High13 Street
The shape and appearance of UK shopping centres have been changing for half a centuryPeople complain that13 centres are losing their identity with one town looking like everyother both in terms of the stores and in terms of the layout But13 there are three trendswhich are having a profound impact13 on many of the most13 vulnerable people in society
bull Centres lock their doors at 6pm or in some cases 10pm -shy‐ thus denying people whosuffer from claustrophobia13 from window shopping at times when other shoppershave left
bull Out13 of town shopping malls -shy‐ these US style centres are ideal for people in carsbecause they offer free parking which is essential for people who want13 to buy largeritems but13 difficult13 for people who have no transport13 and who must13 rely on publictransport13 that13 is often deficient
bull The rise of online shopping -shy‐ which means that13 many potential shoppers only visit13 High Street13 stores to check the prices before returning home to make a purchaseonline
It is the third of these effects that13 has the greatest13 potential for changing the High Street13 forever and it13 is making life for traditional retailers increasingly difficult13 at a time when highrents are crippling stores large and small It is difficult13 to see how this trend is likely tochange because consolidation in banking and estate agencies is already forcing the closure
31
of other High Street13 players while additional pressures on pubs has led to the closure ofthousands of pubs every year
Those figures however demonstrate that13 consumers still value what13 the high street13 canoffer -shy‐ the chance to inspect13 what13 theyrsquore thinking of buying -shy‐ as well as the new opennessof the internet Customer service makes a difference to people especially if there is aproblem and goods need to be returned One of the most13 common reasons for furniture tobe returned for example is that13 when a sofa13 or a wardrobe was delivered it13 couldnrsquot13 fit13 through the front13 door or up the stairs In the future people will be able to benefit from13 visualisation technology they will upload the floor plans of their homes enabling theretailer to inform them of the problem before they try to delivery Augmented reality viewwill similarly allow customers to see what13 a new item of furniture will look like in itsintended place so that13 they can be more informed about13 the effect13 of size and colour
In terms of improving the viability of the High Street stores will have to focus on theimportance of brand which could mean that13 individual independent13 retailers will have topartner with national suppliers to support13 a local tailored offering based on products that13 are designed for a more global market This is a lsquoconnected High Streetrsquo approach whichcould be enabled by the developments in internet13 availability and smart13 phone accessdescribed in the previous section
The overall effect13 of all these changes could mean that13 town centres become smaller but13 more vibrant13 areas They could thrive if people are attracted there in large numbers whichmeans that13 retail must13 be developed alongside restaurants pubs galleries and other leisureopportunities This is possible in new shopping centres which are already being integratedwith transport13 hubs including railway and bus stations but13 may be more of a design13 challenge for older towns and cities with large Victorian buildings To ensure that13 morepeople are welcomed into the new centres they should include attention to green spacesand areas where people can relax without13 feeling that13 they are second class citizensbecause they donrsquot13 have the same buying power
3513 Privacy
To some people privacy is their right13 to live their lives without13 interference they may seethe State as a potential lsquoBig Brotherrsquo spying on their every move and judging their actions13 and activities Other people have fewer concerns about13 the role of the State but13 great13 fearof individuals interfering with and invading their privacy Some embrace the concept13 of lsquomyspacersquo an area13 of a square metre or so into which nobody can enter without13 permissionThis allows them to avoid physical contact13 and to feel safe from any form of threateningbehaviour
Yet13 this idea13 of private space and its potential violation is merely the tip of the iceberg asfar as privacy is concerned more significant13 is the idea13 of personal (and private)information being shared with anyone and everyone This could be related to identityopinion or image for an individual who wants to remain anonymous or even secretive thisis going to become an increasing problem as technology provides the means of taking
32
photographs recording conversations and capturing environment13 with something as smalland ubiquitous as a mobile phone The fact13 that13 this information can then be shared withthe rest13 of the world using e-shy‐mail Twitter and Facebook makes the problem all the moredifficult So the threat13 is no longer solely from the long lenses of the Paparazzi but13 fromanyone (and that13 means everyone) who has even the most13 basic of mobile phones
This relates to the changing views of society on what13 information should remain privateand what13 should be shared with others The success of social media13 has been based on anattitude of lsquosharing everythingrsquo with either your friends or the world This has introduced anaiumlve idea13 in the minds of some younger people (especially those known as Millennials ieaged 18-shy‐30) that13 everyone can be their friends whilst13 perhaps failing to reinforce the bondsof genuine friendship with any form of test13 or restriction Technology could play a role indefining these friendships and allowing individuals to understand what13 makes a goodfriend but13 this approach has yet13 to be developed and may be slow to overcome the needfor some people to measure their own popularity simply as the number of people that13 theycan list13 as friends on their Facebook page
It follows that13 there may be a need for a new definition of privacy that13 is in keeping withthe web and its ability to display images and opinion in an unregulated manner This needsto embrace past13 concerns about13 the ability of an individual to live without13 the threat13 ofothers being able to watch them whilst13 offering some protection from random postingsabout13 them online Perhaps this could include a right13 to be able to edit13 or remove anythingrelating to themselves on the Web including images that13 are not13 news-shy‐worthy Theownership of image rights may be an associated issue that13 needs to be addressedespecially as modern technology can remove an individual from a group (or a background)13 view provide digital touch-shy‐up or air-shy‐brushing and then republish it13 in a different13 contextHowever there is general agreement13 that13 personal information (such as contact13 details andbank codes) should not13 have a place on the web Surprisingly few people take proactivemeasures to prevent13 tracking functions being activated
It follows that13 too much privacy could lead to younger people fearing that13 they maybecome lost13 in a digital world It is not13 surprising then that13 they are prepared to make lots13 of personal information available often with no fear of how it13 might13 be used by othersWhen Google glasses and similar technologies become available during the next13 few yearsthey will have the potential to identify a stranger walking down the street and to find manyof their secrets to present13 to the wearer in a fraction of a second They could know moreabout13 them than their genuine friends know -shy‐ so who will be their friends in the future
36 Data sharing and13 protection
By lsquodata13 sharingrsquo we mean the disclosure of data13 held by one organisation on an individualto a third party organisation(s) or the sharing of data13 between different13 parts of anorganisation Some data13 sharing doesnrsquot13 involve personal data13 because it13 has beenanonymised in such a way that13 the statistics can be used for the collective good without13 theidentification of the individual The Data13 Protection Act13 (DPA) is in place to provide a legal
33
framework that13 ensures that13 organisations that13 hold personal data13 must13 act13 responsibly atall times These principles adequately describe the position of public and government13 bodies especially social services departments who are responsible for the informationconcerning the health and well-shy‐being of individuals -shy‐ and hence by implication thesensitive data13 relating to their vulnerability
The legal framework that13 applies to private and third sector organisations differs from that13 which applies to public sector organisations which may only act13 within the defined limits oftheir statutory powers However all bodies must13 comply fully with the data13 protectionprinciples and this situation is unlikely to change within the next13 10 to 15 years In someprivate sector contexts there are legal constraints on the disclosure of personal dataHowever most13 private and third sector organisations have a general ability to shareinformation provided this does not13 breach the DPA or any other law It is advisable for acompany to check its constitutional documents such as its memorandum and articles13 ofassociation to make sure there are no restrictions that13 would prevent13 it13 from sharingpersonal data13 in a particular context The type of data13 held is therefore a subject13 ofconcern as it13 may be difficult13 for legislation to keep up with the additional layers of data13 created on-shy‐line and through the Internet13 of Things
Private and third sector organisations should have regard to any industry-shy‐specific regulationor guidance about13 handling individualsrsquo information as this may affect13 the organisationrsquosability to share information They should also be aware of the legal issues that13 can arisewhen sharing personal data13 with public sector bodies This becomes more of an issue asprivate and third sector bodies are carrying out13 a wider range of traditionally public sectorfunctions Opportunities for inappropriate sharing of sensitive data13 will therefore inevitablyincrease
Public authorities must13 comply with the Human Rights Act13 (HRA) legislation in theperformance of their functions The HRA also applies to organisations in the private sectorinsofar as they carry out13 functions of a public nature which could include delivering a socialcare activity Where the HRA applies organisations must13 not13 act13 in a way that13 would beincompatible with rights under the European Convention on Human Rights Article 8 of theConvention giving everyone the right13 to respect13 for their private and family life their homeand their correspondence is especially relevant13 to sharing personal data If personal data13 isdisclosed or shared in ways that13 comply with the DPA the sharing or disclosure of that13 information is also likely to comply with the HRA The problem may still be in policing theActs and the rights of an individual if they believe that13 their personal data13 has been sharedor accessed by an inappropriate organisation or individual
A legal industry may be born to deal with such matters but13 this is unlikely to benefit13 peoplewho cannot13 afford the fees involved They would require either legal aid or to employ13 more13 lsquono win no feersquo companies Public attitudes to such costs might13 become negative unlessthey prove successful in preventing breaches of data13 security There may need to belegislation to provide a stronger basis for forcing compliance with privacy laws
34
37 Connecting with13 people
We are social creatures most13 of us rely on our friendships and interactions with friendsand families to share our happiest13 moments and experiences Research suggests that13 thishappiness is infectious at all levels and leads to a 15 increase in the happiness of a closecontact 10 for a second degree contact13 such as the friendrsquos spouse and a 6 increase fora friend of a friend It is hardly surprising that13 the success of social media13 such as Facebookis intimately related to the ability of people to quickly share their happiest13 moments with asmany of their friends and connections as possible
All this has happened during the rise of the Internet13 and the corresponding increase inopportunities for connecting online ie this is a 21st Century phenomenon which has beenfacilitated by Information and Communications Technology But13 the Internet13 remains in itsinfancy and we are only beginning to understand and exploit13 its potential In terms ofaccessing the Internet there are now perhaps two billion people who have access with99 of them having gained this during the past13 decade This number will have doubled bythe period 2020 to 2025 It is likely that13 everyone who wants to be connected in the UK willby then be connected Turning this on its head only those who donrsquot13 want13 to be online willnot13 be on the Internet13 within a decade Connecting with the unconnected will therefore bea case of identifying those people who donrsquot13 want13 to be found unfortunately these mayinclude many people who need the support13 of social care organisations It means that13 theywill be looking for support13 only when they are in crisis unless other ways of finding andormonitoring them are found
While the number of people connected via the Internet13 has exploded this might13 bedwarfed by the number of connected lsquothingsrsquo During 2009 the number of thingsconnected to the Internet13 surpassed the number of connected people at which point13 webegan to experience what13 this report13 has described as the lsquoInternet13 of Thingsrsquo Yet 99 ofall physical objects that13 could join this network are not13 yet13 connected but13 the number couldgrow by 25 every year for the next13 decade so that13 there could be 100 billion connectedobjects by 2025 some of which will be owned or used by everyone in the UK includingthose people who donrsquot13 want13 to be connected themselves We will then have an Internet13 of Everything which will be the smart13 connection of people data events and actions
With each new person object or data13 that13 comes online the connection possibilitiesbetween all these elements grows exponentially The rise of big data mobile networkingcloud storage and data13 mining technologies will all play a critical role in the Internet13 ofEverything The result13 will be new capabilities richer experiences and unprecedentedvalue for individuals businesses communities and countries everywhere The lsquonetworkeffectrsquo of the Internet13 of Everything will be a very powerful thing the true impact13 of whichwe wonrsquot13 fully understand for several years As it13 develops however those who are not13 connected will feel even more digitally and socially excluded There will be a need to reachout13 to vulnerable people unless the process of claiming requires proof of online identityand the payments to be received can only be redeemed using a chipped card or adownloaded app onto a smartphone This is of course the way that13 welfare arrangementsare already developing thus it13 might13 prove impossible to make a successful claim without13
35
already being connected to lsquothe systemrsquo either through an online presence or through theInternet13 of Things
38 Downloading everything
Sixty years ago information was discovered by reading books often in a library wherenotes had to be made because the books or journals couldnrsquot13 be removed Then in theearly 1960s the first13 office photocopying machines were introduced into the UK theyimmediately meant13 that13 pages or articles from books could be copied and taken away to beread and summarised later Within a few years photocopying became a replacement13 forreading as researchers became less adept13 at selecting a few sentences and every deskbecame a depository for reams of printed paper Paper became the means of recordingeverything from bank statements through to music
We now appreciate that13 printing everything is a waste of both the ink (or toner) used tocreate the black print13 and of paper which requires trees to be chopped down and pulpedbefore it13 can be pressed into thin sheets Saving paper is therefore seen as green and goodfor the planet Fortunately we no longer need to print13 everything because computermemory is unlimited thanks to the cloud and we can then view pages and articles onportable or fixed screens
The internet13 has everything and it13 is all available instantly for downloading providing thereis a device available to accept13 it and there is sufficient13 communication bandwidth toperform the transfer of data13 sufficiently quickly Thus we can record all text13 articles that13 are relevant13 to us including digital records of birth certificates qualifications and passportsand the need for original printed versions will decline But13 we can also do this forphotographs Most13 handheld computing devices include at least13 one camera so they cangenerate enormous number of pictures which can be kept13 for posterity without13 having toconsume inks and special papers to print13 them
But13 the materials that13 can be downloaded donrsquot13 stop at pictures software is available that13 can grab TV shows after they air and movies as soon as theyre released In the same wayit13 is possible to schedule music comic books video games and practically anything else asa download with minimal effort People will need enormous hard drives if they want13 theirown digital copies of these files so will more than likely make use of cloud storage that13 willbe available from many organisations The location of the servers may become sensitivedue to border restrictions as will the security of the data13 and the way that13 it13 is backed up sothat13 it13 is resilient13 to failures
It may be evident13 that13 application forms for all types of welfare payment13 will be availableonly for downloading so that once digitised they can be processed by computer andrecords sent13 to various servers for subsequent13 storage and processing Some people maywant13 to keep their data13 on them once it13 has been downloaded Pen drives can already holdseveral GB of data so it13 is likely that13 people will be able to carry their downloaded data13 withthem at all times irrespective of the size and complexities of the information
36
39 Health13 and13 well-shy‐being
The general health of the population is unlikely to deteriorate noticeably within 10 to 20years Indeed expectations of the population are that13 things must13 improve as surgicaltechniques mature and as pharmaceutical interventions become more personalised andpowerful However the rising demand for health services due to an ageing population andthe increasing cost13 of providing sophisticated therapies will make delivering a free anduniversal health service difficult13 without13 substantial increases in taxation This is unlikely tohappen in the UK even though spending on health services will be protected against13 thecuts facing other services
There will have to be changes in how the NHS works For twenty years hospitals have beenclosed and replaced by fewer new facilities so that13 the bed count13 is reduced This has led toa significant13 shift13 in resources to primary care and community care supporting shorter staysin hospital and speedier transfer back home for people after surgery or illness This hasbeen13 successful but13 there remain problems with demand for GP services especially out-shy‐of-shy‐hours and at weekends Indeed despite the introduction of NHS24 and similar help-shy‐linesthe demand for GP appointments continues to increase Delays are inevitable and this willincrease system failures with more unnecessary deaths and a failure for people to access adiagnosis that13 might13 lead to early interventions and ultimately lower delivery costs Over250 more patients are added to waiting lists every day
This will lead to a new model of primary care consistent13 with existing changes which haveseen surgeries move from High Street13 locations to medical centres close to bus routes andwith more parking for patients The process of making an appointment13 is changing from atelephone-shy‐based interview process dominated by a medically-shy‐unqualified receptionist13 to achoose and book approach using an online process linked to electronic patient13 records Thiswill give patients more convenience but13 will allow priority for those who have Internet13 access at the expensive of those who are digitally excluded Making the process of bookingan appointment13 quick and easy may also increase demand from people who do not13 need tobe seen as it13 will fail to identify those in greatest13 need
A greater use of telehealth and telecare technologies will be inevitable beginning with thefirst13 contact13 as an encounter using the telephone e-shy‐mail or video conferencing -shy‐ a visit13 tothe GP surgery should be a last13 resort and should involve a nurse consultation in the first13 instance This would be consistent13 with three quarters of appointments currently involvinga chronic disease or long term condition which relates to improved self-shy‐care The support13 ofthese patients at home should be prioritised through tele-shy‐ and web-shy‐based technologies andshould involve training and coaching through a network of nurse practitioners Home visitsshould generally be unnecessary through the use of these technologies but13 could besupplemented by satellite surgeries manned by nursing in community premises or inpharmacies nurseries and Internet13 cafes
The homes13 of people who13 need13 closer monitoring can then become part13 of virtual wardswith real or electronic visits by health professionals University Hospital Southampton NHSFoundation Trust13 already looks after patients who have undergone surgery such as a hip orknee13 replacements in virtual wards with high levels of satisfaction The Royal Free London
37
NHS Foundation Trust13 offers a similar service but13 plans to add the possibility of videoconsultations between patient13 and consultant
310 Attitudes to public health issues ndash obesity smoking alcohol abuse drugs
As self-shy‐care becomes the focus of the NHS the public will increasingly understand that13 thecosts and availability of services are being harmed by the poor health behaviour ofrelatively small numbers of people The link between public health initiatives today andhealthcare needs and costs in the future will become increasingly evident13 as a result13 of theway that13 information is presented Thus the overweight13 smoker who currently attractsconcern and pity when they are diagnosed with diabetes and COPD is increasingly beingseen as the victim of their own stupidity or lack of self-shy‐discipline If they continue to neglect13 medical advice and continue with an unhealthy lifestyle then the way that13 they receivetreatment13 and consume resources will become a matter for the entire population
Obesity is seen as due to a combination of poor diet13 and a sedentary lifestyle No longer isthe idea13 that13 people are lsquobig bonedrsquo acceptable Governments will respond initially byrequiring manufacturers and food processors to provide nutritional information onpackaging and on menus in restaurants But13 people can choose not13 to read the data13 and toneglect13 both the importance of food quality content13 and quantity This will increasepressure to introduce fat13 or sugar taxes and these are likely to be in force within a decade
Although the high taxes on tobacco products has forced some smokers to reduce theirconsumption or to give up altogether the impact13 has been reduced by the smuggling ofproducts from overseas and by the availability of duty-shy‐free cigarettes for people returningfrom foreign holidays and business meetings Further measures are planned to changepackaging and to include even more graphic images and warnings on cigarette packages tomake smokers aware of the effects of smoking on their health and well-shy‐being There is asyet little evidence of how successful this might13 be More effective has been the banning ofsmoking in public places including trains and aircraft Expensive medical interventions suchas heart13 transplants will be denied to individuals until they change their lifestyle behaviourSmokers might13 therefore be increasingly ostracised leading to a loss of esteem This mayhave a particular impact13 on people who already suffer from mental health problems whoare more likely to smoke
The overuse of alcohol is being recognised as a major factor in hospital admissions withNHS figures showing an increase of over 40 in such admissions over the past13 decadeLinked to this has been a 75 increase in prescriptions to treat13 alcohol dependency Fewpeople have sympathy for those who waste their limited income on booze If they havechildren or other dependents they will be the ones who suffer and who may need thesupport13 of social care
Drug users are already significant13 users of social services as their habit13 is likely to makethem unemployable They receive little sympathy from the general public because they areseen as criminals and people who waste public resources Levels of drug abuse have been
38
slowly increasing over the years but13 this trend is slowly being reversed Indeed the numberof people using drugs during the past13 year has fallen to its lowest13 level for nearly 20 years(below 9) with cannabis being most13 likely often following excessive drinking Aselectronic noses and other technologies can detect13 traces of drugs it13 seems likely that13 success in overcoming addiction can be measured objectively This may become a two-shy‐edged sword rewarding those who can turn around their lives but13 further marginalisingthose who canrsquot13 or wont13 accept13 the lsquocold turkeyrsquo
311 Attitudes to surveillance
Issues associated with privacy confidentiality and data13 security have been discussedpreviously in the context13 of information technology the World Wide Web and the ease ofcollecting recording recalling analysing and displaying data The monitoring of individualsand their methods of using this information can be regarded as surveillance As thequantities of data13 increase along with the number of devices that13 can be used to access itthe surveillance tools will also increase in their sophistication Indeed the Big Data13 approaches described in the previous section will enable the combination of structureddata13 (such as the information held in databases) to be married with unstructured data13 fromimages in such a way that13 it13 can be mined
Whilst13 the lsquodigital surveillancersquo methods described above may cause most13 concern topeople because of its impact13 on anonymity it13 is the collection and analysis of images that13 are the major concern to people as they contemplate the ways that13 lsquoBig Brotherrsquo maydevelop to restrict13 freedom Every major UK city and town centre has an array of CCTVcameras that13 continually record activities from every angle If it13 used to be true that13 nobody in London was more than 10 yards from a rat it13 is certainly the case today that13 nobody can be more than this distance from being in view of a surveillance camera Yetthey receive so much positive publicity from TV programmes where their footage is used todetect13 vehicles close to a crime scene or to monitor the movements of suspects that13 theyare now accepted by the public as a deterrent13 in the same way as lsquobobbies on the beatrsquowere seen 25 years ago There is therefore little public reaction to the expansion in the useof video surveillance except13 for the practical observation of how so many views can beinspected and recorded
Looking to the future the tumbling cost13 of video technology will surely lead to anotherincrease in the number of devices The aerial views taken from towers will besupplemented by more local views taken by devices that13 are embedded in the fabric ofbuildings or carried by individuals either on their person (for example on clothing orspectacles) or in the bags that13 they carry The time and date-shy‐stamped images as Big Datawill be recorded to lsquothe Cloudrsquo where it13 can be added to other data It can then be usedwhen an incident13 has occurred or to provide further detail of night-shy‐time activities
It follows that13 there will be no hiding place for people who simply want13 to disappear Theymay respond by wearing clothing (such as hoodies) that13 hide their faces or which make it13 difficult13 to distinguish gait13 or mannerisms from which they might13 be identified New forms
39
of clothing may be designed to make shapes more difficult13 to analyse and these might13 become the uniforms of a class of person who wants to live in a way that13 they donrsquot13 interact13 with officials from any ministry or local government13 department If they also obstruct13 services then they will be considered to be anarchists of some form sparking protests fromother sectors of society
31213 Attitudes to driving
Motor cars have been a feature of UK roads for over a century but13 it13 is only during the past13 50 years that13 they have become a resource that13 most13 families have had access to enablingthem to travel without13 the restrictions imposed by a limited railway network and non-shy‐integrated bus transport People who have had a car throughout13 their lives often see theircars as an important13 factor in enabling them to remain independent13 and to exercise choicesrelating to where they shop and where they spend their leisure time This extends to theirspouse and to friends and neighbours that13 they might13 take with them on their variousexpeditions
Unfortunately there are incidents involving older drivers who perhaps go down amotorway in the wrong direction who are taken ill at the wheel or who are involved in anaccident13 involving no other vehicles These are small in number but13 often lead to a reactionthat13 they shouldnrsquot13 be allowed to drive lsquoat13 their agersquo Age itself is not13 an indicator ofdriving quality but13 because old age also brings more chance of having limited long termconditions and other illnesses it13 is easy to make a link between driving ability and age Thelicensing system does require continued driving to be linked with medical advice andforbids people with poor eyesight epilepsy and other conditions to hold a licence in oldage
Yet13 statistically older drivers cause far fewer accidents than younger drivers The reasonsfor this may be complex and are likely to include the fact13 that13 they drive less often covershorter distances and donrsquot13 go out13 in the dark or in poor weather However it13 does not13 wholly explain why the UKrsquos drivers aged over 70 and who represent13 some 8 of all driversare involved in only 4 of accidents that13 cause injury This compares favourably with the15 of13 drivers aged between 17 and 29 who are involved in over a third of crashes that13 result13 in injury
By 2020 the number of drivers aged over 70 on UK roads is likely to increase to over 7million This will require a new national strategy perhaps involving support13 for olderdrivers further training raising awareness of issues and making more use of adaptivetechnologies to support13 the driver in avoiding collision or forgetting to check on the statusof their vehicle Poor eyesight13 could be enhanced by camera technologies rather thanforcing people off the road if they are unable to read a licence plate
The International Longevity Centre has found that13 one in four Britons thought13 driversshould be made to switch off the ignition for good somewhere between the ages of 70 and75 The numbers may decrease as the population ages and as cars become safer Forcing
40
older people off the road may be a natural consequence of providing free bus passes andsubsidised rail fares but13 the growth in the pavement13 scooter industry demonstrates that13 older people value their independence and will do almost13 anything to get13 out13 and aboutPerhaps legislation will result13 in more regulation of electric vehicles and where they cantravel
There can be no doubt13 that13 getting out13 will be associated with better quality of life andwell-shy‐being and this is likely to be supported in the future as evidence of improvedoutcomes emerges It is to be hoped that13 positive stories will be publicised so that13 publicattitudes arenrsquot13 hardened This may be supported by more in-shy‐car monitoring of drivers andthe linking of performance with on-shy‐line driving records and licences These could throughremotely monitored ignition systems prevent13 the use of motor vehicles by people without13 a licence or without13 insurance
313 Climate change
There is a general view that13 the emissions of carbon gases are contributing to globalwarming in a manner that13 will change the UK climate in such a way that13 the climate maybecome more Mediterranean However some scientists believe that13 manrsquos impact13 on theenvironment13 may be small compared with natural variations caused for example bycyclical changes in the sunrsquos energy output13 or by the effects of volcanoes and earthquakesRecent13 evidence has suggested that13 we are going through a phase of changing extremesand that13 this is more likely to cause storms periods of excessive rainfall and unusualseasonal trends with snow and frost13 in the spring and warmer winters Considerableuncertainty remains and it13 might13 be necessary to plan for a number of different13 scenariosand for the impact13 on vulnerable people
I Colder winters UK properties are poorly insulated resulting in excess mortalitiesduring cold spells due to an increased number of people suffering from stroke aswell as bronchitis and other pulmonary diseases The cost13 of heating continues toincrease putting more households into a state of fuel poverty Any further coolingduring the winter months will result13 in more people living in unhealthy coldconditions Winter fuel payments are likely to be restricted to the poorest13 peoplebut13 this might13 exclude people who live in larger properties that13 are more difficult13 toheat
II More storms excessive winds and rain can cause flooding at any time of the yearMany UK communities are built13 close to rivers and these can surge during heavyrainfall causing houses to be filled with water and furniture and carpets lostInsurance can be problematic for properties built13 on flood plains which can blight13 properties and prevent13 owners from being able to sell and move on High winds canrip off roofs causing injury and also causing families to be left13 homeless anddependent13 on social services
III Hot13 summers Europe suffered high temperatures during the summers of 2003 and2004 leading to heat13 stroke and hypothermia The UK has not13 previously sufferedfrom such problems but13 might13 be expected to experience days of extreme
41
temperature and humidity at times Older people may not13 be prepared for suchweather Street13 dwellers may be unable to find shade and supplies of drinkingwater
Irrespective of what13 combination of weather scenarios arise it13 must13 be concluded that13 any extremes will have a major negative impact13 on vulnerable people especially if theyare not13 prepared because they havenrsquot13 received the weather warnings and advice that13 can be broadcast13 using the TV radio and online services Once again the digitallyexcluded will suffer and will pay a high cost Society will continue to pick up the bill interms of demands on social care services unless preventive actions are taken in theform of connecting these people to each other and to formal services
42
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
s13 13
13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
n13 13
13 s13
r13 n13
e13 at13
e13 y13 e13 ld13
ly13
13 e13 t13 e13
s13 er13 e13
f13
rt13 13
13 13
13
r13 13
s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
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13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
e13 g13 13
e13
13 13 ial13
13
d13
13 d13 h13 r13
d13 13
s13 y13
e13
13
rd13 r13 e13
13
13
13
e13
e13
d13 13
13
13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
Within the home the stair lift13 has enabled people who live in conventional properties that13 are on two or more floors to continue to use facilities on different13 floors when climbing thestairs has become too difficult This is often the case for people who have arthritis a lowerlimb amputation a long term condition such as Chronic Obstructive Pulmonary Disease orpeople approaching the end of life and who have chosen to die in their own homes
Designs have improved so that13 a curved staircase is no longer an issue and the reliabilityhas reached a level where breakdown is a rare occurrence13 Through-shy‐floor lifts have been analternative proposition but13 they remain too large for most13 properties Alternativeapproaches may emerge using air pressure or water pressure as the driving force ABrazilian design already utilises a plastic tube in which a pod is moved effortlessly up anddown
Electronic wheelchairs are now available that13 allow the individual to become moreindependent13 as they allow the user to control both propulsion and steering Some modelshave the capability of mounting a pavement13 or a step or even a flight13 of stairs Personalmuscle amplification devices have been developed originally with the intention of helpingpeople who are confined to a wheelchair due to a neurological disorder to perform sometasks from a standing position Indeed the Rex walkerrsquos manufacturers claim that13 anyonewho can propel themselves in a wheelchair could walk by using Rex
Other approaches have focused on the rehabilitation of people after major accidents that13 have caused partial paralysis They quickly extend into exoskeleton designs that13 enableanyone to gain a mechanical advantage and thus to tackle physical tasks that13 would not13 otherwise be possible These suits are the focus of major research projects across theworld Some13 products such as the system developed by Honda are being tested inAssisted Living facilities and are likely to become more and more enabling over the next13 decade
Similar benefits are also occurring outside the home with a number of novel carryingsystems appearing over the past13 few years They are generally termed lsquoscootersrsquo but13 thiscovers a wide range of systems and devices ranging from the Segway a device that13 is amobile platform on which the user stands and navigates through to conventional electricvehicles that13 have been developed from golf buggies There remain a number of issuesconcerning their use on roads or on pavements but13 similar problems will need to beresolved for bicycles to play their full part13 in enabling people to get13 more exercise13 Thepotential for hybrid scooters remains
218 Smart domestic appliances and personal hygiene
The bathroom is a dangerous place and one where many older and disabled people slip andsuffer a fall Many older people recall taking a bath in a tin tub in front13 of an open fireToday the options tend to be a level access shower (ie a type of wet13 room) for anyoneunable to get13 into a bath There are various aids to help people get13 into and out13 of thebath most13 involving a seat13 that13 can be raised or lower with some bath-shy‐tubs having a door
21
There has been some research into alternative methods of keeping the body clean Sanyointroduced a machine in 1970 modelled on a clothes or dish washing machines the personsits on a seat13 inside the machine where13 they are cleaned by a set13 of water jets These havenot13 proved popular and furthermore require the individual to be transported to themachine Thus the technology may find application in nursing homes but13 are unlikely to beattractive to people living independently in the community
The washing needs of people change over time Over the past13 20 years body piercingshave appeared which have demanded additional attention to avoid the problemsassociated with poor hygiene and metals Similarly hair may be permed and dyed usingchemicals which are much stronger and which might13 damage the hair Add to this thepainting of finger and toe nails and the washing needs are rather different13 to what13 theymight13 have been even ten years ago Finally tattoos were once popular only with sailorsToday they are likely to be found on the arms backs and legs of both men and womenNew ways of cleaning these tattoos will be needed especially if they become infected orare sites at which pressure sores develop
Even if a personrsquos body is clean if their clothes are dirty they may become socially isolatedBut13 the washing of clothes can be strenuous even if a launderette is used The need toconserve water has driven research into ultrasound techniques to beat13 the dirt13 out13 ofclothing while some companies are experimenting with polymer chips These13 ldquogreenrdquo13 technologies are quickly maturing and are likely to be standard in the next 10 years
Other smart13 household appliances are already appearing on the market13 and may soonbecome common13 in UK homes13
bull Robovac devices have sensors to enable them to detect13 dirt13 on carpets and to adjust13 their operation accordingly
bull Refrigerators can read bar codes or RFID tags to identify their contents and theirldquouse byrdquo13 dates enabling them to inform the owner that13 they should use theproducts before they are out13 of date They can be linked to the Internet13 to reorderitems as they are consumed or to suggest13 menu options for the individual based ontheir preferences or according to the diet13 required to manage a condition
bull Ovens will automatically switch off if they are left13 without13 attention for too longand drying machines will set13 times automatically
Devices may be linked so that13 they are more efficient and report13 maintenance issues sothat13 they can be repaired (perhaps remotely) before they suffer a catastrophic breakdown
219 Personal and home13 security
It might13 appear perverse but13 people with very little personal wealth and property are morelikely to be the victims of crime than those who have expensive items This may be due towhere poorer people tend to live or because people who have valuable assets take greater
22
steps to protect13 them There can be no doubt13 that13 crime has a very negative effect13 onindividuals and on their families creating a fear factor that13 may be difficult13 to remove Theimpact13 on quality of life is therefore very considerable especially if it13 forces people to stayat home behind locked doors effectively isolating themselves from society
Modern policing places increasing reliance on the use of closed circuit13 television (CCTV)Town centres are covered by cameras used increasingly in the fight13 against13 crime by bothdetecting anti-shy‐social incidents and identifying the people involved They are also used tomonitor the movement13 of cars that13 may be involved in incidents of burglary and violenceand are fast13 becoming the primary mechanism of law enforcement13 agencies to solve crime
CCTV has moved into the home to record movement but13 monitoring the footage is timeconsuming and often not13 practical Cameras are now available which provide an instant13 video feed to a smart13 phone when movement13 is detected These may have intercomcapability allowing someone to remotely speak to an intruder sometimes before they havegained access to a building This may serve as a deterrent13 and when fitted alongside simpledevices that13 switch lights on randomly around the home may force burglars to goelsewhere
As the price of cameras continues to fall the option of carrying a camera13 on the body that13 continuously monitors personal space is becoming more useful Using wireless networksthe data13 collected can be sent13 continuously to the cloud for safe storage It cansubsequently be retrieved to provide evidence (video and audio) of confrontations enablingsuccessful prosecutions to be made The smart13 phone itself is becoming a valuable itemthat13 is attractive to criminals These can be tethered to personal attack buttons usingwireless technology allowing the device to be activated by the pressing of a button if theowner is being attacked The phones can then be tracked and located by the police whilebeing rendered useless to the assailant
Bogus callers are a perennial problem for vulnerable people Video door bells can beconfigured to display images and record the words of visitors before they are admittedallowing remote monitoring centres to oversee the situations and use image recognitionsoftware to confirm the bona13 fide of visitors Such13 arrangements may become13 commonplace13 over13 the13 next five13 or13 six years13 significantly13 improving the safety of peopleliving independently
220 Personal safety
The biggest13 risks to personal safety stem from fires and falls Most13 fires are the result13 ofpoor cooking practices resulting in burns or scalds Floods and gas emissions are caused bya failure to remember to close taps
The current13 approach involves detection of an emergency situation as soon as possible but13 always after a problem has already occurred This responsive approach can minimise therisks provided that13 there is a protocol in place for intervening This could increasingly be an
23
automated response such as the switching off of the gas of water or the switching on of asprinkler system or a water mist13 system
In the future monitoring systems will be more sophisticated and will have sensors and localintelligence to identify activities In this way reminders can be issued before an emergencyoccurs13 This lsquosmart kitchenrsquo approach may become13 an integral part of13 homes of13 vulnerable13 people
A prototype system has been developed at the Culture Lab in Newcastle Sensors havebeen embedded into cooking utensils enabling the kitchen to identify what13 the person istrying to cook or prepare It can provide interventions as messages on an instructionscreen
Accidents also occur out13 of doors People with dementia13 might13 become lost13 and may havepoor road safety awareness Location devices based on GPS have advanced from large andheavy receivers that13 were used on ships and boats to small battery-shy‐operated devices that13 can be carried in the hand or in a handbag The current13 generation of locators has limitedbattery life and are rather too large to be secreted about13 a personrsquos clothing while devicesthat13 are integrated into a wrist-shy‐watch are rather clunky and unattractive
Within 10 years the13 technologies13 will have13 matured and will be13 much smaller13 so that theycan be embedded in shoes in walking sticks hats or any other item of clothing Powerrequirements will have reduced so that13 energy harvesting from the movements of theindividual will be sufficient13 to keep these products working for several weeks without13 theneed for recharging The devices will not13 simply indicate to others where the individualhappens to be but13 will provide subtle guidance cues to direct13 them home
Cameras might13 also form part13 of the personal security systems that13 will protect13 people fromaccidents Data13 may be sent13 to the cloud and analysed in real time if the person is in adangerous location and can provide prompts either to the individual or broadcast13 advice toothers to clear the danger These systems may be embedded in items of clothing (such as ahat) or they may be attached to spectacles
221 Energy and13 portable power supplies
The demands of developing economies for more power will inevitably lead to higherdomestic fuel charges in the UK especially as oil and gas reserves dwindle
By 2018 UK homes should be fitted with new smart13 meters The specifications for these13 devices have yet13 to be finalised but13 will include a means of identifying wasteful use ofenergy including TV sets that13 are left13 on and unattended fridges and freezers that13 are set13 attoo low temperatures and dryers that13 are used for too long or when the weather is suitablefor using a washing line They could be an enabling factor that13 supports changes inbehaviour driven by a need to use less power but13 it13 is unlikely that13 they will offer a bigreduction in costs that13 are already a problem for many vulnerable families
24
More generally the need for power conservation will include devices that13 are moreefficient and a significant13 emphasis on heat13 retention in buildings through betterinsulation
The energy crisis may force many people to spend more time in community settingsincluding shops and public buildings where they can benefit13 from the warmth Increasingreliance on mobile communication devices will lead to increasing demand for batterycharging facilities
Greater use may be made of portable devices for generating power based on solar cellswind or hand motion
222 Smart cities and homes
The Digital City initiatives have been based on information and how it13 can be used most13 effectively to make people aware of what13 is going on around them This means bettercoordination of resources more rapid access to advice and a battery of sensors measuringevery conceivable parameter from sound and light13 levels through to air quality andtemperature fluctuations There are several Digital or Smart13 City initiatives currently beingimplemented both in the UK and across the world They may significantly impact13 the livesof the millions of people living in them but13 the timeframe for outcome benefits to influenceplanning and design elsewhere is likely to be at least13 20 years and therefore outside thetimeframe of the current13 project
Housing plays a big role in the lives of most13 people both through their aspirations to moveup in the world (usually to a bigger property with a garden) and as the heart13 of the familylife which is associated with good quality of life UK properties have a life span approaching100 years which is about13 double that13 of their European counterparts (and certainly longerthan the wooden-shy‐frame buildings built13 in North America13 for example) A shortage ofhouses has plagued improvements in social welfare for the past13 30 years There is anargument13 that13 there are enough houses but13 the wrong size and in the wrong places andthis has some basis in fact13 as demography changes lead to more people (and more olderpeople) living alone However if there are two million homes in Scotland each with alifespan of 100 years then the renewal rate needs only to be 20000 per annum to maintainthe status quo However it13 must13 be clear that13 the impact13 of smart13 house development13 willbe small The focus should therefore be on adapting existing properties to render themmore appropriate for vulnerable people
Housing adaptations are a branch of assistive technologies The technologies for providingdifferent13 forms of accessible bath and level access shower are well-shy‐established with littleresearch considering anything other than alternative building materials and methods formaintaining the temperature of the bathwater Different13 technologies for bathing will beconsidered separately
25
Thus housing technologies are not likely to impact on social work13 within the next 20years13 though13 the use of information13 technology13 to ensure that people are aware of what13 is available is likely to be commonplace well before then
26
3 BEHAVIOUR AND ATTITUDE CHANGES DUE TO TECHNOLOGICALADVANCES
Technology is only one factor that13 will affect13 the way society changes in the next13 10 or 15years This chapter will consider the context13 in which the technological developmentsoutlined in the previous chapter will be supported (or held back) by societal factors
When the impact13 of such factors has been considered we can then apply theseassumptions to a number of case studies listed in Appendix13 A13
The headings selected for this chapter are not13 arbitrary as they reflect13 the context13 in whichtechnological changes must13 be considered They must13 include consideration of factors suchas demography and long-shy‐term conditions already addressed in the introduction to thesepapers together with the aspects of workforce and citizenship considered in the parallelpapers The additional elements here focus on trends that13 are already occurring and whichmay leave people struggling with the changes that13 occur
Finally there is a need to consider the attitudes of people to technology generally andespecially to the issues of privacy and social responsibility that13 could be radically changedby technology In some cases public opinion will prevent13 some forms of technology beingdeveloped if not13 commercialised In other cases some technologies will be fast-shy‐trackedeither at the request13 of government13 or because of a clear public demand for theopportunities that13 it13 can bring
Predictions13 about the13 future13 must inevitably be13 subject to considerable13 uncertainty butthat is no reason to stop thinking what might happen
31 The Welfare State
The UK can be rightly proud of the way that13 its welfare state has developed during the past13 100 years to provide a safety net13 of financial support13 to people and to their families whenthey are unemployed destitute homeless or challenged by crises and emergencies Therange of benefits received is considerable some are complex and many people struggle tounderstand their entitlements Some are universal some are discretionary some apply onlyto parents others to anyone
The total cost13 of providing these benefits continues to rise and when the economy isstagnating there is inevitably both political pressure often supported by popular publicopinion to introduce welfare reform so that13 people who do not13 work cannot13 be better offthan they would be if they were in full-shy‐time employment This strategy requires a universalbenefit13 to be introduced so that13 it13 is easier for claimants to access support13 but13 also easierfor agencies to identify the total benefits received The idea13 of a benefits cap then becomes
27
more practical to introduce especially if all the processes involved in making a claim arehandled electronically Indeed this encourages government13 to insist13 on applications forbenefits to be made on-shy‐line Unfortunately this will marginalise those people who haveneither a computer nor access to the internet thus emphasising the digital divide in amanner which works against13 some of the most13 disadvantaged people in society
There are currently few tangible links between digital technology and welfare provisionThe most13 obvious are universal benefits such as a free television licence (worth pound14550)13 for13 everyone aged 75 or older with blind and visually impaired people entitled to a 50discount13 irrespective of their age The significance of this position is that13 6 of revenuesgenerated through licence fees are to fund BBC on-shy‐line services13 such13 as websites and i-shy‐player In Scotland the BBCrsquos Alba Gaelic language television service is predominantlyfunded13 by MG Alba an organisation funded by the Scottish Government It is thereforeconceivable that13 in the future licence fees may be used to directly subsidise access toinformation and advice through the Internet13 for vulnerable people whether it13 is throughbroadband access or through a set-shy‐top box which removes the need for a computer in thehome to access particular websites or to use e-shy‐mail services
A second age-shy‐related benefit13 available in the UK is the winter fuel subsidy People whoreceive certain benefits receive the payments automatically while others must13 make aclaim Those who are not13 eligible for benefit13 due to a lack of an address for example missout13 on these payments and also on Cold Weather payments of pound25 for each seven dayperiod of very cold weather between 1 November and 31 March
The development13 of new warm home initiatives plus the complex of subsidies that13 theelectricity supply industry and government13 offer to people with solar cells further changesthe economic arguments Global warming may lead to greater variations in weatherextremes but13 might13 also increase the amount13 of electricity that13 can be generated byalternative (green) sources such as wind and solar cells It is estimated that13 energyconsumption in the UK increased by 17 between Christmas and Easter 2013 compared toprevious years as a result13 of cold weather but13 the above subsidy scheme did not13 benefit13 older people because two of the seven day cold periods were after 31st March It must13 beassumed that13 there will be more people living in fuel poverty in the future and this will leadto more cases of cold related illness including influenza13 and stroke
32 Management of long term conditions
The management13 of long term conditions will be improved for patients who are compliant13 with their medication regime so it13 is possible that13 there may be compulsion to adhere tothe prescription Such compulsion may be monitored using technology Indeed the remotemonitoring of vital signs using telehealthcare will become commonplace as the old boxesand sensors are replaced by devices that13 can be worn continuously or which can beembedded into the fabric of homes (including furniture and bedding) or can be worn asvests or patches They will wirelessly transmit13 data13 to smartphones or tablets and mobile
28
transmission and cloud technology will enable real-shy‐time data13 collection analysis andfeedback
One of the diseases which is projected to increase most13 significantly over the comingdecade is Type 2 diabetes Whilst13 there is a hereditary susceptibility to this condition formany people including those from the Middle East13 and the Asian sub-shy‐continent it13 is also adisease which tends to affect13 those people who are overweight13 andor have a sedentarylifestyle If untreated diabetes can lead to dizziness and collapse at any time but13 can alsohave more devastating long term consequences which include kidney failure strokeblindness and in extreme cases lower limb amputations Management13 therefore includesdaily monitoring of blood glucose levels and major dietary changes such as a significant13 reduction in the consumption of carbohydrates as well as a rigid exercise regime
Many newly diagnosed diabetics follow this advice closely and can lead normal lives for 40years or more but13 some struggle to accept13 the change in lifestyle required as well asremembering which foods are allowed and how much exercise they need to takeIndividual support13 plans are now forthcoming and over the next13 ten years best13 practicewill emerge in the form of smartphone apps that13 are personalised and which can becomean individualrsquos health coach This level of support13 will be fine for some people but13 otherswill need incentives so it13 is likely that13 gaming technologies will be introduced perhapsoffering rewards for good compliance There will be a temptation for some people tocheat perhaps allowing others to perform exercise for them or changing theirconsumption details
Many of these opportunities for cheating will be removed through the use of a uniquebiometric identifier a technology that13 will be mature enough to use in place of passwordson smartphones However the biggest13 challenge may be in encouraging older people to usethe technology Many older people have multiple morbidities Indeed a survey of Scottishpatients implied that13 42 of people aged over 80 will suffer from three long termconditions It will be essential for those people to comply with treatment13 regimes if they arenot13 to have the functional deficits that13 follow
33 Finding people who13 donrsquot fit
People who have low social capital are likely to have few relatives and friends with whomthey regularly communicate and are also unlikely to be part13 of community or faithorganisations such as clubs societies and church groups They also die several yearsyounger than most13 of the population often because they donrsquot13 engage with public healthinitiatives such as vaccinations against13 flu regular checks on their blood pressure bloodsugar levels or in the case of women smear tests or mammography The most13 likelyreason for disappearing beneath the radar of such initiatives is their mobility which leadsalmost13 inevitably to them having no fixed abode and no fixed telephone line It thenbecomes very difficult13 for them to be contacted because their mobile telephones are likelyto have Pay-shy‐As-shy‐You-shy‐Go contracts that13 donrsquot13 require validated names addresses and bankaccounts
29
It follows that13 some of the most13 vulnerable people in society including those who live onthe streets are effectively unknown to both the NHS and to social work departments untilthey are referred in a crisis This could be an emergency presentation to a hospital Accident13 and Emergency Department13 where they will come into contact13 with a social worker becausedischarge may be unsafe This often highlights the importance of the prevention agenda13 and the potential for avoiding admissions to hospital by intervening at an earlier stage
The advantages of being able to locate people who are vulnerable to specific diseases willincrease as genetic testing becomes more routine It is already possible to determine whomight13 be most13 at risk of breast13 cancer and prostate cancer as a result13 of family history Addto this the evidence that13 particular diet13 and exposure to environmental factors can furtherincrease risk then it13 is evident13 that13 individuals can be identified and offered treatmentsthat13 could save their lives many years before they become ill In the case of cancersperhaps only the individual is involved but13 for infectious diseases it13 is the whole of societythat13 is at risk if someone contracts one of the new strains of influenza or if someonechooses not13 to be vaccinated against13 rubella In Chinese airports all visitors are screenedfor fever and refused entry if they tested positive in cities the public are monitored in thesame way Similar approaches may be necessary in the UK if potential carriers cannot13 otherwise be identified
34 Volunteering
It is estimated that13 72 per cent13 of people volunteered to perform a charitable act13 at least13 once during 2012 a rise from 65 per cent13 the previous year About13 four out13 of every 10volunteers offer their services formally to one or more organisations The remaindervolunteer informally by helping out13 a friend or a neighbour Around 50 per cent13 volunteered at least13 once a month in the past13 year up from 41 per cent13 on the previous13 year Most13 have retired many of them before the statutory retirement13 age Those whodonrsquot13 feel able to offer time have offered their financial support13 at a time when the fundingavailable from sources such as the National Lottery has been decreasing Despite economicausterity donations to charities have been increasing 74 per cent13 said they had given tocharity at least13 once in the previous month up from 72 per cent13 the previous year
Strikingly 78 per cent13 of people strongly believe that13 they are part13 of their localneighbourhood an increase from 70 per cent13 10 years previously Community cohesion isstronger than ever 87 per cent13 of people believe their local area13 is a place where peoplefrom different13 backgrounds get13 on well together compared to 80 per cent13 in 2003
The role of volunteers in supporting vulnerable people is therefore likely to increase overthe next13 decade perhaps exploiting the success of the army of volunteers that13 was highlysuccessful in London during the Olympic and Paralympic games The greatest13 role for suchvolunteers may be in providing informal care for older people Already the UK has someseven million informal carers whose value in monetary terms has been calculated to be
30
more than the combined budgets of the NHS and social care Maintaining or extending thisprovision will help to support13 services in the future and may be supported by technology
Whilst13 there is ample evidence to suggest13 that13 telecare services support13 informal carers asmuch as (if not13 more than) the people that13 they are caring for it13 is the potential for utilisingthe internet13 and apps to make their role easier to coordinate and hence more effectivethat13 is likely to be most13 successful moving forward
Many of these focus on particular tasks that13 informal carers can help offer to older peoplesuch as organising their medication A pillbox program is just13 one feature of an app calledBalance It also includes sections for caregiving tips notes for the doctor and the patientsappointments plus a lsquolearning sectionrsquo with articles on aspects of Alzheimers and an RSSfeed for news about13 the disease Tyze is another multi-shy‐functional app it13 allows carers to
bull Organise appointmentsbull Plan outingsbull Share storiesbull Send updates to other family members
Another application is Rally Round which helps carers to organise someone to perform littlejobs often on a temporary basis when someone has dementia physical frailty or isrecovering from accident13 or illness Similar applications are MeMaxi and Finerday
35 The High13 Street
The shape and appearance of UK shopping centres have been changing for half a centuryPeople complain that13 centres are losing their identity with one town looking like everyother both in terms of the stores and in terms of the layout But13 there are three trendswhich are having a profound impact13 on many of the most13 vulnerable people in society
bull Centres lock their doors at 6pm or in some cases 10pm -shy‐ thus denying people whosuffer from claustrophobia13 from window shopping at times when other shoppershave left
bull Out13 of town shopping malls -shy‐ these US style centres are ideal for people in carsbecause they offer free parking which is essential for people who want13 to buy largeritems but13 difficult13 for people who have no transport13 and who must13 rely on publictransport13 that13 is often deficient
bull The rise of online shopping -shy‐ which means that13 many potential shoppers only visit13 High Street13 stores to check the prices before returning home to make a purchaseonline
It is the third of these effects that13 has the greatest13 potential for changing the High Street13 forever and it13 is making life for traditional retailers increasingly difficult13 at a time when highrents are crippling stores large and small It is difficult13 to see how this trend is likely tochange because consolidation in banking and estate agencies is already forcing the closure
31
of other High Street13 players while additional pressures on pubs has led to the closure ofthousands of pubs every year
Those figures however demonstrate that13 consumers still value what13 the high street13 canoffer -shy‐ the chance to inspect13 what13 theyrsquore thinking of buying -shy‐ as well as the new opennessof the internet Customer service makes a difference to people especially if there is aproblem and goods need to be returned One of the most13 common reasons for furniture tobe returned for example is that13 when a sofa13 or a wardrobe was delivered it13 couldnrsquot13 fit13 through the front13 door or up the stairs In the future people will be able to benefit from13 visualisation technology they will upload the floor plans of their homes enabling theretailer to inform them of the problem before they try to delivery Augmented reality viewwill similarly allow customers to see what13 a new item of furniture will look like in itsintended place so that13 they can be more informed about13 the effect13 of size and colour
In terms of improving the viability of the High Street stores will have to focus on theimportance of brand which could mean that13 individual independent13 retailers will have topartner with national suppliers to support13 a local tailored offering based on products that13 are designed for a more global market This is a lsquoconnected High Streetrsquo approach whichcould be enabled by the developments in internet13 availability and smart13 phone accessdescribed in the previous section
The overall effect13 of all these changes could mean that13 town centres become smaller but13 more vibrant13 areas They could thrive if people are attracted there in large numbers whichmeans that13 retail must13 be developed alongside restaurants pubs galleries and other leisureopportunities This is possible in new shopping centres which are already being integratedwith transport13 hubs including railway and bus stations but13 may be more of a design13 challenge for older towns and cities with large Victorian buildings To ensure that13 morepeople are welcomed into the new centres they should include attention to green spacesand areas where people can relax without13 feeling that13 they are second class citizensbecause they donrsquot13 have the same buying power
3513 Privacy
To some people privacy is their right13 to live their lives without13 interference they may seethe State as a potential lsquoBig Brotherrsquo spying on their every move and judging their actions13 and activities Other people have fewer concerns about13 the role of the State but13 great13 fearof individuals interfering with and invading their privacy Some embrace the concept13 of lsquomyspacersquo an area13 of a square metre or so into which nobody can enter without13 permissionThis allows them to avoid physical contact13 and to feel safe from any form of threateningbehaviour
Yet13 this idea13 of private space and its potential violation is merely the tip of the iceberg asfar as privacy is concerned more significant13 is the idea13 of personal (and private)information being shared with anyone and everyone This could be related to identityopinion or image for an individual who wants to remain anonymous or even secretive thisis going to become an increasing problem as technology provides the means of taking
32
photographs recording conversations and capturing environment13 with something as smalland ubiquitous as a mobile phone The fact13 that13 this information can then be shared withthe rest13 of the world using e-shy‐mail Twitter and Facebook makes the problem all the moredifficult So the threat13 is no longer solely from the long lenses of the Paparazzi but13 fromanyone (and that13 means everyone) who has even the most13 basic of mobile phones
This relates to the changing views of society on what13 information should remain privateand what13 should be shared with others The success of social media13 has been based on anattitude of lsquosharing everythingrsquo with either your friends or the world This has introduced anaiumlve idea13 in the minds of some younger people (especially those known as Millennials ieaged 18-shy‐30) that13 everyone can be their friends whilst13 perhaps failing to reinforce the bondsof genuine friendship with any form of test13 or restriction Technology could play a role indefining these friendships and allowing individuals to understand what13 makes a goodfriend but13 this approach has yet13 to be developed and may be slow to overcome the needfor some people to measure their own popularity simply as the number of people that13 theycan list13 as friends on their Facebook page
It follows that13 there may be a need for a new definition of privacy that13 is in keeping withthe web and its ability to display images and opinion in an unregulated manner This needsto embrace past13 concerns about13 the ability of an individual to live without13 the threat13 ofothers being able to watch them whilst13 offering some protection from random postingsabout13 them online Perhaps this could include a right13 to be able to edit13 or remove anythingrelating to themselves on the Web including images that13 are not13 news-shy‐worthy Theownership of image rights may be an associated issue that13 needs to be addressedespecially as modern technology can remove an individual from a group (or a background)13 view provide digital touch-shy‐up or air-shy‐brushing and then republish it13 in a different13 contextHowever there is general agreement13 that13 personal information (such as contact13 details andbank codes) should not13 have a place on the web Surprisingly few people take proactivemeasures to prevent13 tracking functions being activated
It follows that13 too much privacy could lead to younger people fearing that13 they maybecome lost13 in a digital world It is not13 surprising then that13 they are prepared to make lots13 of personal information available often with no fear of how it13 might13 be used by othersWhen Google glasses and similar technologies become available during the next13 few yearsthey will have the potential to identify a stranger walking down the street and to find manyof their secrets to present13 to the wearer in a fraction of a second They could know moreabout13 them than their genuine friends know -shy‐ so who will be their friends in the future
36 Data sharing and13 protection
By lsquodata13 sharingrsquo we mean the disclosure of data13 held by one organisation on an individualto a third party organisation(s) or the sharing of data13 between different13 parts of anorganisation Some data13 sharing doesnrsquot13 involve personal data13 because it13 has beenanonymised in such a way that13 the statistics can be used for the collective good without13 theidentification of the individual The Data13 Protection Act13 (DPA) is in place to provide a legal
33
framework that13 ensures that13 organisations that13 hold personal data13 must13 act13 responsibly atall times These principles adequately describe the position of public and government13 bodies especially social services departments who are responsible for the informationconcerning the health and well-shy‐being of individuals -shy‐ and hence by implication thesensitive data13 relating to their vulnerability
The legal framework that13 applies to private and third sector organisations differs from that13 which applies to public sector organisations which may only act13 within the defined limits oftheir statutory powers However all bodies must13 comply fully with the data13 protectionprinciples and this situation is unlikely to change within the next13 10 to 15 years In someprivate sector contexts there are legal constraints on the disclosure of personal dataHowever most13 private and third sector organisations have a general ability to shareinformation provided this does not13 breach the DPA or any other law It is advisable for acompany to check its constitutional documents such as its memorandum and articles13 ofassociation to make sure there are no restrictions that13 would prevent13 it13 from sharingpersonal data13 in a particular context The type of data13 held is therefore a subject13 ofconcern as it13 may be difficult13 for legislation to keep up with the additional layers of data13 created on-shy‐line and through the Internet13 of Things
Private and third sector organisations should have regard to any industry-shy‐specific regulationor guidance about13 handling individualsrsquo information as this may affect13 the organisationrsquosability to share information They should also be aware of the legal issues that13 can arisewhen sharing personal data13 with public sector bodies This becomes more of an issue asprivate and third sector bodies are carrying out13 a wider range of traditionally public sectorfunctions Opportunities for inappropriate sharing of sensitive data13 will therefore inevitablyincrease
Public authorities must13 comply with the Human Rights Act13 (HRA) legislation in theperformance of their functions The HRA also applies to organisations in the private sectorinsofar as they carry out13 functions of a public nature which could include delivering a socialcare activity Where the HRA applies organisations must13 not13 act13 in a way that13 would beincompatible with rights under the European Convention on Human Rights Article 8 of theConvention giving everyone the right13 to respect13 for their private and family life their homeand their correspondence is especially relevant13 to sharing personal data If personal data13 isdisclosed or shared in ways that13 comply with the DPA the sharing or disclosure of that13 information is also likely to comply with the HRA The problem may still be in policing theActs and the rights of an individual if they believe that13 their personal data13 has been sharedor accessed by an inappropriate organisation or individual
A legal industry may be born to deal with such matters but13 this is unlikely to benefit13 peoplewho cannot13 afford the fees involved They would require either legal aid or to employ13 more13 lsquono win no feersquo companies Public attitudes to such costs might13 become negative unlessthey prove successful in preventing breaches of data13 security There may need to belegislation to provide a stronger basis for forcing compliance with privacy laws
34
37 Connecting with13 people
We are social creatures most13 of us rely on our friendships and interactions with friendsand families to share our happiest13 moments and experiences Research suggests that13 thishappiness is infectious at all levels and leads to a 15 increase in the happiness of a closecontact 10 for a second degree contact13 such as the friendrsquos spouse and a 6 increase fora friend of a friend It is hardly surprising that13 the success of social media13 such as Facebookis intimately related to the ability of people to quickly share their happiest13 moments with asmany of their friends and connections as possible
All this has happened during the rise of the Internet13 and the corresponding increase inopportunities for connecting online ie this is a 21st Century phenomenon which has beenfacilitated by Information and Communications Technology But13 the Internet13 remains in itsinfancy and we are only beginning to understand and exploit13 its potential In terms ofaccessing the Internet there are now perhaps two billion people who have access with99 of them having gained this during the past13 decade This number will have doubled bythe period 2020 to 2025 It is likely that13 everyone who wants to be connected in the UK willby then be connected Turning this on its head only those who donrsquot13 want13 to be online willnot13 be on the Internet13 within a decade Connecting with the unconnected will therefore bea case of identifying those people who donrsquot13 want13 to be found unfortunately these mayinclude many people who need the support13 of social care organisations It means that13 theywill be looking for support13 only when they are in crisis unless other ways of finding andormonitoring them are found
While the number of people connected via the Internet13 has exploded this might13 bedwarfed by the number of connected lsquothingsrsquo During 2009 the number of thingsconnected to the Internet13 surpassed the number of connected people at which point13 webegan to experience what13 this report13 has described as the lsquoInternet13 of Thingsrsquo Yet 99 ofall physical objects that13 could join this network are not13 yet13 connected but13 the number couldgrow by 25 every year for the next13 decade so that13 there could be 100 billion connectedobjects by 2025 some of which will be owned or used by everyone in the UK includingthose people who donrsquot13 want13 to be connected themselves We will then have an Internet13 of Everything which will be the smart13 connection of people data events and actions
With each new person object or data13 that13 comes online the connection possibilitiesbetween all these elements grows exponentially The rise of big data mobile networkingcloud storage and data13 mining technologies will all play a critical role in the Internet13 ofEverything The result13 will be new capabilities richer experiences and unprecedentedvalue for individuals businesses communities and countries everywhere The lsquonetworkeffectrsquo of the Internet13 of Everything will be a very powerful thing the true impact13 of whichwe wonrsquot13 fully understand for several years As it13 develops however those who are not13 connected will feel even more digitally and socially excluded There will be a need to reachout13 to vulnerable people unless the process of claiming requires proof of online identityand the payments to be received can only be redeemed using a chipped card or adownloaded app onto a smartphone This is of course the way that13 welfare arrangementsare already developing thus it13 might13 prove impossible to make a successful claim without13
35
already being connected to lsquothe systemrsquo either through an online presence or through theInternet13 of Things
38 Downloading everything
Sixty years ago information was discovered by reading books often in a library wherenotes had to be made because the books or journals couldnrsquot13 be removed Then in theearly 1960s the first13 office photocopying machines were introduced into the UK theyimmediately meant13 that13 pages or articles from books could be copied and taken away to beread and summarised later Within a few years photocopying became a replacement13 forreading as researchers became less adept13 at selecting a few sentences and every deskbecame a depository for reams of printed paper Paper became the means of recordingeverything from bank statements through to music
We now appreciate that13 printing everything is a waste of both the ink (or toner) used tocreate the black print13 and of paper which requires trees to be chopped down and pulpedbefore it13 can be pressed into thin sheets Saving paper is therefore seen as green and goodfor the planet Fortunately we no longer need to print13 everything because computermemory is unlimited thanks to the cloud and we can then view pages and articles onportable or fixed screens
The internet13 has everything and it13 is all available instantly for downloading providing thereis a device available to accept13 it and there is sufficient13 communication bandwidth toperform the transfer of data13 sufficiently quickly Thus we can record all text13 articles that13 are relevant13 to us including digital records of birth certificates qualifications and passportsand the need for original printed versions will decline But13 we can also do this forphotographs Most13 handheld computing devices include at least13 one camera so they cangenerate enormous number of pictures which can be kept13 for posterity without13 having toconsume inks and special papers to print13 them
But13 the materials that13 can be downloaded donrsquot13 stop at pictures software is available that13 can grab TV shows after they air and movies as soon as theyre released In the same wayit13 is possible to schedule music comic books video games and practically anything else asa download with minimal effort People will need enormous hard drives if they want13 theirown digital copies of these files so will more than likely make use of cloud storage that13 willbe available from many organisations The location of the servers may become sensitivedue to border restrictions as will the security of the data13 and the way that13 it13 is backed up sothat13 it13 is resilient13 to failures
It may be evident13 that13 application forms for all types of welfare payment13 will be availableonly for downloading so that once digitised they can be processed by computer andrecords sent13 to various servers for subsequent13 storage and processing Some people maywant13 to keep their data13 on them once it13 has been downloaded Pen drives can already holdseveral GB of data so it13 is likely that13 people will be able to carry their downloaded data13 withthem at all times irrespective of the size and complexities of the information
36
39 Health13 and13 well-shy‐being
The general health of the population is unlikely to deteriorate noticeably within 10 to 20years Indeed expectations of the population are that13 things must13 improve as surgicaltechniques mature and as pharmaceutical interventions become more personalised andpowerful However the rising demand for health services due to an ageing population andthe increasing cost13 of providing sophisticated therapies will make delivering a free anduniversal health service difficult13 without13 substantial increases in taxation This is unlikely tohappen in the UK even though spending on health services will be protected against13 thecuts facing other services
There will have to be changes in how the NHS works For twenty years hospitals have beenclosed and replaced by fewer new facilities so that13 the bed count13 is reduced This has led toa significant13 shift13 in resources to primary care and community care supporting shorter staysin hospital and speedier transfer back home for people after surgery or illness This hasbeen13 successful but13 there remain problems with demand for GP services especially out-shy‐of-shy‐hours and at weekends Indeed despite the introduction of NHS24 and similar help-shy‐linesthe demand for GP appointments continues to increase Delays are inevitable and this willincrease system failures with more unnecessary deaths and a failure for people to access adiagnosis that13 might13 lead to early interventions and ultimately lower delivery costs Over250 more patients are added to waiting lists every day
This will lead to a new model of primary care consistent13 with existing changes which haveseen surgeries move from High Street13 locations to medical centres close to bus routes andwith more parking for patients The process of making an appointment13 is changing from atelephone-shy‐based interview process dominated by a medically-shy‐unqualified receptionist13 to achoose and book approach using an online process linked to electronic patient13 records Thiswill give patients more convenience but13 will allow priority for those who have Internet13 access at the expensive of those who are digitally excluded Making the process of bookingan appointment13 quick and easy may also increase demand from people who do not13 need tobe seen as it13 will fail to identify those in greatest13 need
A greater use of telehealth and telecare technologies will be inevitable beginning with thefirst13 contact13 as an encounter using the telephone e-shy‐mail or video conferencing -shy‐ a visit13 tothe GP surgery should be a last13 resort and should involve a nurse consultation in the first13 instance This would be consistent13 with three quarters of appointments currently involvinga chronic disease or long term condition which relates to improved self-shy‐care The support13 ofthese patients at home should be prioritised through tele-shy‐ and web-shy‐based technologies andshould involve training and coaching through a network of nurse practitioners Home visitsshould generally be unnecessary through the use of these technologies but13 could besupplemented by satellite surgeries manned by nursing in community premises or inpharmacies nurseries and Internet13 cafes
The homes13 of people who13 need13 closer monitoring can then become part13 of virtual wardswith real or electronic visits by health professionals University Hospital Southampton NHSFoundation Trust13 already looks after patients who have undergone surgery such as a hip orknee13 replacements in virtual wards with high levels of satisfaction The Royal Free London
37
NHS Foundation Trust13 offers a similar service but13 plans to add the possibility of videoconsultations between patient13 and consultant
310 Attitudes to public health issues ndash obesity smoking alcohol abuse drugs
As self-shy‐care becomes the focus of the NHS the public will increasingly understand that13 thecosts and availability of services are being harmed by the poor health behaviour ofrelatively small numbers of people The link between public health initiatives today andhealthcare needs and costs in the future will become increasingly evident13 as a result13 of theway that13 information is presented Thus the overweight13 smoker who currently attractsconcern and pity when they are diagnosed with diabetes and COPD is increasingly beingseen as the victim of their own stupidity or lack of self-shy‐discipline If they continue to neglect13 medical advice and continue with an unhealthy lifestyle then the way that13 they receivetreatment13 and consume resources will become a matter for the entire population
Obesity is seen as due to a combination of poor diet13 and a sedentary lifestyle No longer isthe idea13 that13 people are lsquobig bonedrsquo acceptable Governments will respond initially byrequiring manufacturers and food processors to provide nutritional information onpackaging and on menus in restaurants But13 people can choose not13 to read the data13 and toneglect13 both the importance of food quality content13 and quantity This will increasepressure to introduce fat13 or sugar taxes and these are likely to be in force within a decade
Although the high taxes on tobacco products has forced some smokers to reduce theirconsumption or to give up altogether the impact13 has been reduced by the smuggling ofproducts from overseas and by the availability of duty-shy‐free cigarettes for people returningfrom foreign holidays and business meetings Further measures are planned to changepackaging and to include even more graphic images and warnings on cigarette packages tomake smokers aware of the effects of smoking on their health and well-shy‐being There is asyet little evidence of how successful this might13 be More effective has been the banning ofsmoking in public places including trains and aircraft Expensive medical interventions suchas heart13 transplants will be denied to individuals until they change their lifestyle behaviourSmokers might13 therefore be increasingly ostracised leading to a loss of esteem This mayhave a particular impact13 on people who already suffer from mental health problems whoare more likely to smoke
The overuse of alcohol is being recognised as a major factor in hospital admissions withNHS figures showing an increase of over 40 in such admissions over the past13 decadeLinked to this has been a 75 increase in prescriptions to treat13 alcohol dependency Fewpeople have sympathy for those who waste their limited income on booze If they havechildren or other dependents they will be the ones who suffer and who may need thesupport13 of social care
Drug users are already significant13 users of social services as their habit13 is likely to makethem unemployable They receive little sympathy from the general public because they areseen as criminals and people who waste public resources Levels of drug abuse have been
38
slowly increasing over the years but13 this trend is slowly being reversed Indeed the numberof people using drugs during the past13 year has fallen to its lowest13 level for nearly 20 years(below 9) with cannabis being most13 likely often following excessive drinking Aselectronic noses and other technologies can detect13 traces of drugs it13 seems likely that13 success in overcoming addiction can be measured objectively This may become a two-shy‐edged sword rewarding those who can turn around their lives but13 further marginalisingthose who canrsquot13 or wont13 accept13 the lsquocold turkeyrsquo
311 Attitudes to surveillance
Issues associated with privacy confidentiality and data13 security have been discussedpreviously in the context13 of information technology the World Wide Web and the ease ofcollecting recording recalling analysing and displaying data The monitoring of individualsand their methods of using this information can be regarded as surveillance As thequantities of data13 increase along with the number of devices that13 can be used to access itthe surveillance tools will also increase in their sophistication Indeed the Big Data13 approaches described in the previous section will enable the combination of structureddata13 (such as the information held in databases) to be married with unstructured data13 fromimages in such a way that13 it13 can be mined
Whilst13 the lsquodigital surveillancersquo methods described above may cause most13 concern topeople because of its impact13 on anonymity it13 is the collection and analysis of images that13 are the major concern to people as they contemplate the ways that13 lsquoBig Brotherrsquo maydevelop to restrict13 freedom Every major UK city and town centre has an array of CCTVcameras that13 continually record activities from every angle If it13 used to be true that13 nobody in London was more than 10 yards from a rat it13 is certainly the case today that13 nobody can be more than this distance from being in view of a surveillance camera Yetthey receive so much positive publicity from TV programmes where their footage is used todetect13 vehicles close to a crime scene or to monitor the movements of suspects that13 theyare now accepted by the public as a deterrent13 in the same way as lsquobobbies on the beatrsquowere seen 25 years ago There is therefore little public reaction to the expansion in the useof video surveillance except13 for the practical observation of how so many views can beinspected and recorded
Looking to the future the tumbling cost13 of video technology will surely lead to anotherincrease in the number of devices The aerial views taken from towers will besupplemented by more local views taken by devices that13 are embedded in the fabric ofbuildings or carried by individuals either on their person (for example on clothing orspectacles) or in the bags that13 they carry The time and date-shy‐stamped images as Big Datawill be recorded to lsquothe Cloudrsquo where it13 can be added to other data It can then be usedwhen an incident13 has occurred or to provide further detail of night-shy‐time activities
It follows that13 there will be no hiding place for people who simply want13 to disappear Theymay respond by wearing clothing (such as hoodies) that13 hide their faces or which make it13 difficult13 to distinguish gait13 or mannerisms from which they might13 be identified New forms
39
of clothing may be designed to make shapes more difficult13 to analyse and these might13 become the uniforms of a class of person who wants to live in a way that13 they donrsquot13 interact13 with officials from any ministry or local government13 department If they also obstruct13 services then they will be considered to be anarchists of some form sparking protests fromother sectors of society
31213 Attitudes to driving
Motor cars have been a feature of UK roads for over a century but13 it13 is only during the past13 50 years that13 they have become a resource that13 most13 families have had access to enablingthem to travel without13 the restrictions imposed by a limited railway network and non-shy‐integrated bus transport People who have had a car throughout13 their lives often see theircars as an important13 factor in enabling them to remain independent13 and to exercise choicesrelating to where they shop and where they spend their leisure time This extends to theirspouse and to friends and neighbours that13 they might13 take with them on their variousexpeditions
Unfortunately there are incidents involving older drivers who perhaps go down amotorway in the wrong direction who are taken ill at the wheel or who are involved in anaccident13 involving no other vehicles These are small in number but13 often lead to a reactionthat13 they shouldnrsquot13 be allowed to drive lsquoat13 their agersquo Age itself is not13 an indicator ofdriving quality but13 because old age also brings more chance of having limited long termconditions and other illnesses it13 is easy to make a link between driving ability and age Thelicensing system does require continued driving to be linked with medical advice andforbids people with poor eyesight epilepsy and other conditions to hold a licence in oldage
Yet13 statistically older drivers cause far fewer accidents than younger drivers The reasonsfor this may be complex and are likely to include the fact13 that13 they drive less often covershorter distances and donrsquot13 go out13 in the dark or in poor weather However it13 does not13 wholly explain why the UKrsquos drivers aged over 70 and who represent13 some 8 of all driversare involved in only 4 of accidents that13 cause injury This compares favourably with the15 of13 drivers aged between 17 and 29 who are involved in over a third of crashes that13 result13 in injury
By 2020 the number of drivers aged over 70 on UK roads is likely to increase to over 7million This will require a new national strategy perhaps involving support13 for olderdrivers further training raising awareness of issues and making more use of adaptivetechnologies to support13 the driver in avoiding collision or forgetting to check on the statusof their vehicle Poor eyesight13 could be enhanced by camera technologies rather thanforcing people off the road if they are unable to read a licence plate
The International Longevity Centre has found that13 one in four Britons thought13 driversshould be made to switch off the ignition for good somewhere between the ages of 70 and75 The numbers may decrease as the population ages and as cars become safer Forcing
40
older people off the road may be a natural consequence of providing free bus passes andsubsidised rail fares but13 the growth in the pavement13 scooter industry demonstrates that13 older people value their independence and will do almost13 anything to get13 out13 and aboutPerhaps legislation will result13 in more regulation of electric vehicles and where they cantravel
There can be no doubt13 that13 getting out13 will be associated with better quality of life andwell-shy‐being and this is likely to be supported in the future as evidence of improvedoutcomes emerges It is to be hoped that13 positive stories will be publicised so that13 publicattitudes arenrsquot13 hardened This may be supported by more in-shy‐car monitoring of drivers andthe linking of performance with on-shy‐line driving records and licences These could throughremotely monitored ignition systems prevent13 the use of motor vehicles by people without13 a licence or without13 insurance
313 Climate change
There is a general view that13 the emissions of carbon gases are contributing to globalwarming in a manner that13 will change the UK climate in such a way that13 the climate maybecome more Mediterranean However some scientists believe that13 manrsquos impact13 on theenvironment13 may be small compared with natural variations caused for example bycyclical changes in the sunrsquos energy output13 or by the effects of volcanoes and earthquakesRecent13 evidence has suggested that13 we are going through a phase of changing extremesand that13 this is more likely to cause storms periods of excessive rainfall and unusualseasonal trends with snow and frost13 in the spring and warmer winters Considerableuncertainty remains and it13 might13 be necessary to plan for a number of different13 scenariosand for the impact13 on vulnerable people
I Colder winters UK properties are poorly insulated resulting in excess mortalitiesduring cold spells due to an increased number of people suffering from stroke aswell as bronchitis and other pulmonary diseases The cost13 of heating continues toincrease putting more households into a state of fuel poverty Any further coolingduring the winter months will result13 in more people living in unhealthy coldconditions Winter fuel payments are likely to be restricted to the poorest13 peoplebut13 this might13 exclude people who live in larger properties that13 are more difficult13 toheat
II More storms excessive winds and rain can cause flooding at any time of the yearMany UK communities are built13 close to rivers and these can surge during heavyrainfall causing houses to be filled with water and furniture and carpets lostInsurance can be problematic for properties built13 on flood plains which can blight13 properties and prevent13 owners from being able to sell and move on High winds canrip off roofs causing injury and also causing families to be left13 homeless anddependent13 on social services
III Hot13 summers Europe suffered high temperatures during the summers of 2003 and2004 leading to heat13 stroke and hypothermia The UK has not13 previously sufferedfrom such problems but13 might13 be expected to experience days of extreme
41
temperature and humidity at times Older people may not13 be prepared for suchweather Street13 dwellers may be unable to find shade and supplies of drinkingwater
Irrespective of what13 combination of weather scenarios arise it13 must13 be concluded that13 any extremes will have a major negative impact13 on vulnerable people especially if theyare not13 prepared because they havenrsquot13 received the weather warnings and advice that13 can be broadcast13 using the TV radio and online services Once again the digitallyexcluded will suffer and will pay a high cost Society will continue to pick up the bill interms of demands on social care services unless preventive actions are taken in theform of connecting these people to each other and to formal services
42
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
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13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
n13 13
13 s13
r13 n13
e13 at13
e13 y13 e13 ld13
ly13
13 e13 t13 e13
s13 er13 e13
f13
rt13 13
13 13
13
r13 13
s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
e13 g13 13
e13
13 13 ial13
13
d13
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d13 13
s13 y13
e13
13
rd13 r13 e13
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e13
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13
13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
There has been some research into alternative methods of keeping the body clean Sanyointroduced a machine in 1970 modelled on a clothes or dish washing machines the personsits on a seat13 inside the machine where13 they are cleaned by a set13 of water jets These havenot13 proved popular and furthermore require the individual to be transported to themachine Thus the technology may find application in nursing homes but13 are unlikely to beattractive to people living independently in the community
The washing needs of people change over time Over the past13 20 years body piercingshave appeared which have demanded additional attention to avoid the problemsassociated with poor hygiene and metals Similarly hair may be permed and dyed usingchemicals which are much stronger and which might13 damage the hair Add to this thepainting of finger and toe nails and the washing needs are rather different13 to what13 theymight13 have been even ten years ago Finally tattoos were once popular only with sailorsToday they are likely to be found on the arms backs and legs of both men and womenNew ways of cleaning these tattoos will be needed especially if they become infected orare sites at which pressure sores develop
Even if a personrsquos body is clean if their clothes are dirty they may become socially isolatedBut13 the washing of clothes can be strenuous even if a launderette is used The need toconserve water has driven research into ultrasound techniques to beat13 the dirt13 out13 ofclothing while some companies are experimenting with polymer chips These13 ldquogreenrdquo13 technologies are quickly maturing and are likely to be standard in the next 10 years
Other smart13 household appliances are already appearing on the market13 and may soonbecome common13 in UK homes13
bull Robovac devices have sensors to enable them to detect13 dirt13 on carpets and to adjust13 their operation accordingly
bull Refrigerators can read bar codes or RFID tags to identify their contents and theirldquouse byrdquo13 dates enabling them to inform the owner that13 they should use theproducts before they are out13 of date They can be linked to the Internet13 to reorderitems as they are consumed or to suggest13 menu options for the individual based ontheir preferences or according to the diet13 required to manage a condition
bull Ovens will automatically switch off if they are left13 without13 attention for too longand drying machines will set13 times automatically
Devices may be linked so that13 they are more efficient and report13 maintenance issues sothat13 they can be repaired (perhaps remotely) before they suffer a catastrophic breakdown
219 Personal and home13 security
It might13 appear perverse but13 people with very little personal wealth and property are morelikely to be the victims of crime than those who have expensive items This may be due towhere poorer people tend to live or because people who have valuable assets take greater
22
steps to protect13 them There can be no doubt13 that13 crime has a very negative effect13 onindividuals and on their families creating a fear factor that13 may be difficult13 to remove Theimpact13 on quality of life is therefore very considerable especially if it13 forces people to stayat home behind locked doors effectively isolating themselves from society
Modern policing places increasing reliance on the use of closed circuit13 television (CCTV)Town centres are covered by cameras used increasingly in the fight13 against13 crime by bothdetecting anti-shy‐social incidents and identifying the people involved They are also used tomonitor the movement13 of cars that13 may be involved in incidents of burglary and violenceand are fast13 becoming the primary mechanism of law enforcement13 agencies to solve crime
CCTV has moved into the home to record movement but13 monitoring the footage is timeconsuming and often not13 practical Cameras are now available which provide an instant13 video feed to a smart13 phone when movement13 is detected These may have intercomcapability allowing someone to remotely speak to an intruder sometimes before they havegained access to a building This may serve as a deterrent13 and when fitted alongside simpledevices that13 switch lights on randomly around the home may force burglars to goelsewhere
As the price of cameras continues to fall the option of carrying a camera13 on the body that13 continuously monitors personal space is becoming more useful Using wireless networksthe data13 collected can be sent13 continuously to the cloud for safe storage It cansubsequently be retrieved to provide evidence (video and audio) of confrontations enablingsuccessful prosecutions to be made The smart13 phone itself is becoming a valuable itemthat13 is attractive to criminals These can be tethered to personal attack buttons usingwireless technology allowing the device to be activated by the pressing of a button if theowner is being attacked The phones can then be tracked and located by the police whilebeing rendered useless to the assailant
Bogus callers are a perennial problem for vulnerable people Video door bells can beconfigured to display images and record the words of visitors before they are admittedallowing remote monitoring centres to oversee the situations and use image recognitionsoftware to confirm the bona13 fide of visitors Such13 arrangements may become13 commonplace13 over13 the13 next five13 or13 six years13 significantly13 improving the safety of peopleliving independently
220 Personal safety
The biggest13 risks to personal safety stem from fires and falls Most13 fires are the result13 ofpoor cooking practices resulting in burns or scalds Floods and gas emissions are caused bya failure to remember to close taps
The current13 approach involves detection of an emergency situation as soon as possible but13 always after a problem has already occurred This responsive approach can minimise therisks provided that13 there is a protocol in place for intervening This could increasingly be an
23
automated response such as the switching off of the gas of water or the switching on of asprinkler system or a water mist13 system
In the future monitoring systems will be more sophisticated and will have sensors and localintelligence to identify activities In this way reminders can be issued before an emergencyoccurs13 This lsquosmart kitchenrsquo approach may become13 an integral part of13 homes of13 vulnerable13 people
A prototype system has been developed at the Culture Lab in Newcastle Sensors havebeen embedded into cooking utensils enabling the kitchen to identify what13 the person istrying to cook or prepare It can provide interventions as messages on an instructionscreen
Accidents also occur out13 of doors People with dementia13 might13 become lost13 and may havepoor road safety awareness Location devices based on GPS have advanced from large andheavy receivers that13 were used on ships and boats to small battery-shy‐operated devices that13 can be carried in the hand or in a handbag The current13 generation of locators has limitedbattery life and are rather too large to be secreted about13 a personrsquos clothing while devicesthat13 are integrated into a wrist-shy‐watch are rather clunky and unattractive
Within 10 years the13 technologies13 will have13 matured and will be13 much smaller13 so that theycan be embedded in shoes in walking sticks hats or any other item of clothing Powerrequirements will have reduced so that13 energy harvesting from the movements of theindividual will be sufficient13 to keep these products working for several weeks without13 theneed for recharging The devices will not13 simply indicate to others where the individualhappens to be but13 will provide subtle guidance cues to direct13 them home
Cameras might13 also form part13 of the personal security systems that13 will protect13 people fromaccidents Data13 may be sent13 to the cloud and analysed in real time if the person is in adangerous location and can provide prompts either to the individual or broadcast13 advice toothers to clear the danger These systems may be embedded in items of clothing (such as ahat) or they may be attached to spectacles
221 Energy and13 portable power supplies
The demands of developing economies for more power will inevitably lead to higherdomestic fuel charges in the UK especially as oil and gas reserves dwindle
By 2018 UK homes should be fitted with new smart13 meters The specifications for these13 devices have yet13 to be finalised but13 will include a means of identifying wasteful use ofenergy including TV sets that13 are left13 on and unattended fridges and freezers that13 are set13 attoo low temperatures and dryers that13 are used for too long or when the weather is suitablefor using a washing line They could be an enabling factor that13 supports changes inbehaviour driven by a need to use less power but13 it13 is unlikely that13 they will offer a bigreduction in costs that13 are already a problem for many vulnerable families
24
More generally the need for power conservation will include devices that13 are moreefficient and a significant13 emphasis on heat13 retention in buildings through betterinsulation
The energy crisis may force many people to spend more time in community settingsincluding shops and public buildings where they can benefit13 from the warmth Increasingreliance on mobile communication devices will lead to increasing demand for batterycharging facilities
Greater use may be made of portable devices for generating power based on solar cellswind or hand motion
222 Smart cities and homes
The Digital City initiatives have been based on information and how it13 can be used most13 effectively to make people aware of what13 is going on around them This means bettercoordination of resources more rapid access to advice and a battery of sensors measuringevery conceivable parameter from sound and light13 levels through to air quality andtemperature fluctuations There are several Digital or Smart13 City initiatives currently beingimplemented both in the UK and across the world They may significantly impact13 the livesof the millions of people living in them but13 the timeframe for outcome benefits to influenceplanning and design elsewhere is likely to be at least13 20 years and therefore outside thetimeframe of the current13 project
Housing plays a big role in the lives of most13 people both through their aspirations to moveup in the world (usually to a bigger property with a garden) and as the heart13 of the familylife which is associated with good quality of life UK properties have a life span approaching100 years which is about13 double that13 of their European counterparts (and certainly longerthan the wooden-shy‐frame buildings built13 in North America13 for example) A shortage ofhouses has plagued improvements in social welfare for the past13 30 years There is anargument13 that13 there are enough houses but13 the wrong size and in the wrong places andthis has some basis in fact13 as demography changes lead to more people (and more olderpeople) living alone However if there are two million homes in Scotland each with alifespan of 100 years then the renewal rate needs only to be 20000 per annum to maintainthe status quo However it13 must13 be clear that13 the impact13 of smart13 house development13 willbe small The focus should therefore be on adapting existing properties to render themmore appropriate for vulnerable people
Housing adaptations are a branch of assistive technologies The technologies for providingdifferent13 forms of accessible bath and level access shower are well-shy‐established with littleresearch considering anything other than alternative building materials and methods formaintaining the temperature of the bathwater Different13 technologies for bathing will beconsidered separately
25
Thus housing technologies are not likely to impact on social work13 within the next 20years13 though13 the use of information13 technology13 to ensure that people are aware of what13 is available is likely to be commonplace well before then
26
3 BEHAVIOUR AND ATTITUDE CHANGES DUE TO TECHNOLOGICALADVANCES
Technology is only one factor that13 will affect13 the way society changes in the next13 10 or 15years This chapter will consider the context13 in which the technological developmentsoutlined in the previous chapter will be supported (or held back) by societal factors
When the impact13 of such factors has been considered we can then apply theseassumptions to a number of case studies listed in Appendix13 A13
The headings selected for this chapter are not13 arbitrary as they reflect13 the context13 in whichtechnological changes must13 be considered They must13 include consideration of factors suchas demography and long-shy‐term conditions already addressed in the introduction to thesepapers together with the aspects of workforce and citizenship considered in the parallelpapers The additional elements here focus on trends that13 are already occurring and whichmay leave people struggling with the changes that13 occur
Finally there is a need to consider the attitudes of people to technology generally andespecially to the issues of privacy and social responsibility that13 could be radically changedby technology In some cases public opinion will prevent13 some forms of technology beingdeveloped if not13 commercialised In other cases some technologies will be fast-shy‐trackedeither at the request13 of government13 or because of a clear public demand for theopportunities that13 it13 can bring
Predictions13 about the13 future13 must inevitably be13 subject to considerable13 uncertainty butthat is no reason to stop thinking what might happen
31 The Welfare State
The UK can be rightly proud of the way that13 its welfare state has developed during the past13 100 years to provide a safety net13 of financial support13 to people and to their families whenthey are unemployed destitute homeless or challenged by crises and emergencies Therange of benefits received is considerable some are complex and many people struggle tounderstand their entitlements Some are universal some are discretionary some apply onlyto parents others to anyone
The total cost13 of providing these benefits continues to rise and when the economy isstagnating there is inevitably both political pressure often supported by popular publicopinion to introduce welfare reform so that13 people who do not13 work cannot13 be better offthan they would be if they were in full-shy‐time employment This strategy requires a universalbenefit13 to be introduced so that13 it13 is easier for claimants to access support13 but13 also easierfor agencies to identify the total benefits received The idea13 of a benefits cap then becomes
27
more practical to introduce especially if all the processes involved in making a claim arehandled electronically Indeed this encourages government13 to insist13 on applications forbenefits to be made on-shy‐line Unfortunately this will marginalise those people who haveneither a computer nor access to the internet thus emphasising the digital divide in amanner which works against13 some of the most13 disadvantaged people in society
There are currently few tangible links between digital technology and welfare provisionThe most13 obvious are universal benefits such as a free television licence (worth pound14550)13 for13 everyone aged 75 or older with blind and visually impaired people entitled to a 50discount13 irrespective of their age The significance of this position is that13 6 of revenuesgenerated through licence fees are to fund BBC on-shy‐line services13 such13 as websites and i-shy‐player In Scotland the BBCrsquos Alba Gaelic language television service is predominantlyfunded13 by MG Alba an organisation funded by the Scottish Government It is thereforeconceivable that13 in the future licence fees may be used to directly subsidise access toinformation and advice through the Internet13 for vulnerable people whether it13 is throughbroadband access or through a set-shy‐top box which removes the need for a computer in thehome to access particular websites or to use e-shy‐mail services
A second age-shy‐related benefit13 available in the UK is the winter fuel subsidy People whoreceive certain benefits receive the payments automatically while others must13 make aclaim Those who are not13 eligible for benefit13 due to a lack of an address for example missout13 on these payments and also on Cold Weather payments of pound25 for each seven dayperiod of very cold weather between 1 November and 31 March
The development13 of new warm home initiatives plus the complex of subsidies that13 theelectricity supply industry and government13 offer to people with solar cells further changesthe economic arguments Global warming may lead to greater variations in weatherextremes but13 might13 also increase the amount13 of electricity that13 can be generated byalternative (green) sources such as wind and solar cells It is estimated that13 energyconsumption in the UK increased by 17 between Christmas and Easter 2013 compared toprevious years as a result13 of cold weather but13 the above subsidy scheme did not13 benefit13 older people because two of the seven day cold periods were after 31st March It must13 beassumed that13 there will be more people living in fuel poverty in the future and this will leadto more cases of cold related illness including influenza13 and stroke
32 Management of long term conditions
The management13 of long term conditions will be improved for patients who are compliant13 with their medication regime so it13 is possible that13 there may be compulsion to adhere tothe prescription Such compulsion may be monitored using technology Indeed the remotemonitoring of vital signs using telehealthcare will become commonplace as the old boxesand sensors are replaced by devices that13 can be worn continuously or which can beembedded into the fabric of homes (including furniture and bedding) or can be worn asvests or patches They will wirelessly transmit13 data13 to smartphones or tablets and mobile
28
transmission and cloud technology will enable real-shy‐time data13 collection analysis andfeedback
One of the diseases which is projected to increase most13 significantly over the comingdecade is Type 2 diabetes Whilst13 there is a hereditary susceptibility to this condition formany people including those from the Middle East13 and the Asian sub-shy‐continent it13 is also adisease which tends to affect13 those people who are overweight13 andor have a sedentarylifestyle If untreated diabetes can lead to dizziness and collapse at any time but13 can alsohave more devastating long term consequences which include kidney failure strokeblindness and in extreme cases lower limb amputations Management13 therefore includesdaily monitoring of blood glucose levels and major dietary changes such as a significant13 reduction in the consumption of carbohydrates as well as a rigid exercise regime
Many newly diagnosed diabetics follow this advice closely and can lead normal lives for 40years or more but13 some struggle to accept13 the change in lifestyle required as well asremembering which foods are allowed and how much exercise they need to takeIndividual support13 plans are now forthcoming and over the next13 ten years best13 practicewill emerge in the form of smartphone apps that13 are personalised and which can becomean individualrsquos health coach This level of support13 will be fine for some people but13 otherswill need incentives so it13 is likely that13 gaming technologies will be introduced perhapsoffering rewards for good compliance There will be a temptation for some people tocheat perhaps allowing others to perform exercise for them or changing theirconsumption details
Many of these opportunities for cheating will be removed through the use of a uniquebiometric identifier a technology that13 will be mature enough to use in place of passwordson smartphones However the biggest13 challenge may be in encouraging older people to usethe technology Many older people have multiple morbidities Indeed a survey of Scottishpatients implied that13 42 of people aged over 80 will suffer from three long termconditions It will be essential for those people to comply with treatment13 regimes if they arenot13 to have the functional deficits that13 follow
33 Finding people who13 donrsquot fit
People who have low social capital are likely to have few relatives and friends with whomthey regularly communicate and are also unlikely to be part13 of community or faithorganisations such as clubs societies and church groups They also die several yearsyounger than most13 of the population often because they donrsquot13 engage with public healthinitiatives such as vaccinations against13 flu regular checks on their blood pressure bloodsugar levels or in the case of women smear tests or mammography The most13 likelyreason for disappearing beneath the radar of such initiatives is their mobility which leadsalmost13 inevitably to them having no fixed abode and no fixed telephone line It thenbecomes very difficult13 for them to be contacted because their mobile telephones are likelyto have Pay-shy‐As-shy‐You-shy‐Go contracts that13 donrsquot13 require validated names addresses and bankaccounts
29
It follows that13 some of the most13 vulnerable people in society including those who live onthe streets are effectively unknown to both the NHS and to social work departments untilthey are referred in a crisis This could be an emergency presentation to a hospital Accident13 and Emergency Department13 where they will come into contact13 with a social worker becausedischarge may be unsafe This often highlights the importance of the prevention agenda13 and the potential for avoiding admissions to hospital by intervening at an earlier stage
The advantages of being able to locate people who are vulnerable to specific diseases willincrease as genetic testing becomes more routine It is already possible to determine whomight13 be most13 at risk of breast13 cancer and prostate cancer as a result13 of family history Addto this the evidence that13 particular diet13 and exposure to environmental factors can furtherincrease risk then it13 is evident13 that13 individuals can be identified and offered treatmentsthat13 could save their lives many years before they become ill In the case of cancersperhaps only the individual is involved but13 for infectious diseases it13 is the whole of societythat13 is at risk if someone contracts one of the new strains of influenza or if someonechooses not13 to be vaccinated against13 rubella In Chinese airports all visitors are screenedfor fever and refused entry if they tested positive in cities the public are monitored in thesame way Similar approaches may be necessary in the UK if potential carriers cannot13 otherwise be identified
34 Volunteering
It is estimated that13 72 per cent13 of people volunteered to perform a charitable act13 at least13 once during 2012 a rise from 65 per cent13 the previous year About13 four out13 of every 10volunteers offer their services formally to one or more organisations The remaindervolunteer informally by helping out13 a friend or a neighbour Around 50 per cent13 volunteered at least13 once a month in the past13 year up from 41 per cent13 on the previous13 year Most13 have retired many of them before the statutory retirement13 age Those whodonrsquot13 feel able to offer time have offered their financial support13 at a time when the fundingavailable from sources such as the National Lottery has been decreasing Despite economicausterity donations to charities have been increasing 74 per cent13 said they had given tocharity at least13 once in the previous month up from 72 per cent13 the previous year
Strikingly 78 per cent13 of people strongly believe that13 they are part13 of their localneighbourhood an increase from 70 per cent13 10 years previously Community cohesion isstronger than ever 87 per cent13 of people believe their local area13 is a place where peoplefrom different13 backgrounds get13 on well together compared to 80 per cent13 in 2003
The role of volunteers in supporting vulnerable people is therefore likely to increase overthe next13 decade perhaps exploiting the success of the army of volunteers that13 was highlysuccessful in London during the Olympic and Paralympic games The greatest13 role for suchvolunteers may be in providing informal care for older people Already the UK has someseven million informal carers whose value in monetary terms has been calculated to be
30
more than the combined budgets of the NHS and social care Maintaining or extending thisprovision will help to support13 services in the future and may be supported by technology
Whilst13 there is ample evidence to suggest13 that13 telecare services support13 informal carers asmuch as (if not13 more than) the people that13 they are caring for it13 is the potential for utilisingthe internet13 and apps to make their role easier to coordinate and hence more effectivethat13 is likely to be most13 successful moving forward
Many of these focus on particular tasks that13 informal carers can help offer to older peoplesuch as organising their medication A pillbox program is just13 one feature of an app calledBalance It also includes sections for caregiving tips notes for the doctor and the patientsappointments plus a lsquolearning sectionrsquo with articles on aspects of Alzheimers and an RSSfeed for news about13 the disease Tyze is another multi-shy‐functional app it13 allows carers to
bull Organise appointmentsbull Plan outingsbull Share storiesbull Send updates to other family members
Another application is Rally Round which helps carers to organise someone to perform littlejobs often on a temporary basis when someone has dementia physical frailty or isrecovering from accident13 or illness Similar applications are MeMaxi and Finerday
35 The High13 Street
The shape and appearance of UK shopping centres have been changing for half a centuryPeople complain that13 centres are losing their identity with one town looking like everyother both in terms of the stores and in terms of the layout But13 there are three trendswhich are having a profound impact13 on many of the most13 vulnerable people in society
bull Centres lock their doors at 6pm or in some cases 10pm -shy‐ thus denying people whosuffer from claustrophobia13 from window shopping at times when other shoppershave left
bull Out13 of town shopping malls -shy‐ these US style centres are ideal for people in carsbecause they offer free parking which is essential for people who want13 to buy largeritems but13 difficult13 for people who have no transport13 and who must13 rely on publictransport13 that13 is often deficient
bull The rise of online shopping -shy‐ which means that13 many potential shoppers only visit13 High Street13 stores to check the prices before returning home to make a purchaseonline
It is the third of these effects that13 has the greatest13 potential for changing the High Street13 forever and it13 is making life for traditional retailers increasingly difficult13 at a time when highrents are crippling stores large and small It is difficult13 to see how this trend is likely tochange because consolidation in banking and estate agencies is already forcing the closure
31
of other High Street13 players while additional pressures on pubs has led to the closure ofthousands of pubs every year
Those figures however demonstrate that13 consumers still value what13 the high street13 canoffer -shy‐ the chance to inspect13 what13 theyrsquore thinking of buying -shy‐ as well as the new opennessof the internet Customer service makes a difference to people especially if there is aproblem and goods need to be returned One of the most13 common reasons for furniture tobe returned for example is that13 when a sofa13 or a wardrobe was delivered it13 couldnrsquot13 fit13 through the front13 door or up the stairs In the future people will be able to benefit from13 visualisation technology they will upload the floor plans of their homes enabling theretailer to inform them of the problem before they try to delivery Augmented reality viewwill similarly allow customers to see what13 a new item of furniture will look like in itsintended place so that13 they can be more informed about13 the effect13 of size and colour
In terms of improving the viability of the High Street stores will have to focus on theimportance of brand which could mean that13 individual independent13 retailers will have topartner with national suppliers to support13 a local tailored offering based on products that13 are designed for a more global market This is a lsquoconnected High Streetrsquo approach whichcould be enabled by the developments in internet13 availability and smart13 phone accessdescribed in the previous section
The overall effect13 of all these changes could mean that13 town centres become smaller but13 more vibrant13 areas They could thrive if people are attracted there in large numbers whichmeans that13 retail must13 be developed alongside restaurants pubs galleries and other leisureopportunities This is possible in new shopping centres which are already being integratedwith transport13 hubs including railway and bus stations but13 may be more of a design13 challenge for older towns and cities with large Victorian buildings To ensure that13 morepeople are welcomed into the new centres they should include attention to green spacesand areas where people can relax without13 feeling that13 they are second class citizensbecause they donrsquot13 have the same buying power
3513 Privacy
To some people privacy is their right13 to live their lives without13 interference they may seethe State as a potential lsquoBig Brotherrsquo spying on their every move and judging their actions13 and activities Other people have fewer concerns about13 the role of the State but13 great13 fearof individuals interfering with and invading their privacy Some embrace the concept13 of lsquomyspacersquo an area13 of a square metre or so into which nobody can enter without13 permissionThis allows them to avoid physical contact13 and to feel safe from any form of threateningbehaviour
Yet13 this idea13 of private space and its potential violation is merely the tip of the iceberg asfar as privacy is concerned more significant13 is the idea13 of personal (and private)information being shared with anyone and everyone This could be related to identityopinion or image for an individual who wants to remain anonymous or even secretive thisis going to become an increasing problem as technology provides the means of taking
32
photographs recording conversations and capturing environment13 with something as smalland ubiquitous as a mobile phone The fact13 that13 this information can then be shared withthe rest13 of the world using e-shy‐mail Twitter and Facebook makes the problem all the moredifficult So the threat13 is no longer solely from the long lenses of the Paparazzi but13 fromanyone (and that13 means everyone) who has even the most13 basic of mobile phones
This relates to the changing views of society on what13 information should remain privateand what13 should be shared with others The success of social media13 has been based on anattitude of lsquosharing everythingrsquo with either your friends or the world This has introduced anaiumlve idea13 in the minds of some younger people (especially those known as Millennials ieaged 18-shy‐30) that13 everyone can be their friends whilst13 perhaps failing to reinforce the bondsof genuine friendship with any form of test13 or restriction Technology could play a role indefining these friendships and allowing individuals to understand what13 makes a goodfriend but13 this approach has yet13 to be developed and may be slow to overcome the needfor some people to measure their own popularity simply as the number of people that13 theycan list13 as friends on their Facebook page
It follows that13 there may be a need for a new definition of privacy that13 is in keeping withthe web and its ability to display images and opinion in an unregulated manner This needsto embrace past13 concerns about13 the ability of an individual to live without13 the threat13 ofothers being able to watch them whilst13 offering some protection from random postingsabout13 them online Perhaps this could include a right13 to be able to edit13 or remove anythingrelating to themselves on the Web including images that13 are not13 news-shy‐worthy Theownership of image rights may be an associated issue that13 needs to be addressedespecially as modern technology can remove an individual from a group (or a background)13 view provide digital touch-shy‐up or air-shy‐brushing and then republish it13 in a different13 contextHowever there is general agreement13 that13 personal information (such as contact13 details andbank codes) should not13 have a place on the web Surprisingly few people take proactivemeasures to prevent13 tracking functions being activated
It follows that13 too much privacy could lead to younger people fearing that13 they maybecome lost13 in a digital world It is not13 surprising then that13 they are prepared to make lots13 of personal information available often with no fear of how it13 might13 be used by othersWhen Google glasses and similar technologies become available during the next13 few yearsthey will have the potential to identify a stranger walking down the street and to find manyof their secrets to present13 to the wearer in a fraction of a second They could know moreabout13 them than their genuine friends know -shy‐ so who will be their friends in the future
36 Data sharing and13 protection
By lsquodata13 sharingrsquo we mean the disclosure of data13 held by one organisation on an individualto a third party organisation(s) or the sharing of data13 between different13 parts of anorganisation Some data13 sharing doesnrsquot13 involve personal data13 because it13 has beenanonymised in such a way that13 the statistics can be used for the collective good without13 theidentification of the individual The Data13 Protection Act13 (DPA) is in place to provide a legal
33
framework that13 ensures that13 organisations that13 hold personal data13 must13 act13 responsibly atall times These principles adequately describe the position of public and government13 bodies especially social services departments who are responsible for the informationconcerning the health and well-shy‐being of individuals -shy‐ and hence by implication thesensitive data13 relating to their vulnerability
The legal framework that13 applies to private and third sector organisations differs from that13 which applies to public sector organisations which may only act13 within the defined limits oftheir statutory powers However all bodies must13 comply fully with the data13 protectionprinciples and this situation is unlikely to change within the next13 10 to 15 years In someprivate sector contexts there are legal constraints on the disclosure of personal dataHowever most13 private and third sector organisations have a general ability to shareinformation provided this does not13 breach the DPA or any other law It is advisable for acompany to check its constitutional documents such as its memorandum and articles13 ofassociation to make sure there are no restrictions that13 would prevent13 it13 from sharingpersonal data13 in a particular context The type of data13 held is therefore a subject13 ofconcern as it13 may be difficult13 for legislation to keep up with the additional layers of data13 created on-shy‐line and through the Internet13 of Things
Private and third sector organisations should have regard to any industry-shy‐specific regulationor guidance about13 handling individualsrsquo information as this may affect13 the organisationrsquosability to share information They should also be aware of the legal issues that13 can arisewhen sharing personal data13 with public sector bodies This becomes more of an issue asprivate and third sector bodies are carrying out13 a wider range of traditionally public sectorfunctions Opportunities for inappropriate sharing of sensitive data13 will therefore inevitablyincrease
Public authorities must13 comply with the Human Rights Act13 (HRA) legislation in theperformance of their functions The HRA also applies to organisations in the private sectorinsofar as they carry out13 functions of a public nature which could include delivering a socialcare activity Where the HRA applies organisations must13 not13 act13 in a way that13 would beincompatible with rights under the European Convention on Human Rights Article 8 of theConvention giving everyone the right13 to respect13 for their private and family life their homeand their correspondence is especially relevant13 to sharing personal data If personal data13 isdisclosed or shared in ways that13 comply with the DPA the sharing or disclosure of that13 information is also likely to comply with the HRA The problem may still be in policing theActs and the rights of an individual if they believe that13 their personal data13 has been sharedor accessed by an inappropriate organisation or individual
A legal industry may be born to deal with such matters but13 this is unlikely to benefit13 peoplewho cannot13 afford the fees involved They would require either legal aid or to employ13 more13 lsquono win no feersquo companies Public attitudes to such costs might13 become negative unlessthey prove successful in preventing breaches of data13 security There may need to belegislation to provide a stronger basis for forcing compliance with privacy laws
34
37 Connecting with13 people
We are social creatures most13 of us rely on our friendships and interactions with friendsand families to share our happiest13 moments and experiences Research suggests that13 thishappiness is infectious at all levels and leads to a 15 increase in the happiness of a closecontact 10 for a second degree contact13 such as the friendrsquos spouse and a 6 increase fora friend of a friend It is hardly surprising that13 the success of social media13 such as Facebookis intimately related to the ability of people to quickly share their happiest13 moments with asmany of their friends and connections as possible
All this has happened during the rise of the Internet13 and the corresponding increase inopportunities for connecting online ie this is a 21st Century phenomenon which has beenfacilitated by Information and Communications Technology But13 the Internet13 remains in itsinfancy and we are only beginning to understand and exploit13 its potential In terms ofaccessing the Internet there are now perhaps two billion people who have access with99 of them having gained this during the past13 decade This number will have doubled bythe period 2020 to 2025 It is likely that13 everyone who wants to be connected in the UK willby then be connected Turning this on its head only those who donrsquot13 want13 to be online willnot13 be on the Internet13 within a decade Connecting with the unconnected will therefore bea case of identifying those people who donrsquot13 want13 to be found unfortunately these mayinclude many people who need the support13 of social care organisations It means that13 theywill be looking for support13 only when they are in crisis unless other ways of finding andormonitoring them are found
While the number of people connected via the Internet13 has exploded this might13 bedwarfed by the number of connected lsquothingsrsquo During 2009 the number of thingsconnected to the Internet13 surpassed the number of connected people at which point13 webegan to experience what13 this report13 has described as the lsquoInternet13 of Thingsrsquo Yet 99 ofall physical objects that13 could join this network are not13 yet13 connected but13 the number couldgrow by 25 every year for the next13 decade so that13 there could be 100 billion connectedobjects by 2025 some of which will be owned or used by everyone in the UK includingthose people who donrsquot13 want13 to be connected themselves We will then have an Internet13 of Everything which will be the smart13 connection of people data events and actions
With each new person object or data13 that13 comes online the connection possibilitiesbetween all these elements grows exponentially The rise of big data mobile networkingcloud storage and data13 mining technologies will all play a critical role in the Internet13 ofEverything The result13 will be new capabilities richer experiences and unprecedentedvalue for individuals businesses communities and countries everywhere The lsquonetworkeffectrsquo of the Internet13 of Everything will be a very powerful thing the true impact13 of whichwe wonrsquot13 fully understand for several years As it13 develops however those who are not13 connected will feel even more digitally and socially excluded There will be a need to reachout13 to vulnerable people unless the process of claiming requires proof of online identityand the payments to be received can only be redeemed using a chipped card or adownloaded app onto a smartphone This is of course the way that13 welfare arrangementsare already developing thus it13 might13 prove impossible to make a successful claim without13
35
already being connected to lsquothe systemrsquo either through an online presence or through theInternet13 of Things
38 Downloading everything
Sixty years ago information was discovered by reading books often in a library wherenotes had to be made because the books or journals couldnrsquot13 be removed Then in theearly 1960s the first13 office photocopying machines were introduced into the UK theyimmediately meant13 that13 pages or articles from books could be copied and taken away to beread and summarised later Within a few years photocopying became a replacement13 forreading as researchers became less adept13 at selecting a few sentences and every deskbecame a depository for reams of printed paper Paper became the means of recordingeverything from bank statements through to music
We now appreciate that13 printing everything is a waste of both the ink (or toner) used tocreate the black print13 and of paper which requires trees to be chopped down and pulpedbefore it13 can be pressed into thin sheets Saving paper is therefore seen as green and goodfor the planet Fortunately we no longer need to print13 everything because computermemory is unlimited thanks to the cloud and we can then view pages and articles onportable or fixed screens
The internet13 has everything and it13 is all available instantly for downloading providing thereis a device available to accept13 it and there is sufficient13 communication bandwidth toperform the transfer of data13 sufficiently quickly Thus we can record all text13 articles that13 are relevant13 to us including digital records of birth certificates qualifications and passportsand the need for original printed versions will decline But13 we can also do this forphotographs Most13 handheld computing devices include at least13 one camera so they cangenerate enormous number of pictures which can be kept13 for posterity without13 having toconsume inks and special papers to print13 them
But13 the materials that13 can be downloaded donrsquot13 stop at pictures software is available that13 can grab TV shows after they air and movies as soon as theyre released In the same wayit13 is possible to schedule music comic books video games and practically anything else asa download with minimal effort People will need enormous hard drives if they want13 theirown digital copies of these files so will more than likely make use of cloud storage that13 willbe available from many organisations The location of the servers may become sensitivedue to border restrictions as will the security of the data13 and the way that13 it13 is backed up sothat13 it13 is resilient13 to failures
It may be evident13 that13 application forms for all types of welfare payment13 will be availableonly for downloading so that once digitised they can be processed by computer andrecords sent13 to various servers for subsequent13 storage and processing Some people maywant13 to keep their data13 on them once it13 has been downloaded Pen drives can already holdseveral GB of data so it13 is likely that13 people will be able to carry their downloaded data13 withthem at all times irrespective of the size and complexities of the information
36
39 Health13 and13 well-shy‐being
The general health of the population is unlikely to deteriorate noticeably within 10 to 20years Indeed expectations of the population are that13 things must13 improve as surgicaltechniques mature and as pharmaceutical interventions become more personalised andpowerful However the rising demand for health services due to an ageing population andthe increasing cost13 of providing sophisticated therapies will make delivering a free anduniversal health service difficult13 without13 substantial increases in taxation This is unlikely tohappen in the UK even though spending on health services will be protected against13 thecuts facing other services
There will have to be changes in how the NHS works For twenty years hospitals have beenclosed and replaced by fewer new facilities so that13 the bed count13 is reduced This has led toa significant13 shift13 in resources to primary care and community care supporting shorter staysin hospital and speedier transfer back home for people after surgery or illness This hasbeen13 successful but13 there remain problems with demand for GP services especially out-shy‐of-shy‐hours and at weekends Indeed despite the introduction of NHS24 and similar help-shy‐linesthe demand for GP appointments continues to increase Delays are inevitable and this willincrease system failures with more unnecessary deaths and a failure for people to access adiagnosis that13 might13 lead to early interventions and ultimately lower delivery costs Over250 more patients are added to waiting lists every day
This will lead to a new model of primary care consistent13 with existing changes which haveseen surgeries move from High Street13 locations to medical centres close to bus routes andwith more parking for patients The process of making an appointment13 is changing from atelephone-shy‐based interview process dominated by a medically-shy‐unqualified receptionist13 to achoose and book approach using an online process linked to electronic patient13 records Thiswill give patients more convenience but13 will allow priority for those who have Internet13 access at the expensive of those who are digitally excluded Making the process of bookingan appointment13 quick and easy may also increase demand from people who do not13 need tobe seen as it13 will fail to identify those in greatest13 need
A greater use of telehealth and telecare technologies will be inevitable beginning with thefirst13 contact13 as an encounter using the telephone e-shy‐mail or video conferencing -shy‐ a visit13 tothe GP surgery should be a last13 resort and should involve a nurse consultation in the first13 instance This would be consistent13 with three quarters of appointments currently involvinga chronic disease or long term condition which relates to improved self-shy‐care The support13 ofthese patients at home should be prioritised through tele-shy‐ and web-shy‐based technologies andshould involve training and coaching through a network of nurse practitioners Home visitsshould generally be unnecessary through the use of these technologies but13 could besupplemented by satellite surgeries manned by nursing in community premises or inpharmacies nurseries and Internet13 cafes
The homes13 of people who13 need13 closer monitoring can then become part13 of virtual wardswith real or electronic visits by health professionals University Hospital Southampton NHSFoundation Trust13 already looks after patients who have undergone surgery such as a hip orknee13 replacements in virtual wards with high levels of satisfaction The Royal Free London
37
NHS Foundation Trust13 offers a similar service but13 plans to add the possibility of videoconsultations between patient13 and consultant
310 Attitudes to public health issues ndash obesity smoking alcohol abuse drugs
As self-shy‐care becomes the focus of the NHS the public will increasingly understand that13 thecosts and availability of services are being harmed by the poor health behaviour ofrelatively small numbers of people The link between public health initiatives today andhealthcare needs and costs in the future will become increasingly evident13 as a result13 of theway that13 information is presented Thus the overweight13 smoker who currently attractsconcern and pity when they are diagnosed with diabetes and COPD is increasingly beingseen as the victim of their own stupidity or lack of self-shy‐discipline If they continue to neglect13 medical advice and continue with an unhealthy lifestyle then the way that13 they receivetreatment13 and consume resources will become a matter for the entire population
Obesity is seen as due to a combination of poor diet13 and a sedentary lifestyle No longer isthe idea13 that13 people are lsquobig bonedrsquo acceptable Governments will respond initially byrequiring manufacturers and food processors to provide nutritional information onpackaging and on menus in restaurants But13 people can choose not13 to read the data13 and toneglect13 both the importance of food quality content13 and quantity This will increasepressure to introduce fat13 or sugar taxes and these are likely to be in force within a decade
Although the high taxes on tobacco products has forced some smokers to reduce theirconsumption or to give up altogether the impact13 has been reduced by the smuggling ofproducts from overseas and by the availability of duty-shy‐free cigarettes for people returningfrom foreign holidays and business meetings Further measures are planned to changepackaging and to include even more graphic images and warnings on cigarette packages tomake smokers aware of the effects of smoking on their health and well-shy‐being There is asyet little evidence of how successful this might13 be More effective has been the banning ofsmoking in public places including trains and aircraft Expensive medical interventions suchas heart13 transplants will be denied to individuals until they change their lifestyle behaviourSmokers might13 therefore be increasingly ostracised leading to a loss of esteem This mayhave a particular impact13 on people who already suffer from mental health problems whoare more likely to smoke
The overuse of alcohol is being recognised as a major factor in hospital admissions withNHS figures showing an increase of over 40 in such admissions over the past13 decadeLinked to this has been a 75 increase in prescriptions to treat13 alcohol dependency Fewpeople have sympathy for those who waste their limited income on booze If they havechildren or other dependents they will be the ones who suffer and who may need thesupport13 of social care
Drug users are already significant13 users of social services as their habit13 is likely to makethem unemployable They receive little sympathy from the general public because they areseen as criminals and people who waste public resources Levels of drug abuse have been
38
slowly increasing over the years but13 this trend is slowly being reversed Indeed the numberof people using drugs during the past13 year has fallen to its lowest13 level for nearly 20 years(below 9) with cannabis being most13 likely often following excessive drinking Aselectronic noses and other technologies can detect13 traces of drugs it13 seems likely that13 success in overcoming addiction can be measured objectively This may become a two-shy‐edged sword rewarding those who can turn around their lives but13 further marginalisingthose who canrsquot13 or wont13 accept13 the lsquocold turkeyrsquo
311 Attitudes to surveillance
Issues associated with privacy confidentiality and data13 security have been discussedpreviously in the context13 of information technology the World Wide Web and the ease ofcollecting recording recalling analysing and displaying data The monitoring of individualsand their methods of using this information can be regarded as surveillance As thequantities of data13 increase along with the number of devices that13 can be used to access itthe surveillance tools will also increase in their sophistication Indeed the Big Data13 approaches described in the previous section will enable the combination of structureddata13 (such as the information held in databases) to be married with unstructured data13 fromimages in such a way that13 it13 can be mined
Whilst13 the lsquodigital surveillancersquo methods described above may cause most13 concern topeople because of its impact13 on anonymity it13 is the collection and analysis of images that13 are the major concern to people as they contemplate the ways that13 lsquoBig Brotherrsquo maydevelop to restrict13 freedom Every major UK city and town centre has an array of CCTVcameras that13 continually record activities from every angle If it13 used to be true that13 nobody in London was more than 10 yards from a rat it13 is certainly the case today that13 nobody can be more than this distance from being in view of a surveillance camera Yetthey receive so much positive publicity from TV programmes where their footage is used todetect13 vehicles close to a crime scene or to monitor the movements of suspects that13 theyare now accepted by the public as a deterrent13 in the same way as lsquobobbies on the beatrsquowere seen 25 years ago There is therefore little public reaction to the expansion in the useof video surveillance except13 for the practical observation of how so many views can beinspected and recorded
Looking to the future the tumbling cost13 of video technology will surely lead to anotherincrease in the number of devices The aerial views taken from towers will besupplemented by more local views taken by devices that13 are embedded in the fabric ofbuildings or carried by individuals either on their person (for example on clothing orspectacles) or in the bags that13 they carry The time and date-shy‐stamped images as Big Datawill be recorded to lsquothe Cloudrsquo where it13 can be added to other data It can then be usedwhen an incident13 has occurred or to provide further detail of night-shy‐time activities
It follows that13 there will be no hiding place for people who simply want13 to disappear Theymay respond by wearing clothing (such as hoodies) that13 hide their faces or which make it13 difficult13 to distinguish gait13 or mannerisms from which they might13 be identified New forms
39
of clothing may be designed to make shapes more difficult13 to analyse and these might13 become the uniforms of a class of person who wants to live in a way that13 they donrsquot13 interact13 with officials from any ministry or local government13 department If they also obstruct13 services then they will be considered to be anarchists of some form sparking protests fromother sectors of society
31213 Attitudes to driving
Motor cars have been a feature of UK roads for over a century but13 it13 is only during the past13 50 years that13 they have become a resource that13 most13 families have had access to enablingthem to travel without13 the restrictions imposed by a limited railway network and non-shy‐integrated bus transport People who have had a car throughout13 their lives often see theircars as an important13 factor in enabling them to remain independent13 and to exercise choicesrelating to where they shop and where they spend their leisure time This extends to theirspouse and to friends and neighbours that13 they might13 take with them on their variousexpeditions
Unfortunately there are incidents involving older drivers who perhaps go down amotorway in the wrong direction who are taken ill at the wheel or who are involved in anaccident13 involving no other vehicles These are small in number but13 often lead to a reactionthat13 they shouldnrsquot13 be allowed to drive lsquoat13 their agersquo Age itself is not13 an indicator ofdriving quality but13 because old age also brings more chance of having limited long termconditions and other illnesses it13 is easy to make a link between driving ability and age Thelicensing system does require continued driving to be linked with medical advice andforbids people with poor eyesight epilepsy and other conditions to hold a licence in oldage
Yet13 statistically older drivers cause far fewer accidents than younger drivers The reasonsfor this may be complex and are likely to include the fact13 that13 they drive less often covershorter distances and donrsquot13 go out13 in the dark or in poor weather However it13 does not13 wholly explain why the UKrsquos drivers aged over 70 and who represent13 some 8 of all driversare involved in only 4 of accidents that13 cause injury This compares favourably with the15 of13 drivers aged between 17 and 29 who are involved in over a third of crashes that13 result13 in injury
By 2020 the number of drivers aged over 70 on UK roads is likely to increase to over 7million This will require a new national strategy perhaps involving support13 for olderdrivers further training raising awareness of issues and making more use of adaptivetechnologies to support13 the driver in avoiding collision or forgetting to check on the statusof their vehicle Poor eyesight13 could be enhanced by camera technologies rather thanforcing people off the road if they are unable to read a licence plate
The International Longevity Centre has found that13 one in four Britons thought13 driversshould be made to switch off the ignition for good somewhere between the ages of 70 and75 The numbers may decrease as the population ages and as cars become safer Forcing
40
older people off the road may be a natural consequence of providing free bus passes andsubsidised rail fares but13 the growth in the pavement13 scooter industry demonstrates that13 older people value their independence and will do almost13 anything to get13 out13 and aboutPerhaps legislation will result13 in more regulation of electric vehicles and where they cantravel
There can be no doubt13 that13 getting out13 will be associated with better quality of life andwell-shy‐being and this is likely to be supported in the future as evidence of improvedoutcomes emerges It is to be hoped that13 positive stories will be publicised so that13 publicattitudes arenrsquot13 hardened This may be supported by more in-shy‐car monitoring of drivers andthe linking of performance with on-shy‐line driving records and licences These could throughremotely monitored ignition systems prevent13 the use of motor vehicles by people without13 a licence or without13 insurance
313 Climate change
There is a general view that13 the emissions of carbon gases are contributing to globalwarming in a manner that13 will change the UK climate in such a way that13 the climate maybecome more Mediterranean However some scientists believe that13 manrsquos impact13 on theenvironment13 may be small compared with natural variations caused for example bycyclical changes in the sunrsquos energy output13 or by the effects of volcanoes and earthquakesRecent13 evidence has suggested that13 we are going through a phase of changing extremesand that13 this is more likely to cause storms periods of excessive rainfall and unusualseasonal trends with snow and frost13 in the spring and warmer winters Considerableuncertainty remains and it13 might13 be necessary to plan for a number of different13 scenariosand for the impact13 on vulnerable people
I Colder winters UK properties are poorly insulated resulting in excess mortalitiesduring cold spells due to an increased number of people suffering from stroke aswell as bronchitis and other pulmonary diseases The cost13 of heating continues toincrease putting more households into a state of fuel poverty Any further coolingduring the winter months will result13 in more people living in unhealthy coldconditions Winter fuel payments are likely to be restricted to the poorest13 peoplebut13 this might13 exclude people who live in larger properties that13 are more difficult13 toheat
II More storms excessive winds and rain can cause flooding at any time of the yearMany UK communities are built13 close to rivers and these can surge during heavyrainfall causing houses to be filled with water and furniture and carpets lostInsurance can be problematic for properties built13 on flood plains which can blight13 properties and prevent13 owners from being able to sell and move on High winds canrip off roofs causing injury and also causing families to be left13 homeless anddependent13 on social services
III Hot13 summers Europe suffered high temperatures during the summers of 2003 and2004 leading to heat13 stroke and hypothermia The UK has not13 previously sufferedfrom such problems but13 might13 be expected to experience days of extreme
41
temperature and humidity at times Older people may not13 be prepared for suchweather Street13 dwellers may be unable to find shade and supplies of drinkingwater
Irrespective of what13 combination of weather scenarios arise it13 must13 be concluded that13 any extremes will have a major negative impact13 on vulnerable people especially if theyare not13 prepared because they havenrsquot13 received the weather warnings and advice that13 can be broadcast13 using the TV radio and online services Once again the digitallyexcluded will suffer and will pay a high cost Society will continue to pick up the bill interms of demands on social care services unless preventive actions are taken in theform of connecting these people to each other and to formal services
42
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
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13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
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b13 13
n13 13
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ly13
13 e13 t13 e13
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13
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13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
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13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
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13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
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e13
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proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
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13
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13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
steps to protect13 them There can be no doubt13 that13 crime has a very negative effect13 onindividuals and on their families creating a fear factor that13 may be difficult13 to remove Theimpact13 on quality of life is therefore very considerable especially if it13 forces people to stayat home behind locked doors effectively isolating themselves from society
Modern policing places increasing reliance on the use of closed circuit13 television (CCTV)Town centres are covered by cameras used increasingly in the fight13 against13 crime by bothdetecting anti-shy‐social incidents and identifying the people involved They are also used tomonitor the movement13 of cars that13 may be involved in incidents of burglary and violenceand are fast13 becoming the primary mechanism of law enforcement13 agencies to solve crime
CCTV has moved into the home to record movement but13 monitoring the footage is timeconsuming and often not13 practical Cameras are now available which provide an instant13 video feed to a smart13 phone when movement13 is detected These may have intercomcapability allowing someone to remotely speak to an intruder sometimes before they havegained access to a building This may serve as a deterrent13 and when fitted alongside simpledevices that13 switch lights on randomly around the home may force burglars to goelsewhere
As the price of cameras continues to fall the option of carrying a camera13 on the body that13 continuously monitors personal space is becoming more useful Using wireless networksthe data13 collected can be sent13 continuously to the cloud for safe storage It cansubsequently be retrieved to provide evidence (video and audio) of confrontations enablingsuccessful prosecutions to be made The smart13 phone itself is becoming a valuable itemthat13 is attractive to criminals These can be tethered to personal attack buttons usingwireless technology allowing the device to be activated by the pressing of a button if theowner is being attacked The phones can then be tracked and located by the police whilebeing rendered useless to the assailant
Bogus callers are a perennial problem for vulnerable people Video door bells can beconfigured to display images and record the words of visitors before they are admittedallowing remote monitoring centres to oversee the situations and use image recognitionsoftware to confirm the bona13 fide of visitors Such13 arrangements may become13 commonplace13 over13 the13 next five13 or13 six years13 significantly13 improving the safety of peopleliving independently
220 Personal safety
The biggest13 risks to personal safety stem from fires and falls Most13 fires are the result13 ofpoor cooking practices resulting in burns or scalds Floods and gas emissions are caused bya failure to remember to close taps
The current13 approach involves detection of an emergency situation as soon as possible but13 always after a problem has already occurred This responsive approach can minimise therisks provided that13 there is a protocol in place for intervening This could increasingly be an
23
automated response such as the switching off of the gas of water or the switching on of asprinkler system or a water mist13 system
In the future monitoring systems will be more sophisticated and will have sensors and localintelligence to identify activities In this way reminders can be issued before an emergencyoccurs13 This lsquosmart kitchenrsquo approach may become13 an integral part of13 homes of13 vulnerable13 people
A prototype system has been developed at the Culture Lab in Newcastle Sensors havebeen embedded into cooking utensils enabling the kitchen to identify what13 the person istrying to cook or prepare It can provide interventions as messages on an instructionscreen
Accidents also occur out13 of doors People with dementia13 might13 become lost13 and may havepoor road safety awareness Location devices based on GPS have advanced from large andheavy receivers that13 were used on ships and boats to small battery-shy‐operated devices that13 can be carried in the hand or in a handbag The current13 generation of locators has limitedbattery life and are rather too large to be secreted about13 a personrsquos clothing while devicesthat13 are integrated into a wrist-shy‐watch are rather clunky and unattractive
Within 10 years the13 technologies13 will have13 matured and will be13 much smaller13 so that theycan be embedded in shoes in walking sticks hats or any other item of clothing Powerrequirements will have reduced so that13 energy harvesting from the movements of theindividual will be sufficient13 to keep these products working for several weeks without13 theneed for recharging The devices will not13 simply indicate to others where the individualhappens to be but13 will provide subtle guidance cues to direct13 them home
Cameras might13 also form part13 of the personal security systems that13 will protect13 people fromaccidents Data13 may be sent13 to the cloud and analysed in real time if the person is in adangerous location and can provide prompts either to the individual or broadcast13 advice toothers to clear the danger These systems may be embedded in items of clothing (such as ahat) or they may be attached to spectacles
221 Energy and13 portable power supplies
The demands of developing economies for more power will inevitably lead to higherdomestic fuel charges in the UK especially as oil and gas reserves dwindle
By 2018 UK homes should be fitted with new smart13 meters The specifications for these13 devices have yet13 to be finalised but13 will include a means of identifying wasteful use ofenergy including TV sets that13 are left13 on and unattended fridges and freezers that13 are set13 attoo low temperatures and dryers that13 are used for too long or when the weather is suitablefor using a washing line They could be an enabling factor that13 supports changes inbehaviour driven by a need to use less power but13 it13 is unlikely that13 they will offer a bigreduction in costs that13 are already a problem for many vulnerable families
24
More generally the need for power conservation will include devices that13 are moreefficient and a significant13 emphasis on heat13 retention in buildings through betterinsulation
The energy crisis may force many people to spend more time in community settingsincluding shops and public buildings where they can benefit13 from the warmth Increasingreliance on mobile communication devices will lead to increasing demand for batterycharging facilities
Greater use may be made of portable devices for generating power based on solar cellswind or hand motion
222 Smart cities and homes
The Digital City initiatives have been based on information and how it13 can be used most13 effectively to make people aware of what13 is going on around them This means bettercoordination of resources more rapid access to advice and a battery of sensors measuringevery conceivable parameter from sound and light13 levels through to air quality andtemperature fluctuations There are several Digital or Smart13 City initiatives currently beingimplemented both in the UK and across the world They may significantly impact13 the livesof the millions of people living in them but13 the timeframe for outcome benefits to influenceplanning and design elsewhere is likely to be at least13 20 years and therefore outside thetimeframe of the current13 project
Housing plays a big role in the lives of most13 people both through their aspirations to moveup in the world (usually to a bigger property with a garden) and as the heart13 of the familylife which is associated with good quality of life UK properties have a life span approaching100 years which is about13 double that13 of their European counterparts (and certainly longerthan the wooden-shy‐frame buildings built13 in North America13 for example) A shortage ofhouses has plagued improvements in social welfare for the past13 30 years There is anargument13 that13 there are enough houses but13 the wrong size and in the wrong places andthis has some basis in fact13 as demography changes lead to more people (and more olderpeople) living alone However if there are two million homes in Scotland each with alifespan of 100 years then the renewal rate needs only to be 20000 per annum to maintainthe status quo However it13 must13 be clear that13 the impact13 of smart13 house development13 willbe small The focus should therefore be on adapting existing properties to render themmore appropriate for vulnerable people
Housing adaptations are a branch of assistive technologies The technologies for providingdifferent13 forms of accessible bath and level access shower are well-shy‐established with littleresearch considering anything other than alternative building materials and methods formaintaining the temperature of the bathwater Different13 technologies for bathing will beconsidered separately
25
Thus housing technologies are not likely to impact on social work13 within the next 20years13 though13 the use of information13 technology13 to ensure that people are aware of what13 is available is likely to be commonplace well before then
26
3 BEHAVIOUR AND ATTITUDE CHANGES DUE TO TECHNOLOGICALADVANCES
Technology is only one factor that13 will affect13 the way society changes in the next13 10 or 15years This chapter will consider the context13 in which the technological developmentsoutlined in the previous chapter will be supported (or held back) by societal factors
When the impact13 of such factors has been considered we can then apply theseassumptions to a number of case studies listed in Appendix13 A13
The headings selected for this chapter are not13 arbitrary as they reflect13 the context13 in whichtechnological changes must13 be considered They must13 include consideration of factors suchas demography and long-shy‐term conditions already addressed in the introduction to thesepapers together with the aspects of workforce and citizenship considered in the parallelpapers The additional elements here focus on trends that13 are already occurring and whichmay leave people struggling with the changes that13 occur
Finally there is a need to consider the attitudes of people to technology generally andespecially to the issues of privacy and social responsibility that13 could be radically changedby technology In some cases public opinion will prevent13 some forms of technology beingdeveloped if not13 commercialised In other cases some technologies will be fast-shy‐trackedeither at the request13 of government13 or because of a clear public demand for theopportunities that13 it13 can bring
Predictions13 about the13 future13 must inevitably be13 subject to considerable13 uncertainty butthat is no reason to stop thinking what might happen
31 The Welfare State
The UK can be rightly proud of the way that13 its welfare state has developed during the past13 100 years to provide a safety net13 of financial support13 to people and to their families whenthey are unemployed destitute homeless or challenged by crises and emergencies Therange of benefits received is considerable some are complex and many people struggle tounderstand their entitlements Some are universal some are discretionary some apply onlyto parents others to anyone
The total cost13 of providing these benefits continues to rise and when the economy isstagnating there is inevitably both political pressure often supported by popular publicopinion to introduce welfare reform so that13 people who do not13 work cannot13 be better offthan they would be if they were in full-shy‐time employment This strategy requires a universalbenefit13 to be introduced so that13 it13 is easier for claimants to access support13 but13 also easierfor agencies to identify the total benefits received The idea13 of a benefits cap then becomes
27
more practical to introduce especially if all the processes involved in making a claim arehandled electronically Indeed this encourages government13 to insist13 on applications forbenefits to be made on-shy‐line Unfortunately this will marginalise those people who haveneither a computer nor access to the internet thus emphasising the digital divide in amanner which works against13 some of the most13 disadvantaged people in society
There are currently few tangible links between digital technology and welfare provisionThe most13 obvious are universal benefits such as a free television licence (worth pound14550)13 for13 everyone aged 75 or older with blind and visually impaired people entitled to a 50discount13 irrespective of their age The significance of this position is that13 6 of revenuesgenerated through licence fees are to fund BBC on-shy‐line services13 such13 as websites and i-shy‐player In Scotland the BBCrsquos Alba Gaelic language television service is predominantlyfunded13 by MG Alba an organisation funded by the Scottish Government It is thereforeconceivable that13 in the future licence fees may be used to directly subsidise access toinformation and advice through the Internet13 for vulnerable people whether it13 is throughbroadband access or through a set-shy‐top box which removes the need for a computer in thehome to access particular websites or to use e-shy‐mail services
A second age-shy‐related benefit13 available in the UK is the winter fuel subsidy People whoreceive certain benefits receive the payments automatically while others must13 make aclaim Those who are not13 eligible for benefit13 due to a lack of an address for example missout13 on these payments and also on Cold Weather payments of pound25 for each seven dayperiod of very cold weather between 1 November and 31 March
The development13 of new warm home initiatives plus the complex of subsidies that13 theelectricity supply industry and government13 offer to people with solar cells further changesthe economic arguments Global warming may lead to greater variations in weatherextremes but13 might13 also increase the amount13 of electricity that13 can be generated byalternative (green) sources such as wind and solar cells It is estimated that13 energyconsumption in the UK increased by 17 between Christmas and Easter 2013 compared toprevious years as a result13 of cold weather but13 the above subsidy scheme did not13 benefit13 older people because two of the seven day cold periods were after 31st March It must13 beassumed that13 there will be more people living in fuel poverty in the future and this will leadto more cases of cold related illness including influenza13 and stroke
32 Management of long term conditions
The management13 of long term conditions will be improved for patients who are compliant13 with their medication regime so it13 is possible that13 there may be compulsion to adhere tothe prescription Such compulsion may be monitored using technology Indeed the remotemonitoring of vital signs using telehealthcare will become commonplace as the old boxesand sensors are replaced by devices that13 can be worn continuously or which can beembedded into the fabric of homes (including furniture and bedding) or can be worn asvests or patches They will wirelessly transmit13 data13 to smartphones or tablets and mobile
28
transmission and cloud technology will enable real-shy‐time data13 collection analysis andfeedback
One of the diseases which is projected to increase most13 significantly over the comingdecade is Type 2 diabetes Whilst13 there is a hereditary susceptibility to this condition formany people including those from the Middle East13 and the Asian sub-shy‐continent it13 is also adisease which tends to affect13 those people who are overweight13 andor have a sedentarylifestyle If untreated diabetes can lead to dizziness and collapse at any time but13 can alsohave more devastating long term consequences which include kidney failure strokeblindness and in extreme cases lower limb amputations Management13 therefore includesdaily monitoring of blood glucose levels and major dietary changes such as a significant13 reduction in the consumption of carbohydrates as well as a rigid exercise regime
Many newly diagnosed diabetics follow this advice closely and can lead normal lives for 40years or more but13 some struggle to accept13 the change in lifestyle required as well asremembering which foods are allowed and how much exercise they need to takeIndividual support13 plans are now forthcoming and over the next13 ten years best13 practicewill emerge in the form of smartphone apps that13 are personalised and which can becomean individualrsquos health coach This level of support13 will be fine for some people but13 otherswill need incentives so it13 is likely that13 gaming technologies will be introduced perhapsoffering rewards for good compliance There will be a temptation for some people tocheat perhaps allowing others to perform exercise for them or changing theirconsumption details
Many of these opportunities for cheating will be removed through the use of a uniquebiometric identifier a technology that13 will be mature enough to use in place of passwordson smartphones However the biggest13 challenge may be in encouraging older people to usethe technology Many older people have multiple morbidities Indeed a survey of Scottishpatients implied that13 42 of people aged over 80 will suffer from three long termconditions It will be essential for those people to comply with treatment13 regimes if they arenot13 to have the functional deficits that13 follow
33 Finding people who13 donrsquot fit
People who have low social capital are likely to have few relatives and friends with whomthey regularly communicate and are also unlikely to be part13 of community or faithorganisations such as clubs societies and church groups They also die several yearsyounger than most13 of the population often because they donrsquot13 engage with public healthinitiatives such as vaccinations against13 flu regular checks on their blood pressure bloodsugar levels or in the case of women smear tests or mammography The most13 likelyreason for disappearing beneath the radar of such initiatives is their mobility which leadsalmost13 inevitably to them having no fixed abode and no fixed telephone line It thenbecomes very difficult13 for them to be contacted because their mobile telephones are likelyto have Pay-shy‐As-shy‐You-shy‐Go contracts that13 donrsquot13 require validated names addresses and bankaccounts
29
It follows that13 some of the most13 vulnerable people in society including those who live onthe streets are effectively unknown to both the NHS and to social work departments untilthey are referred in a crisis This could be an emergency presentation to a hospital Accident13 and Emergency Department13 where they will come into contact13 with a social worker becausedischarge may be unsafe This often highlights the importance of the prevention agenda13 and the potential for avoiding admissions to hospital by intervening at an earlier stage
The advantages of being able to locate people who are vulnerable to specific diseases willincrease as genetic testing becomes more routine It is already possible to determine whomight13 be most13 at risk of breast13 cancer and prostate cancer as a result13 of family history Addto this the evidence that13 particular diet13 and exposure to environmental factors can furtherincrease risk then it13 is evident13 that13 individuals can be identified and offered treatmentsthat13 could save their lives many years before they become ill In the case of cancersperhaps only the individual is involved but13 for infectious diseases it13 is the whole of societythat13 is at risk if someone contracts one of the new strains of influenza or if someonechooses not13 to be vaccinated against13 rubella In Chinese airports all visitors are screenedfor fever and refused entry if they tested positive in cities the public are monitored in thesame way Similar approaches may be necessary in the UK if potential carriers cannot13 otherwise be identified
34 Volunteering
It is estimated that13 72 per cent13 of people volunteered to perform a charitable act13 at least13 once during 2012 a rise from 65 per cent13 the previous year About13 four out13 of every 10volunteers offer their services formally to one or more organisations The remaindervolunteer informally by helping out13 a friend or a neighbour Around 50 per cent13 volunteered at least13 once a month in the past13 year up from 41 per cent13 on the previous13 year Most13 have retired many of them before the statutory retirement13 age Those whodonrsquot13 feel able to offer time have offered their financial support13 at a time when the fundingavailable from sources such as the National Lottery has been decreasing Despite economicausterity donations to charities have been increasing 74 per cent13 said they had given tocharity at least13 once in the previous month up from 72 per cent13 the previous year
Strikingly 78 per cent13 of people strongly believe that13 they are part13 of their localneighbourhood an increase from 70 per cent13 10 years previously Community cohesion isstronger than ever 87 per cent13 of people believe their local area13 is a place where peoplefrom different13 backgrounds get13 on well together compared to 80 per cent13 in 2003
The role of volunteers in supporting vulnerable people is therefore likely to increase overthe next13 decade perhaps exploiting the success of the army of volunteers that13 was highlysuccessful in London during the Olympic and Paralympic games The greatest13 role for suchvolunteers may be in providing informal care for older people Already the UK has someseven million informal carers whose value in monetary terms has been calculated to be
30
more than the combined budgets of the NHS and social care Maintaining or extending thisprovision will help to support13 services in the future and may be supported by technology
Whilst13 there is ample evidence to suggest13 that13 telecare services support13 informal carers asmuch as (if not13 more than) the people that13 they are caring for it13 is the potential for utilisingthe internet13 and apps to make their role easier to coordinate and hence more effectivethat13 is likely to be most13 successful moving forward
Many of these focus on particular tasks that13 informal carers can help offer to older peoplesuch as organising their medication A pillbox program is just13 one feature of an app calledBalance It also includes sections for caregiving tips notes for the doctor and the patientsappointments plus a lsquolearning sectionrsquo with articles on aspects of Alzheimers and an RSSfeed for news about13 the disease Tyze is another multi-shy‐functional app it13 allows carers to
bull Organise appointmentsbull Plan outingsbull Share storiesbull Send updates to other family members
Another application is Rally Round which helps carers to organise someone to perform littlejobs often on a temporary basis when someone has dementia physical frailty or isrecovering from accident13 or illness Similar applications are MeMaxi and Finerday
35 The High13 Street
The shape and appearance of UK shopping centres have been changing for half a centuryPeople complain that13 centres are losing their identity with one town looking like everyother both in terms of the stores and in terms of the layout But13 there are three trendswhich are having a profound impact13 on many of the most13 vulnerable people in society
bull Centres lock their doors at 6pm or in some cases 10pm -shy‐ thus denying people whosuffer from claustrophobia13 from window shopping at times when other shoppershave left
bull Out13 of town shopping malls -shy‐ these US style centres are ideal for people in carsbecause they offer free parking which is essential for people who want13 to buy largeritems but13 difficult13 for people who have no transport13 and who must13 rely on publictransport13 that13 is often deficient
bull The rise of online shopping -shy‐ which means that13 many potential shoppers only visit13 High Street13 stores to check the prices before returning home to make a purchaseonline
It is the third of these effects that13 has the greatest13 potential for changing the High Street13 forever and it13 is making life for traditional retailers increasingly difficult13 at a time when highrents are crippling stores large and small It is difficult13 to see how this trend is likely tochange because consolidation in banking and estate agencies is already forcing the closure
31
of other High Street13 players while additional pressures on pubs has led to the closure ofthousands of pubs every year
Those figures however demonstrate that13 consumers still value what13 the high street13 canoffer -shy‐ the chance to inspect13 what13 theyrsquore thinking of buying -shy‐ as well as the new opennessof the internet Customer service makes a difference to people especially if there is aproblem and goods need to be returned One of the most13 common reasons for furniture tobe returned for example is that13 when a sofa13 or a wardrobe was delivered it13 couldnrsquot13 fit13 through the front13 door or up the stairs In the future people will be able to benefit from13 visualisation technology they will upload the floor plans of their homes enabling theretailer to inform them of the problem before they try to delivery Augmented reality viewwill similarly allow customers to see what13 a new item of furniture will look like in itsintended place so that13 they can be more informed about13 the effect13 of size and colour
In terms of improving the viability of the High Street stores will have to focus on theimportance of brand which could mean that13 individual independent13 retailers will have topartner with national suppliers to support13 a local tailored offering based on products that13 are designed for a more global market This is a lsquoconnected High Streetrsquo approach whichcould be enabled by the developments in internet13 availability and smart13 phone accessdescribed in the previous section
The overall effect13 of all these changes could mean that13 town centres become smaller but13 more vibrant13 areas They could thrive if people are attracted there in large numbers whichmeans that13 retail must13 be developed alongside restaurants pubs galleries and other leisureopportunities This is possible in new shopping centres which are already being integratedwith transport13 hubs including railway and bus stations but13 may be more of a design13 challenge for older towns and cities with large Victorian buildings To ensure that13 morepeople are welcomed into the new centres they should include attention to green spacesand areas where people can relax without13 feeling that13 they are second class citizensbecause they donrsquot13 have the same buying power
3513 Privacy
To some people privacy is their right13 to live their lives without13 interference they may seethe State as a potential lsquoBig Brotherrsquo spying on their every move and judging their actions13 and activities Other people have fewer concerns about13 the role of the State but13 great13 fearof individuals interfering with and invading their privacy Some embrace the concept13 of lsquomyspacersquo an area13 of a square metre or so into which nobody can enter without13 permissionThis allows them to avoid physical contact13 and to feel safe from any form of threateningbehaviour
Yet13 this idea13 of private space and its potential violation is merely the tip of the iceberg asfar as privacy is concerned more significant13 is the idea13 of personal (and private)information being shared with anyone and everyone This could be related to identityopinion or image for an individual who wants to remain anonymous or even secretive thisis going to become an increasing problem as technology provides the means of taking
32
photographs recording conversations and capturing environment13 with something as smalland ubiquitous as a mobile phone The fact13 that13 this information can then be shared withthe rest13 of the world using e-shy‐mail Twitter and Facebook makes the problem all the moredifficult So the threat13 is no longer solely from the long lenses of the Paparazzi but13 fromanyone (and that13 means everyone) who has even the most13 basic of mobile phones
This relates to the changing views of society on what13 information should remain privateand what13 should be shared with others The success of social media13 has been based on anattitude of lsquosharing everythingrsquo with either your friends or the world This has introduced anaiumlve idea13 in the minds of some younger people (especially those known as Millennials ieaged 18-shy‐30) that13 everyone can be their friends whilst13 perhaps failing to reinforce the bondsof genuine friendship with any form of test13 or restriction Technology could play a role indefining these friendships and allowing individuals to understand what13 makes a goodfriend but13 this approach has yet13 to be developed and may be slow to overcome the needfor some people to measure their own popularity simply as the number of people that13 theycan list13 as friends on their Facebook page
It follows that13 there may be a need for a new definition of privacy that13 is in keeping withthe web and its ability to display images and opinion in an unregulated manner This needsto embrace past13 concerns about13 the ability of an individual to live without13 the threat13 ofothers being able to watch them whilst13 offering some protection from random postingsabout13 them online Perhaps this could include a right13 to be able to edit13 or remove anythingrelating to themselves on the Web including images that13 are not13 news-shy‐worthy Theownership of image rights may be an associated issue that13 needs to be addressedespecially as modern technology can remove an individual from a group (or a background)13 view provide digital touch-shy‐up or air-shy‐brushing and then republish it13 in a different13 contextHowever there is general agreement13 that13 personal information (such as contact13 details andbank codes) should not13 have a place on the web Surprisingly few people take proactivemeasures to prevent13 tracking functions being activated
It follows that13 too much privacy could lead to younger people fearing that13 they maybecome lost13 in a digital world It is not13 surprising then that13 they are prepared to make lots13 of personal information available often with no fear of how it13 might13 be used by othersWhen Google glasses and similar technologies become available during the next13 few yearsthey will have the potential to identify a stranger walking down the street and to find manyof their secrets to present13 to the wearer in a fraction of a second They could know moreabout13 them than their genuine friends know -shy‐ so who will be their friends in the future
36 Data sharing and13 protection
By lsquodata13 sharingrsquo we mean the disclosure of data13 held by one organisation on an individualto a third party organisation(s) or the sharing of data13 between different13 parts of anorganisation Some data13 sharing doesnrsquot13 involve personal data13 because it13 has beenanonymised in such a way that13 the statistics can be used for the collective good without13 theidentification of the individual The Data13 Protection Act13 (DPA) is in place to provide a legal
33
framework that13 ensures that13 organisations that13 hold personal data13 must13 act13 responsibly atall times These principles adequately describe the position of public and government13 bodies especially social services departments who are responsible for the informationconcerning the health and well-shy‐being of individuals -shy‐ and hence by implication thesensitive data13 relating to their vulnerability
The legal framework that13 applies to private and third sector organisations differs from that13 which applies to public sector organisations which may only act13 within the defined limits oftheir statutory powers However all bodies must13 comply fully with the data13 protectionprinciples and this situation is unlikely to change within the next13 10 to 15 years In someprivate sector contexts there are legal constraints on the disclosure of personal dataHowever most13 private and third sector organisations have a general ability to shareinformation provided this does not13 breach the DPA or any other law It is advisable for acompany to check its constitutional documents such as its memorandum and articles13 ofassociation to make sure there are no restrictions that13 would prevent13 it13 from sharingpersonal data13 in a particular context The type of data13 held is therefore a subject13 ofconcern as it13 may be difficult13 for legislation to keep up with the additional layers of data13 created on-shy‐line and through the Internet13 of Things
Private and third sector organisations should have regard to any industry-shy‐specific regulationor guidance about13 handling individualsrsquo information as this may affect13 the organisationrsquosability to share information They should also be aware of the legal issues that13 can arisewhen sharing personal data13 with public sector bodies This becomes more of an issue asprivate and third sector bodies are carrying out13 a wider range of traditionally public sectorfunctions Opportunities for inappropriate sharing of sensitive data13 will therefore inevitablyincrease
Public authorities must13 comply with the Human Rights Act13 (HRA) legislation in theperformance of their functions The HRA also applies to organisations in the private sectorinsofar as they carry out13 functions of a public nature which could include delivering a socialcare activity Where the HRA applies organisations must13 not13 act13 in a way that13 would beincompatible with rights under the European Convention on Human Rights Article 8 of theConvention giving everyone the right13 to respect13 for their private and family life their homeand their correspondence is especially relevant13 to sharing personal data If personal data13 isdisclosed or shared in ways that13 comply with the DPA the sharing or disclosure of that13 information is also likely to comply with the HRA The problem may still be in policing theActs and the rights of an individual if they believe that13 their personal data13 has been sharedor accessed by an inappropriate organisation or individual
A legal industry may be born to deal with such matters but13 this is unlikely to benefit13 peoplewho cannot13 afford the fees involved They would require either legal aid or to employ13 more13 lsquono win no feersquo companies Public attitudes to such costs might13 become negative unlessthey prove successful in preventing breaches of data13 security There may need to belegislation to provide a stronger basis for forcing compliance with privacy laws
34
37 Connecting with13 people
We are social creatures most13 of us rely on our friendships and interactions with friendsand families to share our happiest13 moments and experiences Research suggests that13 thishappiness is infectious at all levels and leads to a 15 increase in the happiness of a closecontact 10 for a second degree contact13 such as the friendrsquos spouse and a 6 increase fora friend of a friend It is hardly surprising that13 the success of social media13 such as Facebookis intimately related to the ability of people to quickly share their happiest13 moments with asmany of their friends and connections as possible
All this has happened during the rise of the Internet13 and the corresponding increase inopportunities for connecting online ie this is a 21st Century phenomenon which has beenfacilitated by Information and Communications Technology But13 the Internet13 remains in itsinfancy and we are only beginning to understand and exploit13 its potential In terms ofaccessing the Internet there are now perhaps two billion people who have access with99 of them having gained this during the past13 decade This number will have doubled bythe period 2020 to 2025 It is likely that13 everyone who wants to be connected in the UK willby then be connected Turning this on its head only those who donrsquot13 want13 to be online willnot13 be on the Internet13 within a decade Connecting with the unconnected will therefore bea case of identifying those people who donrsquot13 want13 to be found unfortunately these mayinclude many people who need the support13 of social care organisations It means that13 theywill be looking for support13 only when they are in crisis unless other ways of finding andormonitoring them are found
While the number of people connected via the Internet13 has exploded this might13 bedwarfed by the number of connected lsquothingsrsquo During 2009 the number of thingsconnected to the Internet13 surpassed the number of connected people at which point13 webegan to experience what13 this report13 has described as the lsquoInternet13 of Thingsrsquo Yet 99 ofall physical objects that13 could join this network are not13 yet13 connected but13 the number couldgrow by 25 every year for the next13 decade so that13 there could be 100 billion connectedobjects by 2025 some of which will be owned or used by everyone in the UK includingthose people who donrsquot13 want13 to be connected themselves We will then have an Internet13 of Everything which will be the smart13 connection of people data events and actions
With each new person object or data13 that13 comes online the connection possibilitiesbetween all these elements grows exponentially The rise of big data mobile networkingcloud storage and data13 mining technologies will all play a critical role in the Internet13 ofEverything The result13 will be new capabilities richer experiences and unprecedentedvalue for individuals businesses communities and countries everywhere The lsquonetworkeffectrsquo of the Internet13 of Everything will be a very powerful thing the true impact13 of whichwe wonrsquot13 fully understand for several years As it13 develops however those who are not13 connected will feel even more digitally and socially excluded There will be a need to reachout13 to vulnerable people unless the process of claiming requires proof of online identityand the payments to be received can only be redeemed using a chipped card or adownloaded app onto a smartphone This is of course the way that13 welfare arrangementsare already developing thus it13 might13 prove impossible to make a successful claim without13
35
already being connected to lsquothe systemrsquo either through an online presence or through theInternet13 of Things
38 Downloading everything
Sixty years ago information was discovered by reading books often in a library wherenotes had to be made because the books or journals couldnrsquot13 be removed Then in theearly 1960s the first13 office photocopying machines were introduced into the UK theyimmediately meant13 that13 pages or articles from books could be copied and taken away to beread and summarised later Within a few years photocopying became a replacement13 forreading as researchers became less adept13 at selecting a few sentences and every deskbecame a depository for reams of printed paper Paper became the means of recordingeverything from bank statements through to music
We now appreciate that13 printing everything is a waste of both the ink (or toner) used tocreate the black print13 and of paper which requires trees to be chopped down and pulpedbefore it13 can be pressed into thin sheets Saving paper is therefore seen as green and goodfor the planet Fortunately we no longer need to print13 everything because computermemory is unlimited thanks to the cloud and we can then view pages and articles onportable or fixed screens
The internet13 has everything and it13 is all available instantly for downloading providing thereis a device available to accept13 it and there is sufficient13 communication bandwidth toperform the transfer of data13 sufficiently quickly Thus we can record all text13 articles that13 are relevant13 to us including digital records of birth certificates qualifications and passportsand the need for original printed versions will decline But13 we can also do this forphotographs Most13 handheld computing devices include at least13 one camera so they cangenerate enormous number of pictures which can be kept13 for posterity without13 having toconsume inks and special papers to print13 them
But13 the materials that13 can be downloaded donrsquot13 stop at pictures software is available that13 can grab TV shows after they air and movies as soon as theyre released In the same wayit13 is possible to schedule music comic books video games and practically anything else asa download with minimal effort People will need enormous hard drives if they want13 theirown digital copies of these files so will more than likely make use of cloud storage that13 willbe available from many organisations The location of the servers may become sensitivedue to border restrictions as will the security of the data13 and the way that13 it13 is backed up sothat13 it13 is resilient13 to failures
It may be evident13 that13 application forms for all types of welfare payment13 will be availableonly for downloading so that once digitised they can be processed by computer andrecords sent13 to various servers for subsequent13 storage and processing Some people maywant13 to keep their data13 on them once it13 has been downloaded Pen drives can already holdseveral GB of data so it13 is likely that13 people will be able to carry their downloaded data13 withthem at all times irrespective of the size and complexities of the information
36
39 Health13 and13 well-shy‐being
The general health of the population is unlikely to deteriorate noticeably within 10 to 20years Indeed expectations of the population are that13 things must13 improve as surgicaltechniques mature and as pharmaceutical interventions become more personalised andpowerful However the rising demand for health services due to an ageing population andthe increasing cost13 of providing sophisticated therapies will make delivering a free anduniversal health service difficult13 without13 substantial increases in taxation This is unlikely tohappen in the UK even though spending on health services will be protected against13 thecuts facing other services
There will have to be changes in how the NHS works For twenty years hospitals have beenclosed and replaced by fewer new facilities so that13 the bed count13 is reduced This has led toa significant13 shift13 in resources to primary care and community care supporting shorter staysin hospital and speedier transfer back home for people after surgery or illness This hasbeen13 successful but13 there remain problems with demand for GP services especially out-shy‐of-shy‐hours and at weekends Indeed despite the introduction of NHS24 and similar help-shy‐linesthe demand for GP appointments continues to increase Delays are inevitable and this willincrease system failures with more unnecessary deaths and a failure for people to access adiagnosis that13 might13 lead to early interventions and ultimately lower delivery costs Over250 more patients are added to waiting lists every day
This will lead to a new model of primary care consistent13 with existing changes which haveseen surgeries move from High Street13 locations to medical centres close to bus routes andwith more parking for patients The process of making an appointment13 is changing from atelephone-shy‐based interview process dominated by a medically-shy‐unqualified receptionist13 to achoose and book approach using an online process linked to electronic patient13 records Thiswill give patients more convenience but13 will allow priority for those who have Internet13 access at the expensive of those who are digitally excluded Making the process of bookingan appointment13 quick and easy may also increase demand from people who do not13 need tobe seen as it13 will fail to identify those in greatest13 need
A greater use of telehealth and telecare technologies will be inevitable beginning with thefirst13 contact13 as an encounter using the telephone e-shy‐mail or video conferencing -shy‐ a visit13 tothe GP surgery should be a last13 resort and should involve a nurse consultation in the first13 instance This would be consistent13 with three quarters of appointments currently involvinga chronic disease or long term condition which relates to improved self-shy‐care The support13 ofthese patients at home should be prioritised through tele-shy‐ and web-shy‐based technologies andshould involve training and coaching through a network of nurse practitioners Home visitsshould generally be unnecessary through the use of these technologies but13 could besupplemented by satellite surgeries manned by nursing in community premises or inpharmacies nurseries and Internet13 cafes
The homes13 of people who13 need13 closer monitoring can then become part13 of virtual wardswith real or electronic visits by health professionals University Hospital Southampton NHSFoundation Trust13 already looks after patients who have undergone surgery such as a hip orknee13 replacements in virtual wards with high levels of satisfaction The Royal Free London
37
NHS Foundation Trust13 offers a similar service but13 plans to add the possibility of videoconsultations between patient13 and consultant
310 Attitudes to public health issues ndash obesity smoking alcohol abuse drugs
As self-shy‐care becomes the focus of the NHS the public will increasingly understand that13 thecosts and availability of services are being harmed by the poor health behaviour ofrelatively small numbers of people The link between public health initiatives today andhealthcare needs and costs in the future will become increasingly evident13 as a result13 of theway that13 information is presented Thus the overweight13 smoker who currently attractsconcern and pity when they are diagnosed with diabetes and COPD is increasingly beingseen as the victim of their own stupidity or lack of self-shy‐discipline If they continue to neglect13 medical advice and continue with an unhealthy lifestyle then the way that13 they receivetreatment13 and consume resources will become a matter for the entire population
Obesity is seen as due to a combination of poor diet13 and a sedentary lifestyle No longer isthe idea13 that13 people are lsquobig bonedrsquo acceptable Governments will respond initially byrequiring manufacturers and food processors to provide nutritional information onpackaging and on menus in restaurants But13 people can choose not13 to read the data13 and toneglect13 both the importance of food quality content13 and quantity This will increasepressure to introduce fat13 or sugar taxes and these are likely to be in force within a decade
Although the high taxes on tobacco products has forced some smokers to reduce theirconsumption or to give up altogether the impact13 has been reduced by the smuggling ofproducts from overseas and by the availability of duty-shy‐free cigarettes for people returningfrom foreign holidays and business meetings Further measures are planned to changepackaging and to include even more graphic images and warnings on cigarette packages tomake smokers aware of the effects of smoking on their health and well-shy‐being There is asyet little evidence of how successful this might13 be More effective has been the banning ofsmoking in public places including trains and aircraft Expensive medical interventions suchas heart13 transplants will be denied to individuals until they change their lifestyle behaviourSmokers might13 therefore be increasingly ostracised leading to a loss of esteem This mayhave a particular impact13 on people who already suffer from mental health problems whoare more likely to smoke
The overuse of alcohol is being recognised as a major factor in hospital admissions withNHS figures showing an increase of over 40 in such admissions over the past13 decadeLinked to this has been a 75 increase in prescriptions to treat13 alcohol dependency Fewpeople have sympathy for those who waste their limited income on booze If they havechildren or other dependents they will be the ones who suffer and who may need thesupport13 of social care
Drug users are already significant13 users of social services as their habit13 is likely to makethem unemployable They receive little sympathy from the general public because they areseen as criminals and people who waste public resources Levels of drug abuse have been
38
slowly increasing over the years but13 this trend is slowly being reversed Indeed the numberof people using drugs during the past13 year has fallen to its lowest13 level for nearly 20 years(below 9) with cannabis being most13 likely often following excessive drinking Aselectronic noses and other technologies can detect13 traces of drugs it13 seems likely that13 success in overcoming addiction can be measured objectively This may become a two-shy‐edged sword rewarding those who can turn around their lives but13 further marginalisingthose who canrsquot13 or wont13 accept13 the lsquocold turkeyrsquo
311 Attitudes to surveillance
Issues associated with privacy confidentiality and data13 security have been discussedpreviously in the context13 of information technology the World Wide Web and the ease ofcollecting recording recalling analysing and displaying data The monitoring of individualsand their methods of using this information can be regarded as surveillance As thequantities of data13 increase along with the number of devices that13 can be used to access itthe surveillance tools will also increase in their sophistication Indeed the Big Data13 approaches described in the previous section will enable the combination of structureddata13 (such as the information held in databases) to be married with unstructured data13 fromimages in such a way that13 it13 can be mined
Whilst13 the lsquodigital surveillancersquo methods described above may cause most13 concern topeople because of its impact13 on anonymity it13 is the collection and analysis of images that13 are the major concern to people as they contemplate the ways that13 lsquoBig Brotherrsquo maydevelop to restrict13 freedom Every major UK city and town centre has an array of CCTVcameras that13 continually record activities from every angle If it13 used to be true that13 nobody in London was more than 10 yards from a rat it13 is certainly the case today that13 nobody can be more than this distance from being in view of a surveillance camera Yetthey receive so much positive publicity from TV programmes where their footage is used todetect13 vehicles close to a crime scene or to monitor the movements of suspects that13 theyare now accepted by the public as a deterrent13 in the same way as lsquobobbies on the beatrsquowere seen 25 years ago There is therefore little public reaction to the expansion in the useof video surveillance except13 for the practical observation of how so many views can beinspected and recorded
Looking to the future the tumbling cost13 of video technology will surely lead to anotherincrease in the number of devices The aerial views taken from towers will besupplemented by more local views taken by devices that13 are embedded in the fabric ofbuildings or carried by individuals either on their person (for example on clothing orspectacles) or in the bags that13 they carry The time and date-shy‐stamped images as Big Datawill be recorded to lsquothe Cloudrsquo where it13 can be added to other data It can then be usedwhen an incident13 has occurred or to provide further detail of night-shy‐time activities
It follows that13 there will be no hiding place for people who simply want13 to disappear Theymay respond by wearing clothing (such as hoodies) that13 hide their faces or which make it13 difficult13 to distinguish gait13 or mannerisms from which they might13 be identified New forms
39
of clothing may be designed to make shapes more difficult13 to analyse and these might13 become the uniforms of a class of person who wants to live in a way that13 they donrsquot13 interact13 with officials from any ministry or local government13 department If they also obstruct13 services then they will be considered to be anarchists of some form sparking protests fromother sectors of society
31213 Attitudes to driving
Motor cars have been a feature of UK roads for over a century but13 it13 is only during the past13 50 years that13 they have become a resource that13 most13 families have had access to enablingthem to travel without13 the restrictions imposed by a limited railway network and non-shy‐integrated bus transport People who have had a car throughout13 their lives often see theircars as an important13 factor in enabling them to remain independent13 and to exercise choicesrelating to where they shop and where they spend their leisure time This extends to theirspouse and to friends and neighbours that13 they might13 take with them on their variousexpeditions
Unfortunately there are incidents involving older drivers who perhaps go down amotorway in the wrong direction who are taken ill at the wheel or who are involved in anaccident13 involving no other vehicles These are small in number but13 often lead to a reactionthat13 they shouldnrsquot13 be allowed to drive lsquoat13 their agersquo Age itself is not13 an indicator ofdriving quality but13 because old age also brings more chance of having limited long termconditions and other illnesses it13 is easy to make a link between driving ability and age Thelicensing system does require continued driving to be linked with medical advice andforbids people with poor eyesight epilepsy and other conditions to hold a licence in oldage
Yet13 statistically older drivers cause far fewer accidents than younger drivers The reasonsfor this may be complex and are likely to include the fact13 that13 they drive less often covershorter distances and donrsquot13 go out13 in the dark or in poor weather However it13 does not13 wholly explain why the UKrsquos drivers aged over 70 and who represent13 some 8 of all driversare involved in only 4 of accidents that13 cause injury This compares favourably with the15 of13 drivers aged between 17 and 29 who are involved in over a third of crashes that13 result13 in injury
By 2020 the number of drivers aged over 70 on UK roads is likely to increase to over 7million This will require a new national strategy perhaps involving support13 for olderdrivers further training raising awareness of issues and making more use of adaptivetechnologies to support13 the driver in avoiding collision or forgetting to check on the statusof their vehicle Poor eyesight13 could be enhanced by camera technologies rather thanforcing people off the road if they are unable to read a licence plate
The International Longevity Centre has found that13 one in four Britons thought13 driversshould be made to switch off the ignition for good somewhere between the ages of 70 and75 The numbers may decrease as the population ages and as cars become safer Forcing
40
older people off the road may be a natural consequence of providing free bus passes andsubsidised rail fares but13 the growth in the pavement13 scooter industry demonstrates that13 older people value their independence and will do almost13 anything to get13 out13 and aboutPerhaps legislation will result13 in more regulation of electric vehicles and where they cantravel
There can be no doubt13 that13 getting out13 will be associated with better quality of life andwell-shy‐being and this is likely to be supported in the future as evidence of improvedoutcomes emerges It is to be hoped that13 positive stories will be publicised so that13 publicattitudes arenrsquot13 hardened This may be supported by more in-shy‐car monitoring of drivers andthe linking of performance with on-shy‐line driving records and licences These could throughremotely monitored ignition systems prevent13 the use of motor vehicles by people without13 a licence or without13 insurance
313 Climate change
There is a general view that13 the emissions of carbon gases are contributing to globalwarming in a manner that13 will change the UK climate in such a way that13 the climate maybecome more Mediterranean However some scientists believe that13 manrsquos impact13 on theenvironment13 may be small compared with natural variations caused for example bycyclical changes in the sunrsquos energy output13 or by the effects of volcanoes and earthquakesRecent13 evidence has suggested that13 we are going through a phase of changing extremesand that13 this is more likely to cause storms periods of excessive rainfall and unusualseasonal trends with snow and frost13 in the spring and warmer winters Considerableuncertainty remains and it13 might13 be necessary to plan for a number of different13 scenariosand for the impact13 on vulnerable people
I Colder winters UK properties are poorly insulated resulting in excess mortalitiesduring cold spells due to an increased number of people suffering from stroke aswell as bronchitis and other pulmonary diseases The cost13 of heating continues toincrease putting more households into a state of fuel poverty Any further coolingduring the winter months will result13 in more people living in unhealthy coldconditions Winter fuel payments are likely to be restricted to the poorest13 peoplebut13 this might13 exclude people who live in larger properties that13 are more difficult13 toheat
II More storms excessive winds and rain can cause flooding at any time of the yearMany UK communities are built13 close to rivers and these can surge during heavyrainfall causing houses to be filled with water and furniture and carpets lostInsurance can be problematic for properties built13 on flood plains which can blight13 properties and prevent13 owners from being able to sell and move on High winds canrip off roofs causing injury and also causing families to be left13 homeless anddependent13 on social services
III Hot13 summers Europe suffered high temperatures during the summers of 2003 and2004 leading to heat13 stroke and hypothermia The UK has not13 previously sufferedfrom such problems but13 might13 be expected to experience days of extreme
41
temperature and humidity at times Older people may not13 be prepared for suchweather Street13 dwellers may be unable to find shade and supplies of drinkingwater
Irrespective of what13 combination of weather scenarios arise it13 must13 be concluded that13 any extremes will have a major negative impact13 on vulnerable people especially if theyare not13 prepared because they havenrsquot13 received the weather warnings and advice that13 can be broadcast13 using the TV radio and online services Once again the digitallyexcluded will suffer and will pay a high cost Society will continue to pick up the bill interms of demands on social care services unless preventive actions are taken in theform of connecting these people to each other and to formal services
42
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
s13 13
13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
n13 13
13 s13
r13 n13
e13 at13
e13 y13 e13 ld13
ly13
13 e13 t13 e13
s13 er13 e13
f13
rt13 13
13 13
13
r13 13
s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
e13 g13 13
e13
13 13 ial13
13
d13
13 d13 h13 r13
d13 13
s13 y13
e13
13
rd13 r13 e13
13
13
13
e13
e13
d13 13
13
13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
automated response such as the switching off of the gas of water or the switching on of asprinkler system or a water mist13 system
In the future monitoring systems will be more sophisticated and will have sensors and localintelligence to identify activities In this way reminders can be issued before an emergencyoccurs13 This lsquosmart kitchenrsquo approach may become13 an integral part of13 homes of13 vulnerable13 people
A prototype system has been developed at the Culture Lab in Newcastle Sensors havebeen embedded into cooking utensils enabling the kitchen to identify what13 the person istrying to cook or prepare It can provide interventions as messages on an instructionscreen
Accidents also occur out13 of doors People with dementia13 might13 become lost13 and may havepoor road safety awareness Location devices based on GPS have advanced from large andheavy receivers that13 were used on ships and boats to small battery-shy‐operated devices that13 can be carried in the hand or in a handbag The current13 generation of locators has limitedbattery life and are rather too large to be secreted about13 a personrsquos clothing while devicesthat13 are integrated into a wrist-shy‐watch are rather clunky and unattractive
Within 10 years the13 technologies13 will have13 matured and will be13 much smaller13 so that theycan be embedded in shoes in walking sticks hats or any other item of clothing Powerrequirements will have reduced so that13 energy harvesting from the movements of theindividual will be sufficient13 to keep these products working for several weeks without13 theneed for recharging The devices will not13 simply indicate to others where the individualhappens to be but13 will provide subtle guidance cues to direct13 them home
Cameras might13 also form part13 of the personal security systems that13 will protect13 people fromaccidents Data13 may be sent13 to the cloud and analysed in real time if the person is in adangerous location and can provide prompts either to the individual or broadcast13 advice toothers to clear the danger These systems may be embedded in items of clothing (such as ahat) or they may be attached to spectacles
221 Energy and13 portable power supplies
The demands of developing economies for more power will inevitably lead to higherdomestic fuel charges in the UK especially as oil and gas reserves dwindle
By 2018 UK homes should be fitted with new smart13 meters The specifications for these13 devices have yet13 to be finalised but13 will include a means of identifying wasteful use ofenergy including TV sets that13 are left13 on and unattended fridges and freezers that13 are set13 attoo low temperatures and dryers that13 are used for too long or when the weather is suitablefor using a washing line They could be an enabling factor that13 supports changes inbehaviour driven by a need to use less power but13 it13 is unlikely that13 they will offer a bigreduction in costs that13 are already a problem for many vulnerable families
24
More generally the need for power conservation will include devices that13 are moreefficient and a significant13 emphasis on heat13 retention in buildings through betterinsulation
The energy crisis may force many people to spend more time in community settingsincluding shops and public buildings where they can benefit13 from the warmth Increasingreliance on mobile communication devices will lead to increasing demand for batterycharging facilities
Greater use may be made of portable devices for generating power based on solar cellswind or hand motion
222 Smart cities and homes
The Digital City initiatives have been based on information and how it13 can be used most13 effectively to make people aware of what13 is going on around them This means bettercoordination of resources more rapid access to advice and a battery of sensors measuringevery conceivable parameter from sound and light13 levels through to air quality andtemperature fluctuations There are several Digital or Smart13 City initiatives currently beingimplemented both in the UK and across the world They may significantly impact13 the livesof the millions of people living in them but13 the timeframe for outcome benefits to influenceplanning and design elsewhere is likely to be at least13 20 years and therefore outside thetimeframe of the current13 project
Housing plays a big role in the lives of most13 people both through their aspirations to moveup in the world (usually to a bigger property with a garden) and as the heart13 of the familylife which is associated with good quality of life UK properties have a life span approaching100 years which is about13 double that13 of their European counterparts (and certainly longerthan the wooden-shy‐frame buildings built13 in North America13 for example) A shortage ofhouses has plagued improvements in social welfare for the past13 30 years There is anargument13 that13 there are enough houses but13 the wrong size and in the wrong places andthis has some basis in fact13 as demography changes lead to more people (and more olderpeople) living alone However if there are two million homes in Scotland each with alifespan of 100 years then the renewal rate needs only to be 20000 per annum to maintainthe status quo However it13 must13 be clear that13 the impact13 of smart13 house development13 willbe small The focus should therefore be on adapting existing properties to render themmore appropriate for vulnerable people
Housing adaptations are a branch of assistive technologies The technologies for providingdifferent13 forms of accessible bath and level access shower are well-shy‐established with littleresearch considering anything other than alternative building materials and methods formaintaining the temperature of the bathwater Different13 technologies for bathing will beconsidered separately
25
Thus housing technologies are not likely to impact on social work13 within the next 20years13 though13 the use of information13 technology13 to ensure that people are aware of what13 is available is likely to be commonplace well before then
26
3 BEHAVIOUR AND ATTITUDE CHANGES DUE TO TECHNOLOGICALADVANCES
Technology is only one factor that13 will affect13 the way society changes in the next13 10 or 15years This chapter will consider the context13 in which the technological developmentsoutlined in the previous chapter will be supported (or held back) by societal factors
When the impact13 of such factors has been considered we can then apply theseassumptions to a number of case studies listed in Appendix13 A13
The headings selected for this chapter are not13 arbitrary as they reflect13 the context13 in whichtechnological changes must13 be considered They must13 include consideration of factors suchas demography and long-shy‐term conditions already addressed in the introduction to thesepapers together with the aspects of workforce and citizenship considered in the parallelpapers The additional elements here focus on trends that13 are already occurring and whichmay leave people struggling with the changes that13 occur
Finally there is a need to consider the attitudes of people to technology generally andespecially to the issues of privacy and social responsibility that13 could be radically changedby technology In some cases public opinion will prevent13 some forms of technology beingdeveloped if not13 commercialised In other cases some technologies will be fast-shy‐trackedeither at the request13 of government13 or because of a clear public demand for theopportunities that13 it13 can bring
Predictions13 about the13 future13 must inevitably be13 subject to considerable13 uncertainty butthat is no reason to stop thinking what might happen
31 The Welfare State
The UK can be rightly proud of the way that13 its welfare state has developed during the past13 100 years to provide a safety net13 of financial support13 to people and to their families whenthey are unemployed destitute homeless or challenged by crises and emergencies Therange of benefits received is considerable some are complex and many people struggle tounderstand their entitlements Some are universal some are discretionary some apply onlyto parents others to anyone
The total cost13 of providing these benefits continues to rise and when the economy isstagnating there is inevitably both political pressure often supported by popular publicopinion to introduce welfare reform so that13 people who do not13 work cannot13 be better offthan they would be if they were in full-shy‐time employment This strategy requires a universalbenefit13 to be introduced so that13 it13 is easier for claimants to access support13 but13 also easierfor agencies to identify the total benefits received The idea13 of a benefits cap then becomes
27
more practical to introduce especially if all the processes involved in making a claim arehandled electronically Indeed this encourages government13 to insist13 on applications forbenefits to be made on-shy‐line Unfortunately this will marginalise those people who haveneither a computer nor access to the internet thus emphasising the digital divide in amanner which works against13 some of the most13 disadvantaged people in society
There are currently few tangible links between digital technology and welfare provisionThe most13 obvious are universal benefits such as a free television licence (worth pound14550)13 for13 everyone aged 75 or older with blind and visually impaired people entitled to a 50discount13 irrespective of their age The significance of this position is that13 6 of revenuesgenerated through licence fees are to fund BBC on-shy‐line services13 such13 as websites and i-shy‐player In Scotland the BBCrsquos Alba Gaelic language television service is predominantlyfunded13 by MG Alba an organisation funded by the Scottish Government It is thereforeconceivable that13 in the future licence fees may be used to directly subsidise access toinformation and advice through the Internet13 for vulnerable people whether it13 is throughbroadband access or through a set-shy‐top box which removes the need for a computer in thehome to access particular websites or to use e-shy‐mail services
A second age-shy‐related benefit13 available in the UK is the winter fuel subsidy People whoreceive certain benefits receive the payments automatically while others must13 make aclaim Those who are not13 eligible for benefit13 due to a lack of an address for example missout13 on these payments and also on Cold Weather payments of pound25 for each seven dayperiod of very cold weather between 1 November and 31 March
The development13 of new warm home initiatives plus the complex of subsidies that13 theelectricity supply industry and government13 offer to people with solar cells further changesthe economic arguments Global warming may lead to greater variations in weatherextremes but13 might13 also increase the amount13 of electricity that13 can be generated byalternative (green) sources such as wind and solar cells It is estimated that13 energyconsumption in the UK increased by 17 between Christmas and Easter 2013 compared toprevious years as a result13 of cold weather but13 the above subsidy scheme did not13 benefit13 older people because two of the seven day cold periods were after 31st March It must13 beassumed that13 there will be more people living in fuel poverty in the future and this will leadto more cases of cold related illness including influenza13 and stroke
32 Management of long term conditions
The management13 of long term conditions will be improved for patients who are compliant13 with their medication regime so it13 is possible that13 there may be compulsion to adhere tothe prescription Such compulsion may be monitored using technology Indeed the remotemonitoring of vital signs using telehealthcare will become commonplace as the old boxesand sensors are replaced by devices that13 can be worn continuously or which can beembedded into the fabric of homes (including furniture and bedding) or can be worn asvests or patches They will wirelessly transmit13 data13 to smartphones or tablets and mobile
28
transmission and cloud technology will enable real-shy‐time data13 collection analysis andfeedback
One of the diseases which is projected to increase most13 significantly over the comingdecade is Type 2 diabetes Whilst13 there is a hereditary susceptibility to this condition formany people including those from the Middle East13 and the Asian sub-shy‐continent it13 is also adisease which tends to affect13 those people who are overweight13 andor have a sedentarylifestyle If untreated diabetes can lead to dizziness and collapse at any time but13 can alsohave more devastating long term consequences which include kidney failure strokeblindness and in extreme cases lower limb amputations Management13 therefore includesdaily monitoring of blood glucose levels and major dietary changes such as a significant13 reduction in the consumption of carbohydrates as well as a rigid exercise regime
Many newly diagnosed diabetics follow this advice closely and can lead normal lives for 40years or more but13 some struggle to accept13 the change in lifestyle required as well asremembering which foods are allowed and how much exercise they need to takeIndividual support13 plans are now forthcoming and over the next13 ten years best13 practicewill emerge in the form of smartphone apps that13 are personalised and which can becomean individualrsquos health coach This level of support13 will be fine for some people but13 otherswill need incentives so it13 is likely that13 gaming technologies will be introduced perhapsoffering rewards for good compliance There will be a temptation for some people tocheat perhaps allowing others to perform exercise for them or changing theirconsumption details
Many of these opportunities for cheating will be removed through the use of a uniquebiometric identifier a technology that13 will be mature enough to use in place of passwordson smartphones However the biggest13 challenge may be in encouraging older people to usethe technology Many older people have multiple morbidities Indeed a survey of Scottishpatients implied that13 42 of people aged over 80 will suffer from three long termconditions It will be essential for those people to comply with treatment13 regimes if they arenot13 to have the functional deficits that13 follow
33 Finding people who13 donrsquot fit
People who have low social capital are likely to have few relatives and friends with whomthey regularly communicate and are also unlikely to be part13 of community or faithorganisations such as clubs societies and church groups They also die several yearsyounger than most13 of the population often because they donrsquot13 engage with public healthinitiatives such as vaccinations against13 flu regular checks on their blood pressure bloodsugar levels or in the case of women smear tests or mammography The most13 likelyreason for disappearing beneath the radar of such initiatives is their mobility which leadsalmost13 inevitably to them having no fixed abode and no fixed telephone line It thenbecomes very difficult13 for them to be contacted because their mobile telephones are likelyto have Pay-shy‐As-shy‐You-shy‐Go contracts that13 donrsquot13 require validated names addresses and bankaccounts
29
It follows that13 some of the most13 vulnerable people in society including those who live onthe streets are effectively unknown to both the NHS and to social work departments untilthey are referred in a crisis This could be an emergency presentation to a hospital Accident13 and Emergency Department13 where they will come into contact13 with a social worker becausedischarge may be unsafe This often highlights the importance of the prevention agenda13 and the potential for avoiding admissions to hospital by intervening at an earlier stage
The advantages of being able to locate people who are vulnerable to specific diseases willincrease as genetic testing becomes more routine It is already possible to determine whomight13 be most13 at risk of breast13 cancer and prostate cancer as a result13 of family history Addto this the evidence that13 particular diet13 and exposure to environmental factors can furtherincrease risk then it13 is evident13 that13 individuals can be identified and offered treatmentsthat13 could save their lives many years before they become ill In the case of cancersperhaps only the individual is involved but13 for infectious diseases it13 is the whole of societythat13 is at risk if someone contracts one of the new strains of influenza or if someonechooses not13 to be vaccinated against13 rubella In Chinese airports all visitors are screenedfor fever and refused entry if they tested positive in cities the public are monitored in thesame way Similar approaches may be necessary in the UK if potential carriers cannot13 otherwise be identified
34 Volunteering
It is estimated that13 72 per cent13 of people volunteered to perform a charitable act13 at least13 once during 2012 a rise from 65 per cent13 the previous year About13 four out13 of every 10volunteers offer their services formally to one or more organisations The remaindervolunteer informally by helping out13 a friend or a neighbour Around 50 per cent13 volunteered at least13 once a month in the past13 year up from 41 per cent13 on the previous13 year Most13 have retired many of them before the statutory retirement13 age Those whodonrsquot13 feel able to offer time have offered their financial support13 at a time when the fundingavailable from sources such as the National Lottery has been decreasing Despite economicausterity donations to charities have been increasing 74 per cent13 said they had given tocharity at least13 once in the previous month up from 72 per cent13 the previous year
Strikingly 78 per cent13 of people strongly believe that13 they are part13 of their localneighbourhood an increase from 70 per cent13 10 years previously Community cohesion isstronger than ever 87 per cent13 of people believe their local area13 is a place where peoplefrom different13 backgrounds get13 on well together compared to 80 per cent13 in 2003
The role of volunteers in supporting vulnerable people is therefore likely to increase overthe next13 decade perhaps exploiting the success of the army of volunteers that13 was highlysuccessful in London during the Olympic and Paralympic games The greatest13 role for suchvolunteers may be in providing informal care for older people Already the UK has someseven million informal carers whose value in monetary terms has been calculated to be
30
more than the combined budgets of the NHS and social care Maintaining or extending thisprovision will help to support13 services in the future and may be supported by technology
Whilst13 there is ample evidence to suggest13 that13 telecare services support13 informal carers asmuch as (if not13 more than) the people that13 they are caring for it13 is the potential for utilisingthe internet13 and apps to make their role easier to coordinate and hence more effectivethat13 is likely to be most13 successful moving forward
Many of these focus on particular tasks that13 informal carers can help offer to older peoplesuch as organising their medication A pillbox program is just13 one feature of an app calledBalance It also includes sections for caregiving tips notes for the doctor and the patientsappointments plus a lsquolearning sectionrsquo with articles on aspects of Alzheimers and an RSSfeed for news about13 the disease Tyze is another multi-shy‐functional app it13 allows carers to
bull Organise appointmentsbull Plan outingsbull Share storiesbull Send updates to other family members
Another application is Rally Round which helps carers to organise someone to perform littlejobs often on a temporary basis when someone has dementia physical frailty or isrecovering from accident13 or illness Similar applications are MeMaxi and Finerday
35 The High13 Street
The shape and appearance of UK shopping centres have been changing for half a centuryPeople complain that13 centres are losing their identity with one town looking like everyother both in terms of the stores and in terms of the layout But13 there are three trendswhich are having a profound impact13 on many of the most13 vulnerable people in society
bull Centres lock their doors at 6pm or in some cases 10pm -shy‐ thus denying people whosuffer from claustrophobia13 from window shopping at times when other shoppershave left
bull Out13 of town shopping malls -shy‐ these US style centres are ideal for people in carsbecause they offer free parking which is essential for people who want13 to buy largeritems but13 difficult13 for people who have no transport13 and who must13 rely on publictransport13 that13 is often deficient
bull The rise of online shopping -shy‐ which means that13 many potential shoppers only visit13 High Street13 stores to check the prices before returning home to make a purchaseonline
It is the third of these effects that13 has the greatest13 potential for changing the High Street13 forever and it13 is making life for traditional retailers increasingly difficult13 at a time when highrents are crippling stores large and small It is difficult13 to see how this trend is likely tochange because consolidation in banking and estate agencies is already forcing the closure
31
of other High Street13 players while additional pressures on pubs has led to the closure ofthousands of pubs every year
Those figures however demonstrate that13 consumers still value what13 the high street13 canoffer -shy‐ the chance to inspect13 what13 theyrsquore thinking of buying -shy‐ as well as the new opennessof the internet Customer service makes a difference to people especially if there is aproblem and goods need to be returned One of the most13 common reasons for furniture tobe returned for example is that13 when a sofa13 or a wardrobe was delivered it13 couldnrsquot13 fit13 through the front13 door or up the stairs In the future people will be able to benefit from13 visualisation technology they will upload the floor plans of their homes enabling theretailer to inform them of the problem before they try to delivery Augmented reality viewwill similarly allow customers to see what13 a new item of furniture will look like in itsintended place so that13 they can be more informed about13 the effect13 of size and colour
In terms of improving the viability of the High Street stores will have to focus on theimportance of brand which could mean that13 individual independent13 retailers will have topartner with national suppliers to support13 a local tailored offering based on products that13 are designed for a more global market This is a lsquoconnected High Streetrsquo approach whichcould be enabled by the developments in internet13 availability and smart13 phone accessdescribed in the previous section
The overall effect13 of all these changes could mean that13 town centres become smaller but13 more vibrant13 areas They could thrive if people are attracted there in large numbers whichmeans that13 retail must13 be developed alongside restaurants pubs galleries and other leisureopportunities This is possible in new shopping centres which are already being integratedwith transport13 hubs including railway and bus stations but13 may be more of a design13 challenge for older towns and cities with large Victorian buildings To ensure that13 morepeople are welcomed into the new centres they should include attention to green spacesand areas where people can relax without13 feeling that13 they are second class citizensbecause they donrsquot13 have the same buying power
3513 Privacy
To some people privacy is their right13 to live their lives without13 interference they may seethe State as a potential lsquoBig Brotherrsquo spying on their every move and judging their actions13 and activities Other people have fewer concerns about13 the role of the State but13 great13 fearof individuals interfering with and invading their privacy Some embrace the concept13 of lsquomyspacersquo an area13 of a square metre or so into which nobody can enter without13 permissionThis allows them to avoid physical contact13 and to feel safe from any form of threateningbehaviour
Yet13 this idea13 of private space and its potential violation is merely the tip of the iceberg asfar as privacy is concerned more significant13 is the idea13 of personal (and private)information being shared with anyone and everyone This could be related to identityopinion or image for an individual who wants to remain anonymous or even secretive thisis going to become an increasing problem as technology provides the means of taking
32
photographs recording conversations and capturing environment13 with something as smalland ubiquitous as a mobile phone The fact13 that13 this information can then be shared withthe rest13 of the world using e-shy‐mail Twitter and Facebook makes the problem all the moredifficult So the threat13 is no longer solely from the long lenses of the Paparazzi but13 fromanyone (and that13 means everyone) who has even the most13 basic of mobile phones
This relates to the changing views of society on what13 information should remain privateand what13 should be shared with others The success of social media13 has been based on anattitude of lsquosharing everythingrsquo with either your friends or the world This has introduced anaiumlve idea13 in the minds of some younger people (especially those known as Millennials ieaged 18-shy‐30) that13 everyone can be their friends whilst13 perhaps failing to reinforce the bondsof genuine friendship with any form of test13 or restriction Technology could play a role indefining these friendships and allowing individuals to understand what13 makes a goodfriend but13 this approach has yet13 to be developed and may be slow to overcome the needfor some people to measure their own popularity simply as the number of people that13 theycan list13 as friends on their Facebook page
It follows that13 there may be a need for a new definition of privacy that13 is in keeping withthe web and its ability to display images and opinion in an unregulated manner This needsto embrace past13 concerns about13 the ability of an individual to live without13 the threat13 ofothers being able to watch them whilst13 offering some protection from random postingsabout13 them online Perhaps this could include a right13 to be able to edit13 or remove anythingrelating to themselves on the Web including images that13 are not13 news-shy‐worthy Theownership of image rights may be an associated issue that13 needs to be addressedespecially as modern technology can remove an individual from a group (or a background)13 view provide digital touch-shy‐up or air-shy‐brushing and then republish it13 in a different13 contextHowever there is general agreement13 that13 personal information (such as contact13 details andbank codes) should not13 have a place on the web Surprisingly few people take proactivemeasures to prevent13 tracking functions being activated
It follows that13 too much privacy could lead to younger people fearing that13 they maybecome lost13 in a digital world It is not13 surprising then that13 they are prepared to make lots13 of personal information available often with no fear of how it13 might13 be used by othersWhen Google glasses and similar technologies become available during the next13 few yearsthey will have the potential to identify a stranger walking down the street and to find manyof their secrets to present13 to the wearer in a fraction of a second They could know moreabout13 them than their genuine friends know -shy‐ so who will be their friends in the future
36 Data sharing and13 protection
By lsquodata13 sharingrsquo we mean the disclosure of data13 held by one organisation on an individualto a third party organisation(s) or the sharing of data13 between different13 parts of anorganisation Some data13 sharing doesnrsquot13 involve personal data13 because it13 has beenanonymised in such a way that13 the statistics can be used for the collective good without13 theidentification of the individual The Data13 Protection Act13 (DPA) is in place to provide a legal
33
framework that13 ensures that13 organisations that13 hold personal data13 must13 act13 responsibly atall times These principles adequately describe the position of public and government13 bodies especially social services departments who are responsible for the informationconcerning the health and well-shy‐being of individuals -shy‐ and hence by implication thesensitive data13 relating to their vulnerability
The legal framework that13 applies to private and third sector organisations differs from that13 which applies to public sector organisations which may only act13 within the defined limits oftheir statutory powers However all bodies must13 comply fully with the data13 protectionprinciples and this situation is unlikely to change within the next13 10 to 15 years In someprivate sector contexts there are legal constraints on the disclosure of personal dataHowever most13 private and third sector organisations have a general ability to shareinformation provided this does not13 breach the DPA or any other law It is advisable for acompany to check its constitutional documents such as its memorandum and articles13 ofassociation to make sure there are no restrictions that13 would prevent13 it13 from sharingpersonal data13 in a particular context The type of data13 held is therefore a subject13 ofconcern as it13 may be difficult13 for legislation to keep up with the additional layers of data13 created on-shy‐line and through the Internet13 of Things
Private and third sector organisations should have regard to any industry-shy‐specific regulationor guidance about13 handling individualsrsquo information as this may affect13 the organisationrsquosability to share information They should also be aware of the legal issues that13 can arisewhen sharing personal data13 with public sector bodies This becomes more of an issue asprivate and third sector bodies are carrying out13 a wider range of traditionally public sectorfunctions Opportunities for inappropriate sharing of sensitive data13 will therefore inevitablyincrease
Public authorities must13 comply with the Human Rights Act13 (HRA) legislation in theperformance of their functions The HRA also applies to organisations in the private sectorinsofar as they carry out13 functions of a public nature which could include delivering a socialcare activity Where the HRA applies organisations must13 not13 act13 in a way that13 would beincompatible with rights under the European Convention on Human Rights Article 8 of theConvention giving everyone the right13 to respect13 for their private and family life their homeand their correspondence is especially relevant13 to sharing personal data If personal data13 isdisclosed or shared in ways that13 comply with the DPA the sharing or disclosure of that13 information is also likely to comply with the HRA The problem may still be in policing theActs and the rights of an individual if they believe that13 their personal data13 has been sharedor accessed by an inappropriate organisation or individual
A legal industry may be born to deal with such matters but13 this is unlikely to benefit13 peoplewho cannot13 afford the fees involved They would require either legal aid or to employ13 more13 lsquono win no feersquo companies Public attitudes to such costs might13 become negative unlessthey prove successful in preventing breaches of data13 security There may need to belegislation to provide a stronger basis for forcing compliance with privacy laws
34
37 Connecting with13 people
We are social creatures most13 of us rely on our friendships and interactions with friendsand families to share our happiest13 moments and experiences Research suggests that13 thishappiness is infectious at all levels and leads to a 15 increase in the happiness of a closecontact 10 for a second degree contact13 such as the friendrsquos spouse and a 6 increase fora friend of a friend It is hardly surprising that13 the success of social media13 such as Facebookis intimately related to the ability of people to quickly share their happiest13 moments with asmany of their friends and connections as possible
All this has happened during the rise of the Internet13 and the corresponding increase inopportunities for connecting online ie this is a 21st Century phenomenon which has beenfacilitated by Information and Communications Technology But13 the Internet13 remains in itsinfancy and we are only beginning to understand and exploit13 its potential In terms ofaccessing the Internet there are now perhaps two billion people who have access with99 of them having gained this during the past13 decade This number will have doubled bythe period 2020 to 2025 It is likely that13 everyone who wants to be connected in the UK willby then be connected Turning this on its head only those who donrsquot13 want13 to be online willnot13 be on the Internet13 within a decade Connecting with the unconnected will therefore bea case of identifying those people who donrsquot13 want13 to be found unfortunately these mayinclude many people who need the support13 of social care organisations It means that13 theywill be looking for support13 only when they are in crisis unless other ways of finding andormonitoring them are found
While the number of people connected via the Internet13 has exploded this might13 bedwarfed by the number of connected lsquothingsrsquo During 2009 the number of thingsconnected to the Internet13 surpassed the number of connected people at which point13 webegan to experience what13 this report13 has described as the lsquoInternet13 of Thingsrsquo Yet 99 ofall physical objects that13 could join this network are not13 yet13 connected but13 the number couldgrow by 25 every year for the next13 decade so that13 there could be 100 billion connectedobjects by 2025 some of which will be owned or used by everyone in the UK includingthose people who donrsquot13 want13 to be connected themselves We will then have an Internet13 of Everything which will be the smart13 connection of people data events and actions
With each new person object or data13 that13 comes online the connection possibilitiesbetween all these elements grows exponentially The rise of big data mobile networkingcloud storage and data13 mining technologies will all play a critical role in the Internet13 ofEverything The result13 will be new capabilities richer experiences and unprecedentedvalue for individuals businesses communities and countries everywhere The lsquonetworkeffectrsquo of the Internet13 of Everything will be a very powerful thing the true impact13 of whichwe wonrsquot13 fully understand for several years As it13 develops however those who are not13 connected will feel even more digitally and socially excluded There will be a need to reachout13 to vulnerable people unless the process of claiming requires proof of online identityand the payments to be received can only be redeemed using a chipped card or adownloaded app onto a smartphone This is of course the way that13 welfare arrangementsare already developing thus it13 might13 prove impossible to make a successful claim without13
35
already being connected to lsquothe systemrsquo either through an online presence or through theInternet13 of Things
38 Downloading everything
Sixty years ago information was discovered by reading books often in a library wherenotes had to be made because the books or journals couldnrsquot13 be removed Then in theearly 1960s the first13 office photocopying machines were introduced into the UK theyimmediately meant13 that13 pages or articles from books could be copied and taken away to beread and summarised later Within a few years photocopying became a replacement13 forreading as researchers became less adept13 at selecting a few sentences and every deskbecame a depository for reams of printed paper Paper became the means of recordingeverything from bank statements through to music
We now appreciate that13 printing everything is a waste of both the ink (or toner) used tocreate the black print13 and of paper which requires trees to be chopped down and pulpedbefore it13 can be pressed into thin sheets Saving paper is therefore seen as green and goodfor the planet Fortunately we no longer need to print13 everything because computermemory is unlimited thanks to the cloud and we can then view pages and articles onportable or fixed screens
The internet13 has everything and it13 is all available instantly for downloading providing thereis a device available to accept13 it and there is sufficient13 communication bandwidth toperform the transfer of data13 sufficiently quickly Thus we can record all text13 articles that13 are relevant13 to us including digital records of birth certificates qualifications and passportsand the need for original printed versions will decline But13 we can also do this forphotographs Most13 handheld computing devices include at least13 one camera so they cangenerate enormous number of pictures which can be kept13 for posterity without13 having toconsume inks and special papers to print13 them
But13 the materials that13 can be downloaded donrsquot13 stop at pictures software is available that13 can grab TV shows after they air and movies as soon as theyre released In the same wayit13 is possible to schedule music comic books video games and practically anything else asa download with minimal effort People will need enormous hard drives if they want13 theirown digital copies of these files so will more than likely make use of cloud storage that13 willbe available from many organisations The location of the servers may become sensitivedue to border restrictions as will the security of the data13 and the way that13 it13 is backed up sothat13 it13 is resilient13 to failures
It may be evident13 that13 application forms for all types of welfare payment13 will be availableonly for downloading so that once digitised they can be processed by computer andrecords sent13 to various servers for subsequent13 storage and processing Some people maywant13 to keep their data13 on them once it13 has been downloaded Pen drives can already holdseveral GB of data so it13 is likely that13 people will be able to carry their downloaded data13 withthem at all times irrespective of the size and complexities of the information
36
39 Health13 and13 well-shy‐being
The general health of the population is unlikely to deteriorate noticeably within 10 to 20years Indeed expectations of the population are that13 things must13 improve as surgicaltechniques mature and as pharmaceutical interventions become more personalised andpowerful However the rising demand for health services due to an ageing population andthe increasing cost13 of providing sophisticated therapies will make delivering a free anduniversal health service difficult13 without13 substantial increases in taxation This is unlikely tohappen in the UK even though spending on health services will be protected against13 thecuts facing other services
There will have to be changes in how the NHS works For twenty years hospitals have beenclosed and replaced by fewer new facilities so that13 the bed count13 is reduced This has led toa significant13 shift13 in resources to primary care and community care supporting shorter staysin hospital and speedier transfer back home for people after surgery or illness This hasbeen13 successful but13 there remain problems with demand for GP services especially out-shy‐of-shy‐hours and at weekends Indeed despite the introduction of NHS24 and similar help-shy‐linesthe demand for GP appointments continues to increase Delays are inevitable and this willincrease system failures with more unnecessary deaths and a failure for people to access adiagnosis that13 might13 lead to early interventions and ultimately lower delivery costs Over250 more patients are added to waiting lists every day
This will lead to a new model of primary care consistent13 with existing changes which haveseen surgeries move from High Street13 locations to medical centres close to bus routes andwith more parking for patients The process of making an appointment13 is changing from atelephone-shy‐based interview process dominated by a medically-shy‐unqualified receptionist13 to achoose and book approach using an online process linked to electronic patient13 records Thiswill give patients more convenience but13 will allow priority for those who have Internet13 access at the expensive of those who are digitally excluded Making the process of bookingan appointment13 quick and easy may also increase demand from people who do not13 need tobe seen as it13 will fail to identify those in greatest13 need
A greater use of telehealth and telecare technologies will be inevitable beginning with thefirst13 contact13 as an encounter using the telephone e-shy‐mail or video conferencing -shy‐ a visit13 tothe GP surgery should be a last13 resort and should involve a nurse consultation in the first13 instance This would be consistent13 with three quarters of appointments currently involvinga chronic disease or long term condition which relates to improved self-shy‐care The support13 ofthese patients at home should be prioritised through tele-shy‐ and web-shy‐based technologies andshould involve training and coaching through a network of nurse practitioners Home visitsshould generally be unnecessary through the use of these technologies but13 could besupplemented by satellite surgeries manned by nursing in community premises or inpharmacies nurseries and Internet13 cafes
The homes13 of people who13 need13 closer monitoring can then become part13 of virtual wardswith real or electronic visits by health professionals University Hospital Southampton NHSFoundation Trust13 already looks after patients who have undergone surgery such as a hip orknee13 replacements in virtual wards with high levels of satisfaction The Royal Free London
37
NHS Foundation Trust13 offers a similar service but13 plans to add the possibility of videoconsultations between patient13 and consultant
310 Attitudes to public health issues ndash obesity smoking alcohol abuse drugs
As self-shy‐care becomes the focus of the NHS the public will increasingly understand that13 thecosts and availability of services are being harmed by the poor health behaviour ofrelatively small numbers of people The link between public health initiatives today andhealthcare needs and costs in the future will become increasingly evident13 as a result13 of theway that13 information is presented Thus the overweight13 smoker who currently attractsconcern and pity when they are diagnosed with diabetes and COPD is increasingly beingseen as the victim of their own stupidity or lack of self-shy‐discipline If they continue to neglect13 medical advice and continue with an unhealthy lifestyle then the way that13 they receivetreatment13 and consume resources will become a matter for the entire population
Obesity is seen as due to a combination of poor diet13 and a sedentary lifestyle No longer isthe idea13 that13 people are lsquobig bonedrsquo acceptable Governments will respond initially byrequiring manufacturers and food processors to provide nutritional information onpackaging and on menus in restaurants But13 people can choose not13 to read the data13 and toneglect13 both the importance of food quality content13 and quantity This will increasepressure to introduce fat13 or sugar taxes and these are likely to be in force within a decade
Although the high taxes on tobacco products has forced some smokers to reduce theirconsumption or to give up altogether the impact13 has been reduced by the smuggling ofproducts from overseas and by the availability of duty-shy‐free cigarettes for people returningfrom foreign holidays and business meetings Further measures are planned to changepackaging and to include even more graphic images and warnings on cigarette packages tomake smokers aware of the effects of smoking on their health and well-shy‐being There is asyet little evidence of how successful this might13 be More effective has been the banning ofsmoking in public places including trains and aircraft Expensive medical interventions suchas heart13 transplants will be denied to individuals until they change their lifestyle behaviourSmokers might13 therefore be increasingly ostracised leading to a loss of esteem This mayhave a particular impact13 on people who already suffer from mental health problems whoare more likely to smoke
The overuse of alcohol is being recognised as a major factor in hospital admissions withNHS figures showing an increase of over 40 in such admissions over the past13 decadeLinked to this has been a 75 increase in prescriptions to treat13 alcohol dependency Fewpeople have sympathy for those who waste their limited income on booze If they havechildren or other dependents they will be the ones who suffer and who may need thesupport13 of social care
Drug users are already significant13 users of social services as their habit13 is likely to makethem unemployable They receive little sympathy from the general public because they areseen as criminals and people who waste public resources Levels of drug abuse have been
38
slowly increasing over the years but13 this trend is slowly being reversed Indeed the numberof people using drugs during the past13 year has fallen to its lowest13 level for nearly 20 years(below 9) with cannabis being most13 likely often following excessive drinking Aselectronic noses and other technologies can detect13 traces of drugs it13 seems likely that13 success in overcoming addiction can be measured objectively This may become a two-shy‐edged sword rewarding those who can turn around their lives but13 further marginalisingthose who canrsquot13 or wont13 accept13 the lsquocold turkeyrsquo
311 Attitudes to surveillance
Issues associated with privacy confidentiality and data13 security have been discussedpreviously in the context13 of information technology the World Wide Web and the ease ofcollecting recording recalling analysing and displaying data The monitoring of individualsand their methods of using this information can be regarded as surveillance As thequantities of data13 increase along with the number of devices that13 can be used to access itthe surveillance tools will also increase in their sophistication Indeed the Big Data13 approaches described in the previous section will enable the combination of structureddata13 (such as the information held in databases) to be married with unstructured data13 fromimages in such a way that13 it13 can be mined
Whilst13 the lsquodigital surveillancersquo methods described above may cause most13 concern topeople because of its impact13 on anonymity it13 is the collection and analysis of images that13 are the major concern to people as they contemplate the ways that13 lsquoBig Brotherrsquo maydevelop to restrict13 freedom Every major UK city and town centre has an array of CCTVcameras that13 continually record activities from every angle If it13 used to be true that13 nobody in London was more than 10 yards from a rat it13 is certainly the case today that13 nobody can be more than this distance from being in view of a surveillance camera Yetthey receive so much positive publicity from TV programmes where their footage is used todetect13 vehicles close to a crime scene or to monitor the movements of suspects that13 theyare now accepted by the public as a deterrent13 in the same way as lsquobobbies on the beatrsquowere seen 25 years ago There is therefore little public reaction to the expansion in the useof video surveillance except13 for the practical observation of how so many views can beinspected and recorded
Looking to the future the tumbling cost13 of video technology will surely lead to anotherincrease in the number of devices The aerial views taken from towers will besupplemented by more local views taken by devices that13 are embedded in the fabric ofbuildings or carried by individuals either on their person (for example on clothing orspectacles) or in the bags that13 they carry The time and date-shy‐stamped images as Big Datawill be recorded to lsquothe Cloudrsquo where it13 can be added to other data It can then be usedwhen an incident13 has occurred or to provide further detail of night-shy‐time activities
It follows that13 there will be no hiding place for people who simply want13 to disappear Theymay respond by wearing clothing (such as hoodies) that13 hide their faces or which make it13 difficult13 to distinguish gait13 or mannerisms from which they might13 be identified New forms
39
of clothing may be designed to make shapes more difficult13 to analyse and these might13 become the uniforms of a class of person who wants to live in a way that13 they donrsquot13 interact13 with officials from any ministry or local government13 department If they also obstruct13 services then they will be considered to be anarchists of some form sparking protests fromother sectors of society
31213 Attitudes to driving
Motor cars have been a feature of UK roads for over a century but13 it13 is only during the past13 50 years that13 they have become a resource that13 most13 families have had access to enablingthem to travel without13 the restrictions imposed by a limited railway network and non-shy‐integrated bus transport People who have had a car throughout13 their lives often see theircars as an important13 factor in enabling them to remain independent13 and to exercise choicesrelating to where they shop and where they spend their leisure time This extends to theirspouse and to friends and neighbours that13 they might13 take with them on their variousexpeditions
Unfortunately there are incidents involving older drivers who perhaps go down amotorway in the wrong direction who are taken ill at the wheel or who are involved in anaccident13 involving no other vehicles These are small in number but13 often lead to a reactionthat13 they shouldnrsquot13 be allowed to drive lsquoat13 their agersquo Age itself is not13 an indicator ofdriving quality but13 because old age also brings more chance of having limited long termconditions and other illnesses it13 is easy to make a link between driving ability and age Thelicensing system does require continued driving to be linked with medical advice andforbids people with poor eyesight epilepsy and other conditions to hold a licence in oldage
Yet13 statistically older drivers cause far fewer accidents than younger drivers The reasonsfor this may be complex and are likely to include the fact13 that13 they drive less often covershorter distances and donrsquot13 go out13 in the dark or in poor weather However it13 does not13 wholly explain why the UKrsquos drivers aged over 70 and who represent13 some 8 of all driversare involved in only 4 of accidents that13 cause injury This compares favourably with the15 of13 drivers aged between 17 and 29 who are involved in over a third of crashes that13 result13 in injury
By 2020 the number of drivers aged over 70 on UK roads is likely to increase to over 7million This will require a new national strategy perhaps involving support13 for olderdrivers further training raising awareness of issues and making more use of adaptivetechnologies to support13 the driver in avoiding collision or forgetting to check on the statusof their vehicle Poor eyesight13 could be enhanced by camera technologies rather thanforcing people off the road if they are unable to read a licence plate
The International Longevity Centre has found that13 one in four Britons thought13 driversshould be made to switch off the ignition for good somewhere between the ages of 70 and75 The numbers may decrease as the population ages and as cars become safer Forcing
40
older people off the road may be a natural consequence of providing free bus passes andsubsidised rail fares but13 the growth in the pavement13 scooter industry demonstrates that13 older people value their independence and will do almost13 anything to get13 out13 and aboutPerhaps legislation will result13 in more regulation of electric vehicles and where they cantravel
There can be no doubt13 that13 getting out13 will be associated with better quality of life andwell-shy‐being and this is likely to be supported in the future as evidence of improvedoutcomes emerges It is to be hoped that13 positive stories will be publicised so that13 publicattitudes arenrsquot13 hardened This may be supported by more in-shy‐car monitoring of drivers andthe linking of performance with on-shy‐line driving records and licences These could throughremotely monitored ignition systems prevent13 the use of motor vehicles by people without13 a licence or without13 insurance
313 Climate change
There is a general view that13 the emissions of carbon gases are contributing to globalwarming in a manner that13 will change the UK climate in such a way that13 the climate maybecome more Mediterranean However some scientists believe that13 manrsquos impact13 on theenvironment13 may be small compared with natural variations caused for example bycyclical changes in the sunrsquos energy output13 or by the effects of volcanoes and earthquakesRecent13 evidence has suggested that13 we are going through a phase of changing extremesand that13 this is more likely to cause storms periods of excessive rainfall and unusualseasonal trends with snow and frost13 in the spring and warmer winters Considerableuncertainty remains and it13 might13 be necessary to plan for a number of different13 scenariosand for the impact13 on vulnerable people
I Colder winters UK properties are poorly insulated resulting in excess mortalitiesduring cold spells due to an increased number of people suffering from stroke aswell as bronchitis and other pulmonary diseases The cost13 of heating continues toincrease putting more households into a state of fuel poverty Any further coolingduring the winter months will result13 in more people living in unhealthy coldconditions Winter fuel payments are likely to be restricted to the poorest13 peoplebut13 this might13 exclude people who live in larger properties that13 are more difficult13 toheat
II More storms excessive winds and rain can cause flooding at any time of the yearMany UK communities are built13 close to rivers and these can surge during heavyrainfall causing houses to be filled with water and furniture and carpets lostInsurance can be problematic for properties built13 on flood plains which can blight13 properties and prevent13 owners from being able to sell and move on High winds canrip off roofs causing injury and also causing families to be left13 homeless anddependent13 on social services
III Hot13 summers Europe suffered high temperatures during the summers of 2003 and2004 leading to heat13 stroke and hypothermia The UK has not13 previously sufferedfrom such problems but13 might13 be expected to experience days of extreme
41
temperature and humidity at times Older people may not13 be prepared for suchweather Street13 dwellers may be unable to find shade and supplies of drinkingwater
Irrespective of what13 combination of weather scenarios arise it13 must13 be concluded that13 any extremes will have a major negative impact13 on vulnerable people especially if theyare not13 prepared because they havenrsquot13 received the weather warnings and advice that13 can be broadcast13 using the TV radio and online services Once again the digitallyexcluded will suffer and will pay a high cost Society will continue to pick up the bill interms of demands on social care services unless preventive actions are taken in theform of connecting these people to each other and to formal services
42
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
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13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
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b13 13
n13 13
13 s13
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ly13
13 e13 t13 e13
s13 er13 e13
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13 13
13
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13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
e13 g13 13
e13
13 13 ial13
13
d13
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s13 y13
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13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
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13
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le13
y13
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le13 13 13
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13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
More generally the need for power conservation will include devices that13 are moreefficient and a significant13 emphasis on heat13 retention in buildings through betterinsulation
The energy crisis may force many people to spend more time in community settingsincluding shops and public buildings where they can benefit13 from the warmth Increasingreliance on mobile communication devices will lead to increasing demand for batterycharging facilities
Greater use may be made of portable devices for generating power based on solar cellswind or hand motion
222 Smart cities and homes
The Digital City initiatives have been based on information and how it13 can be used most13 effectively to make people aware of what13 is going on around them This means bettercoordination of resources more rapid access to advice and a battery of sensors measuringevery conceivable parameter from sound and light13 levels through to air quality andtemperature fluctuations There are several Digital or Smart13 City initiatives currently beingimplemented both in the UK and across the world They may significantly impact13 the livesof the millions of people living in them but13 the timeframe for outcome benefits to influenceplanning and design elsewhere is likely to be at least13 20 years and therefore outside thetimeframe of the current13 project
Housing plays a big role in the lives of most13 people both through their aspirations to moveup in the world (usually to a bigger property with a garden) and as the heart13 of the familylife which is associated with good quality of life UK properties have a life span approaching100 years which is about13 double that13 of their European counterparts (and certainly longerthan the wooden-shy‐frame buildings built13 in North America13 for example) A shortage ofhouses has plagued improvements in social welfare for the past13 30 years There is anargument13 that13 there are enough houses but13 the wrong size and in the wrong places andthis has some basis in fact13 as demography changes lead to more people (and more olderpeople) living alone However if there are two million homes in Scotland each with alifespan of 100 years then the renewal rate needs only to be 20000 per annum to maintainthe status quo However it13 must13 be clear that13 the impact13 of smart13 house development13 willbe small The focus should therefore be on adapting existing properties to render themmore appropriate for vulnerable people
Housing adaptations are a branch of assistive technologies The technologies for providingdifferent13 forms of accessible bath and level access shower are well-shy‐established with littleresearch considering anything other than alternative building materials and methods formaintaining the temperature of the bathwater Different13 technologies for bathing will beconsidered separately
25
Thus housing technologies are not likely to impact on social work13 within the next 20years13 though13 the use of information13 technology13 to ensure that people are aware of what13 is available is likely to be commonplace well before then
26
3 BEHAVIOUR AND ATTITUDE CHANGES DUE TO TECHNOLOGICALADVANCES
Technology is only one factor that13 will affect13 the way society changes in the next13 10 or 15years This chapter will consider the context13 in which the technological developmentsoutlined in the previous chapter will be supported (or held back) by societal factors
When the impact13 of such factors has been considered we can then apply theseassumptions to a number of case studies listed in Appendix13 A13
The headings selected for this chapter are not13 arbitrary as they reflect13 the context13 in whichtechnological changes must13 be considered They must13 include consideration of factors suchas demography and long-shy‐term conditions already addressed in the introduction to thesepapers together with the aspects of workforce and citizenship considered in the parallelpapers The additional elements here focus on trends that13 are already occurring and whichmay leave people struggling with the changes that13 occur
Finally there is a need to consider the attitudes of people to technology generally andespecially to the issues of privacy and social responsibility that13 could be radically changedby technology In some cases public opinion will prevent13 some forms of technology beingdeveloped if not13 commercialised In other cases some technologies will be fast-shy‐trackedeither at the request13 of government13 or because of a clear public demand for theopportunities that13 it13 can bring
Predictions13 about the13 future13 must inevitably be13 subject to considerable13 uncertainty butthat is no reason to stop thinking what might happen
31 The Welfare State
The UK can be rightly proud of the way that13 its welfare state has developed during the past13 100 years to provide a safety net13 of financial support13 to people and to their families whenthey are unemployed destitute homeless or challenged by crises and emergencies Therange of benefits received is considerable some are complex and many people struggle tounderstand their entitlements Some are universal some are discretionary some apply onlyto parents others to anyone
The total cost13 of providing these benefits continues to rise and when the economy isstagnating there is inevitably both political pressure often supported by popular publicopinion to introduce welfare reform so that13 people who do not13 work cannot13 be better offthan they would be if they were in full-shy‐time employment This strategy requires a universalbenefit13 to be introduced so that13 it13 is easier for claimants to access support13 but13 also easierfor agencies to identify the total benefits received The idea13 of a benefits cap then becomes
27
more practical to introduce especially if all the processes involved in making a claim arehandled electronically Indeed this encourages government13 to insist13 on applications forbenefits to be made on-shy‐line Unfortunately this will marginalise those people who haveneither a computer nor access to the internet thus emphasising the digital divide in amanner which works against13 some of the most13 disadvantaged people in society
There are currently few tangible links between digital technology and welfare provisionThe most13 obvious are universal benefits such as a free television licence (worth pound14550)13 for13 everyone aged 75 or older with blind and visually impaired people entitled to a 50discount13 irrespective of their age The significance of this position is that13 6 of revenuesgenerated through licence fees are to fund BBC on-shy‐line services13 such13 as websites and i-shy‐player In Scotland the BBCrsquos Alba Gaelic language television service is predominantlyfunded13 by MG Alba an organisation funded by the Scottish Government It is thereforeconceivable that13 in the future licence fees may be used to directly subsidise access toinformation and advice through the Internet13 for vulnerable people whether it13 is throughbroadband access or through a set-shy‐top box which removes the need for a computer in thehome to access particular websites or to use e-shy‐mail services
A second age-shy‐related benefit13 available in the UK is the winter fuel subsidy People whoreceive certain benefits receive the payments automatically while others must13 make aclaim Those who are not13 eligible for benefit13 due to a lack of an address for example missout13 on these payments and also on Cold Weather payments of pound25 for each seven dayperiod of very cold weather between 1 November and 31 March
The development13 of new warm home initiatives plus the complex of subsidies that13 theelectricity supply industry and government13 offer to people with solar cells further changesthe economic arguments Global warming may lead to greater variations in weatherextremes but13 might13 also increase the amount13 of electricity that13 can be generated byalternative (green) sources such as wind and solar cells It is estimated that13 energyconsumption in the UK increased by 17 between Christmas and Easter 2013 compared toprevious years as a result13 of cold weather but13 the above subsidy scheme did not13 benefit13 older people because two of the seven day cold periods were after 31st March It must13 beassumed that13 there will be more people living in fuel poverty in the future and this will leadto more cases of cold related illness including influenza13 and stroke
32 Management of long term conditions
The management13 of long term conditions will be improved for patients who are compliant13 with their medication regime so it13 is possible that13 there may be compulsion to adhere tothe prescription Such compulsion may be monitored using technology Indeed the remotemonitoring of vital signs using telehealthcare will become commonplace as the old boxesand sensors are replaced by devices that13 can be worn continuously or which can beembedded into the fabric of homes (including furniture and bedding) or can be worn asvests or patches They will wirelessly transmit13 data13 to smartphones or tablets and mobile
28
transmission and cloud technology will enable real-shy‐time data13 collection analysis andfeedback
One of the diseases which is projected to increase most13 significantly over the comingdecade is Type 2 diabetes Whilst13 there is a hereditary susceptibility to this condition formany people including those from the Middle East13 and the Asian sub-shy‐continent it13 is also adisease which tends to affect13 those people who are overweight13 andor have a sedentarylifestyle If untreated diabetes can lead to dizziness and collapse at any time but13 can alsohave more devastating long term consequences which include kidney failure strokeblindness and in extreme cases lower limb amputations Management13 therefore includesdaily monitoring of blood glucose levels and major dietary changes such as a significant13 reduction in the consumption of carbohydrates as well as a rigid exercise regime
Many newly diagnosed diabetics follow this advice closely and can lead normal lives for 40years or more but13 some struggle to accept13 the change in lifestyle required as well asremembering which foods are allowed and how much exercise they need to takeIndividual support13 plans are now forthcoming and over the next13 ten years best13 practicewill emerge in the form of smartphone apps that13 are personalised and which can becomean individualrsquos health coach This level of support13 will be fine for some people but13 otherswill need incentives so it13 is likely that13 gaming technologies will be introduced perhapsoffering rewards for good compliance There will be a temptation for some people tocheat perhaps allowing others to perform exercise for them or changing theirconsumption details
Many of these opportunities for cheating will be removed through the use of a uniquebiometric identifier a technology that13 will be mature enough to use in place of passwordson smartphones However the biggest13 challenge may be in encouraging older people to usethe technology Many older people have multiple morbidities Indeed a survey of Scottishpatients implied that13 42 of people aged over 80 will suffer from three long termconditions It will be essential for those people to comply with treatment13 regimes if they arenot13 to have the functional deficits that13 follow
33 Finding people who13 donrsquot fit
People who have low social capital are likely to have few relatives and friends with whomthey regularly communicate and are also unlikely to be part13 of community or faithorganisations such as clubs societies and church groups They also die several yearsyounger than most13 of the population often because they donrsquot13 engage with public healthinitiatives such as vaccinations against13 flu regular checks on their blood pressure bloodsugar levels or in the case of women smear tests or mammography The most13 likelyreason for disappearing beneath the radar of such initiatives is their mobility which leadsalmost13 inevitably to them having no fixed abode and no fixed telephone line It thenbecomes very difficult13 for them to be contacted because their mobile telephones are likelyto have Pay-shy‐As-shy‐You-shy‐Go contracts that13 donrsquot13 require validated names addresses and bankaccounts
29
It follows that13 some of the most13 vulnerable people in society including those who live onthe streets are effectively unknown to both the NHS and to social work departments untilthey are referred in a crisis This could be an emergency presentation to a hospital Accident13 and Emergency Department13 where they will come into contact13 with a social worker becausedischarge may be unsafe This often highlights the importance of the prevention agenda13 and the potential for avoiding admissions to hospital by intervening at an earlier stage
The advantages of being able to locate people who are vulnerable to specific diseases willincrease as genetic testing becomes more routine It is already possible to determine whomight13 be most13 at risk of breast13 cancer and prostate cancer as a result13 of family history Addto this the evidence that13 particular diet13 and exposure to environmental factors can furtherincrease risk then it13 is evident13 that13 individuals can be identified and offered treatmentsthat13 could save their lives many years before they become ill In the case of cancersperhaps only the individual is involved but13 for infectious diseases it13 is the whole of societythat13 is at risk if someone contracts one of the new strains of influenza or if someonechooses not13 to be vaccinated against13 rubella In Chinese airports all visitors are screenedfor fever and refused entry if they tested positive in cities the public are monitored in thesame way Similar approaches may be necessary in the UK if potential carriers cannot13 otherwise be identified
34 Volunteering
It is estimated that13 72 per cent13 of people volunteered to perform a charitable act13 at least13 once during 2012 a rise from 65 per cent13 the previous year About13 four out13 of every 10volunteers offer their services formally to one or more organisations The remaindervolunteer informally by helping out13 a friend or a neighbour Around 50 per cent13 volunteered at least13 once a month in the past13 year up from 41 per cent13 on the previous13 year Most13 have retired many of them before the statutory retirement13 age Those whodonrsquot13 feel able to offer time have offered their financial support13 at a time when the fundingavailable from sources such as the National Lottery has been decreasing Despite economicausterity donations to charities have been increasing 74 per cent13 said they had given tocharity at least13 once in the previous month up from 72 per cent13 the previous year
Strikingly 78 per cent13 of people strongly believe that13 they are part13 of their localneighbourhood an increase from 70 per cent13 10 years previously Community cohesion isstronger than ever 87 per cent13 of people believe their local area13 is a place where peoplefrom different13 backgrounds get13 on well together compared to 80 per cent13 in 2003
The role of volunteers in supporting vulnerable people is therefore likely to increase overthe next13 decade perhaps exploiting the success of the army of volunteers that13 was highlysuccessful in London during the Olympic and Paralympic games The greatest13 role for suchvolunteers may be in providing informal care for older people Already the UK has someseven million informal carers whose value in monetary terms has been calculated to be
30
more than the combined budgets of the NHS and social care Maintaining or extending thisprovision will help to support13 services in the future and may be supported by technology
Whilst13 there is ample evidence to suggest13 that13 telecare services support13 informal carers asmuch as (if not13 more than) the people that13 they are caring for it13 is the potential for utilisingthe internet13 and apps to make their role easier to coordinate and hence more effectivethat13 is likely to be most13 successful moving forward
Many of these focus on particular tasks that13 informal carers can help offer to older peoplesuch as organising their medication A pillbox program is just13 one feature of an app calledBalance It also includes sections for caregiving tips notes for the doctor and the patientsappointments plus a lsquolearning sectionrsquo with articles on aspects of Alzheimers and an RSSfeed for news about13 the disease Tyze is another multi-shy‐functional app it13 allows carers to
bull Organise appointmentsbull Plan outingsbull Share storiesbull Send updates to other family members
Another application is Rally Round which helps carers to organise someone to perform littlejobs often on a temporary basis when someone has dementia physical frailty or isrecovering from accident13 or illness Similar applications are MeMaxi and Finerday
35 The High13 Street
The shape and appearance of UK shopping centres have been changing for half a centuryPeople complain that13 centres are losing their identity with one town looking like everyother both in terms of the stores and in terms of the layout But13 there are three trendswhich are having a profound impact13 on many of the most13 vulnerable people in society
bull Centres lock their doors at 6pm or in some cases 10pm -shy‐ thus denying people whosuffer from claustrophobia13 from window shopping at times when other shoppershave left
bull Out13 of town shopping malls -shy‐ these US style centres are ideal for people in carsbecause they offer free parking which is essential for people who want13 to buy largeritems but13 difficult13 for people who have no transport13 and who must13 rely on publictransport13 that13 is often deficient
bull The rise of online shopping -shy‐ which means that13 many potential shoppers only visit13 High Street13 stores to check the prices before returning home to make a purchaseonline
It is the third of these effects that13 has the greatest13 potential for changing the High Street13 forever and it13 is making life for traditional retailers increasingly difficult13 at a time when highrents are crippling stores large and small It is difficult13 to see how this trend is likely tochange because consolidation in banking and estate agencies is already forcing the closure
31
of other High Street13 players while additional pressures on pubs has led to the closure ofthousands of pubs every year
Those figures however demonstrate that13 consumers still value what13 the high street13 canoffer -shy‐ the chance to inspect13 what13 theyrsquore thinking of buying -shy‐ as well as the new opennessof the internet Customer service makes a difference to people especially if there is aproblem and goods need to be returned One of the most13 common reasons for furniture tobe returned for example is that13 when a sofa13 or a wardrobe was delivered it13 couldnrsquot13 fit13 through the front13 door or up the stairs In the future people will be able to benefit from13 visualisation technology they will upload the floor plans of their homes enabling theretailer to inform them of the problem before they try to delivery Augmented reality viewwill similarly allow customers to see what13 a new item of furniture will look like in itsintended place so that13 they can be more informed about13 the effect13 of size and colour
In terms of improving the viability of the High Street stores will have to focus on theimportance of brand which could mean that13 individual independent13 retailers will have topartner with national suppliers to support13 a local tailored offering based on products that13 are designed for a more global market This is a lsquoconnected High Streetrsquo approach whichcould be enabled by the developments in internet13 availability and smart13 phone accessdescribed in the previous section
The overall effect13 of all these changes could mean that13 town centres become smaller but13 more vibrant13 areas They could thrive if people are attracted there in large numbers whichmeans that13 retail must13 be developed alongside restaurants pubs galleries and other leisureopportunities This is possible in new shopping centres which are already being integratedwith transport13 hubs including railway and bus stations but13 may be more of a design13 challenge for older towns and cities with large Victorian buildings To ensure that13 morepeople are welcomed into the new centres they should include attention to green spacesand areas where people can relax without13 feeling that13 they are second class citizensbecause they donrsquot13 have the same buying power
3513 Privacy
To some people privacy is their right13 to live their lives without13 interference they may seethe State as a potential lsquoBig Brotherrsquo spying on their every move and judging their actions13 and activities Other people have fewer concerns about13 the role of the State but13 great13 fearof individuals interfering with and invading their privacy Some embrace the concept13 of lsquomyspacersquo an area13 of a square metre or so into which nobody can enter without13 permissionThis allows them to avoid physical contact13 and to feel safe from any form of threateningbehaviour
Yet13 this idea13 of private space and its potential violation is merely the tip of the iceberg asfar as privacy is concerned more significant13 is the idea13 of personal (and private)information being shared with anyone and everyone This could be related to identityopinion or image for an individual who wants to remain anonymous or even secretive thisis going to become an increasing problem as technology provides the means of taking
32
photographs recording conversations and capturing environment13 with something as smalland ubiquitous as a mobile phone The fact13 that13 this information can then be shared withthe rest13 of the world using e-shy‐mail Twitter and Facebook makes the problem all the moredifficult So the threat13 is no longer solely from the long lenses of the Paparazzi but13 fromanyone (and that13 means everyone) who has even the most13 basic of mobile phones
This relates to the changing views of society on what13 information should remain privateand what13 should be shared with others The success of social media13 has been based on anattitude of lsquosharing everythingrsquo with either your friends or the world This has introduced anaiumlve idea13 in the minds of some younger people (especially those known as Millennials ieaged 18-shy‐30) that13 everyone can be their friends whilst13 perhaps failing to reinforce the bondsof genuine friendship with any form of test13 or restriction Technology could play a role indefining these friendships and allowing individuals to understand what13 makes a goodfriend but13 this approach has yet13 to be developed and may be slow to overcome the needfor some people to measure their own popularity simply as the number of people that13 theycan list13 as friends on their Facebook page
It follows that13 there may be a need for a new definition of privacy that13 is in keeping withthe web and its ability to display images and opinion in an unregulated manner This needsto embrace past13 concerns about13 the ability of an individual to live without13 the threat13 ofothers being able to watch them whilst13 offering some protection from random postingsabout13 them online Perhaps this could include a right13 to be able to edit13 or remove anythingrelating to themselves on the Web including images that13 are not13 news-shy‐worthy Theownership of image rights may be an associated issue that13 needs to be addressedespecially as modern technology can remove an individual from a group (or a background)13 view provide digital touch-shy‐up or air-shy‐brushing and then republish it13 in a different13 contextHowever there is general agreement13 that13 personal information (such as contact13 details andbank codes) should not13 have a place on the web Surprisingly few people take proactivemeasures to prevent13 tracking functions being activated
It follows that13 too much privacy could lead to younger people fearing that13 they maybecome lost13 in a digital world It is not13 surprising then that13 they are prepared to make lots13 of personal information available often with no fear of how it13 might13 be used by othersWhen Google glasses and similar technologies become available during the next13 few yearsthey will have the potential to identify a stranger walking down the street and to find manyof their secrets to present13 to the wearer in a fraction of a second They could know moreabout13 them than their genuine friends know -shy‐ so who will be their friends in the future
36 Data sharing and13 protection
By lsquodata13 sharingrsquo we mean the disclosure of data13 held by one organisation on an individualto a third party organisation(s) or the sharing of data13 between different13 parts of anorganisation Some data13 sharing doesnrsquot13 involve personal data13 because it13 has beenanonymised in such a way that13 the statistics can be used for the collective good without13 theidentification of the individual The Data13 Protection Act13 (DPA) is in place to provide a legal
33
framework that13 ensures that13 organisations that13 hold personal data13 must13 act13 responsibly atall times These principles adequately describe the position of public and government13 bodies especially social services departments who are responsible for the informationconcerning the health and well-shy‐being of individuals -shy‐ and hence by implication thesensitive data13 relating to their vulnerability
The legal framework that13 applies to private and third sector organisations differs from that13 which applies to public sector organisations which may only act13 within the defined limits oftheir statutory powers However all bodies must13 comply fully with the data13 protectionprinciples and this situation is unlikely to change within the next13 10 to 15 years In someprivate sector contexts there are legal constraints on the disclosure of personal dataHowever most13 private and third sector organisations have a general ability to shareinformation provided this does not13 breach the DPA or any other law It is advisable for acompany to check its constitutional documents such as its memorandum and articles13 ofassociation to make sure there are no restrictions that13 would prevent13 it13 from sharingpersonal data13 in a particular context The type of data13 held is therefore a subject13 ofconcern as it13 may be difficult13 for legislation to keep up with the additional layers of data13 created on-shy‐line and through the Internet13 of Things
Private and third sector organisations should have regard to any industry-shy‐specific regulationor guidance about13 handling individualsrsquo information as this may affect13 the organisationrsquosability to share information They should also be aware of the legal issues that13 can arisewhen sharing personal data13 with public sector bodies This becomes more of an issue asprivate and third sector bodies are carrying out13 a wider range of traditionally public sectorfunctions Opportunities for inappropriate sharing of sensitive data13 will therefore inevitablyincrease
Public authorities must13 comply with the Human Rights Act13 (HRA) legislation in theperformance of their functions The HRA also applies to organisations in the private sectorinsofar as they carry out13 functions of a public nature which could include delivering a socialcare activity Where the HRA applies organisations must13 not13 act13 in a way that13 would beincompatible with rights under the European Convention on Human Rights Article 8 of theConvention giving everyone the right13 to respect13 for their private and family life their homeand their correspondence is especially relevant13 to sharing personal data If personal data13 isdisclosed or shared in ways that13 comply with the DPA the sharing or disclosure of that13 information is also likely to comply with the HRA The problem may still be in policing theActs and the rights of an individual if they believe that13 their personal data13 has been sharedor accessed by an inappropriate organisation or individual
A legal industry may be born to deal with such matters but13 this is unlikely to benefit13 peoplewho cannot13 afford the fees involved They would require either legal aid or to employ13 more13 lsquono win no feersquo companies Public attitudes to such costs might13 become negative unlessthey prove successful in preventing breaches of data13 security There may need to belegislation to provide a stronger basis for forcing compliance with privacy laws
34
37 Connecting with13 people
We are social creatures most13 of us rely on our friendships and interactions with friendsand families to share our happiest13 moments and experiences Research suggests that13 thishappiness is infectious at all levels and leads to a 15 increase in the happiness of a closecontact 10 for a second degree contact13 such as the friendrsquos spouse and a 6 increase fora friend of a friend It is hardly surprising that13 the success of social media13 such as Facebookis intimately related to the ability of people to quickly share their happiest13 moments with asmany of their friends and connections as possible
All this has happened during the rise of the Internet13 and the corresponding increase inopportunities for connecting online ie this is a 21st Century phenomenon which has beenfacilitated by Information and Communications Technology But13 the Internet13 remains in itsinfancy and we are only beginning to understand and exploit13 its potential In terms ofaccessing the Internet there are now perhaps two billion people who have access with99 of them having gained this during the past13 decade This number will have doubled bythe period 2020 to 2025 It is likely that13 everyone who wants to be connected in the UK willby then be connected Turning this on its head only those who donrsquot13 want13 to be online willnot13 be on the Internet13 within a decade Connecting with the unconnected will therefore bea case of identifying those people who donrsquot13 want13 to be found unfortunately these mayinclude many people who need the support13 of social care organisations It means that13 theywill be looking for support13 only when they are in crisis unless other ways of finding andormonitoring them are found
While the number of people connected via the Internet13 has exploded this might13 bedwarfed by the number of connected lsquothingsrsquo During 2009 the number of thingsconnected to the Internet13 surpassed the number of connected people at which point13 webegan to experience what13 this report13 has described as the lsquoInternet13 of Thingsrsquo Yet 99 ofall physical objects that13 could join this network are not13 yet13 connected but13 the number couldgrow by 25 every year for the next13 decade so that13 there could be 100 billion connectedobjects by 2025 some of which will be owned or used by everyone in the UK includingthose people who donrsquot13 want13 to be connected themselves We will then have an Internet13 of Everything which will be the smart13 connection of people data events and actions
With each new person object or data13 that13 comes online the connection possibilitiesbetween all these elements grows exponentially The rise of big data mobile networkingcloud storage and data13 mining technologies will all play a critical role in the Internet13 ofEverything The result13 will be new capabilities richer experiences and unprecedentedvalue for individuals businesses communities and countries everywhere The lsquonetworkeffectrsquo of the Internet13 of Everything will be a very powerful thing the true impact13 of whichwe wonrsquot13 fully understand for several years As it13 develops however those who are not13 connected will feel even more digitally and socially excluded There will be a need to reachout13 to vulnerable people unless the process of claiming requires proof of online identityand the payments to be received can only be redeemed using a chipped card or adownloaded app onto a smartphone This is of course the way that13 welfare arrangementsare already developing thus it13 might13 prove impossible to make a successful claim without13
35
already being connected to lsquothe systemrsquo either through an online presence or through theInternet13 of Things
38 Downloading everything
Sixty years ago information was discovered by reading books often in a library wherenotes had to be made because the books or journals couldnrsquot13 be removed Then in theearly 1960s the first13 office photocopying machines were introduced into the UK theyimmediately meant13 that13 pages or articles from books could be copied and taken away to beread and summarised later Within a few years photocopying became a replacement13 forreading as researchers became less adept13 at selecting a few sentences and every deskbecame a depository for reams of printed paper Paper became the means of recordingeverything from bank statements through to music
We now appreciate that13 printing everything is a waste of both the ink (or toner) used tocreate the black print13 and of paper which requires trees to be chopped down and pulpedbefore it13 can be pressed into thin sheets Saving paper is therefore seen as green and goodfor the planet Fortunately we no longer need to print13 everything because computermemory is unlimited thanks to the cloud and we can then view pages and articles onportable or fixed screens
The internet13 has everything and it13 is all available instantly for downloading providing thereis a device available to accept13 it and there is sufficient13 communication bandwidth toperform the transfer of data13 sufficiently quickly Thus we can record all text13 articles that13 are relevant13 to us including digital records of birth certificates qualifications and passportsand the need for original printed versions will decline But13 we can also do this forphotographs Most13 handheld computing devices include at least13 one camera so they cangenerate enormous number of pictures which can be kept13 for posterity without13 having toconsume inks and special papers to print13 them
But13 the materials that13 can be downloaded donrsquot13 stop at pictures software is available that13 can grab TV shows after they air and movies as soon as theyre released In the same wayit13 is possible to schedule music comic books video games and practically anything else asa download with minimal effort People will need enormous hard drives if they want13 theirown digital copies of these files so will more than likely make use of cloud storage that13 willbe available from many organisations The location of the servers may become sensitivedue to border restrictions as will the security of the data13 and the way that13 it13 is backed up sothat13 it13 is resilient13 to failures
It may be evident13 that13 application forms for all types of welfare payment13 will be availableonly for downloading so that once digitised they can be processed by computer andrecords sent13 to various servers for subsequent13 storage and processing Some people maywant13 to keep their data13 on them once it13 has been downloaded Pen drives can already holdseveral GB of data so it13 is likely that13 people will be able to carry their downloaded data13 withthem at all times irrespective of the size and complexities of the information
36
39 Health13 and13 well-shy‐being
The general health of the population is unlikely to deteriorate noticeably within 10 to 20years Indeed expectations of the population are that13 things must13 improve as surgicaltechniques mature and as pharmaceutical interventions become more personalised andpowerful However the rising demand for health services due to an ageing population andthe increasing cost13 of providing sophisticated therapies will make delivering a free anduniversal health service difficult13 without13 substantial increases in taxation This is unlikely tohappen in the UK even though spending on health services will be protected against13 thecuts facing other services
There will have to be changes in how the NHS works For twenty years hospitals have beenclosed and replaced by fewer new facilities so that13 the bed count13 is reduced This has led toa significant13 shift13 in resources to primary care and community care supporting shorter staysin hospital and speedier transfer back home for people after surgery or illness This hasbeen13 successful but13 there remain problems with demand for GP services especially out-shy‐of-shy‐hours and at weekends Indeed despite the introduction of NHS24 and similar help-shy‐linesthe demand for GP appointments continues to increase Delays are inevitable and this willincrease system failures with more unnecessary deaths and a failure for people to access adiagnosis that13 might13 lead to early interventions and ultimately lower delivery costs Over250 more patients are added to waiting lists every day
This will lead to a new model of primary care consistent13 with existing changes which haveseen surgeries move from High Street13 locations to medical centres close to bus routes andwith more parking for patients The process of making an appointment13 is changing from atelephone-shy‐based interview process dominated by a medically-shy‐unqualified receptionist13 to achoose and book approach using an online process linked to electronic patient13 records Thiswill give patients more convenience but13 will allow priority for those who have Internet13 access at the expensive of those who are digitally excluded Making the process of bookingan appointment13 quick and easy may also increase demand from people who do not13 need tobe seen as it13 will fail to identify those in greatest13 need
A greater use of telehealth and telecare technologies will be inevitable beginning with thefirst13 contact13 as an encounter using the telephone e-shy‐mail or video conferencing -shy‐ a visit13 tothe GP surgery should be a last13 resort and should involve a nurse consultation in the first13 instance This would be consistent13 with three quarters of appointments currently involvinga chronic disease or long term condition which relates to improved self-shy‐care The support13 ofthese patients at home should be prioritised through tele-shy‐ and web-shy‐based technologies andshould involve training and coaching through a network of nurse practitioners Home visitsshould generally be unnecessary through the use of these technologies but13 could besupplemented by satellite surgeries manned by nursing in community premises or inpharmacies nurseries and Internet13 cafes
The homes13 of people who13 need13 closer monitoring can then become part13 of virtual wardswith real or electronic visits by health professionals University Hospital Southampton NHSFoundation Trust13 already looks after patients who have undergone surgery such as a hip orknee13 replacements in virtual wards with high levels of satisfaction The Royal Free London
37
NHS Foundation Trust13 offers a similar service but13 plans to add the possibility of videoconsultations between patient13 and consultant
310 Attitudes to public health issues ndash obesity smoking alcohol abuse drugs
As self-shy‐care becomes the focus of the NHS the public will increasingly understand that13 thecosts and availability of services are being harmed by the poor health behaviour ofrelatively small numbers of people The link between public health initiatives today andhealthcare needs and costs in the future will become increasingly evident13 as a result13 of theway that13 information is presented Thus the overweight13 smoker who currently attractsconcern and pity when they are diagnosed with diabetes and COPD is increasingly beingseen as the victim of their own stupidity or lack of self-shy‐discipline If they continue to neglect13 medical advice and continue with an unhealthy lifestyle then the way that13 they receivetreatment13 and consume resources will become a matter for the entire population
Obesity is seen as due to a combination of poor diet13 and a sedentary lifestyle No longer isthe idea13 that13 people are lsquobig bonedrsquo acceptable Governments will respond initially byrequiring manufacturers and food processors to provide nutritional information onpackaging and on menus in restaurants But13 people can choose not13 to read the data13 and toneglect13 both the importance of food quality content13 and quantity This will increasepressure to introduce fat13 or sugar taxes and these are likely to be in force within a decade
Although the high taxes on tobacco products has forced some smokers to reduce theirconsumption or to give up altogether the impact13 has been reduced by the smuggling ofproducts from overseas and by the availability of duty-shy‐free cigarettes for people returningfrom foreign holidays and business meetings Further measures are planned to changepackaging and to include even more graphic images and warnings on cigarette packages tomake smokers aware of the effects of smoking on their health and well-shy‐being There is asyet little evidence of how successful this might13 be More effective has been the banning ofsmoking in public places including trains and aircraft Expensive medical interventions suchas heart13 transplants will be denied to individuals until they change their lifestyle behaviourSmokers might13 therefore be increasingly ostracised leading to a loss of esteem This mayhave a particular impact13 on people who already suffer from mental health problems whoare more likely to smoke
The overuse of alcohol is being recognised as a major factor in hospital admissions withNHS figures showing an increase of over 40 in such admissions over the past13 decadeLinked to this has been a 75 increase in prescriptions to treat13 alcohol dependency Fewpeople have sympathy for those who waste their limited income on booze If they havechildren or other dependents they will be the ones who suffer and who may need thesupport13 of social care
Drug users are already significant13 users of social services as their habit13 is likely to makethem unemployable They receive little sympathy from the general public because they areseen as criminals and people who waste public resources Levels of drug abuse have been
38
slowly increasing over the years but13 this trend is slowly being reversed Indeed the numberof people using drugs during the past13 year has fallen to its lowest13 level for nearly 20 years(below 9) with cannabis being most13 likely often following excessive drinking Aselectronic noses and other technologies can detect13 traces of drugs it13 seems likely that13 success in overcoming addiction can be measured objectively This may become a two-shy‐edged sword rewarding those who can turn around their lives but13 further marginalisingthose who canrsquot13 or wont13 accept13 the lsquocold turkeyrsquo
311 Attitudes to surveillance
Issues associated with privacy confidentiality and data13 security have been discussedpreviously in the context13 of information technology the World Wide Web and the ease ofcollecting recording recalling analysing and displaying data The monitoring of individualsand their methods of using this information can be regarded as surveillance As thequantities of data13 increase along with the number of devices that13 can be used to access itthe surveillance tools will also increase in their sophistication Indeed the Big Data13 approaches described in the previous section will enable the combination of structureddata13 (such as the information held in databases) to be married with unstructured data13 fromimages in such a way that13 it13 can be mined
Whilst13 the lsquodigital surveillancersquo methods described above may cause most13 concern topeople because of its impact13 on anonymity it13 is the collection and analysis of images that13 are the major concern to people as they contemplate the ways that13 lsquoBig Brotherrsquo maydevelop to restrict13 freedom Every major UK city and town centre has an array of CCTVcameras that13 continually record activities from every angle If it13 used to be true that13 nobody in London was more than 10 yards from a rat it13 is certainly the case today that13 nobody can be more than this distance from being in view of a surveillance camera Yetthey receive so much positive publicity from TV programmes where their footage is used todetect13 vehicles close to a crime scene or to monitor the movements of suspects that13 theyare now accepted by the public as a deterrent13 in the same way as lsquobobbies on the beatrsquowere seen 25 years ago There is therefore little public reaction to the expansion in the useof video surveillance except13 for the practical observation of how so many views can beinspected and recorded
Looking to the future the tumbling cost13 of video technology will surely lead to anotherincrease in the number of devices The aerial views taken from towers will besupplemented by more local views taken by devices that13 are embedded in the fabric ofbuildings or carried by individuals either on their person (for example on clothing orspectacles) or in the bags that13 they carry The time and date-shy‐stamped images as Big Datawill be recorded to lsquothe Cloudrsquo where it13 can be added to other data It can then be usedwhen an incident13 has occurred or to provide further detail of night-shy‐time activities
It follows that13 there will be no hiding place for people who simply want13 to disappear Theymay respond by wearing clothing (such as hoodies) that13 hide their faces or which make it13 difficult13 to distinguish gait13 or mannerisms from which they might13 be identified New forms
39
of clothing may be designed to make shapes more difficult13 to analyse and these might13 become the uniforms of a class of person who wants to live in a way that13 they donrsquot13 interact13 with officials from any ministry or local government13 department If they also obstruct13 services then they will be considered to be anarchists of some form sparking protests fromother sectors of society
31213 Attitudes to driving
Motor cars have been a feature of UK roads for over a century but13 it13 is only during the past13 50 years that13 they have become a resource that13 most13 families have had access to enablingthem to travel without13 the restrictions imposed by a limited railway network and non-shy‐integrated bus transport People who have had a car throughout13 their lives often see theircars as an important13 factor in enabling them to remain independent13 and to exercise choicesrelating to where they shop and where they spend their leisure time This extends to theirspouse and to friends and neighbours that13 they might13 take with them on their variousexpeditions
Unfortunately there are incidents involving older drivers who perhaps go down amotorway in the wrong direction who are taken ill at the wheel or who are involved in anaccident13 involving no other vehicles These are small in number but13 often lead to a reactionthat13 they shouldnrsquot13 be allowed to drive lsquoat13 their agersquo Age itself is not13 an indicator ofdriving quality but13 because old age also brings more chance of having limited long termconditions and other illnesses it13 is easy to make a link between driving ability and age Thelicensing system does require continued driving to be linked with medical advice andforbids people with poor eyesight epilepsy and other conditions to hold a licence in oldage
Yet13 statistically older drivers cause far fewer accidents than younger drivers The reasonsfor this may be complex and are likely to include the fact13 that13 they drive less often covershorter distances and donrsquot13 go out13 in the dark or in poor weather However it13 does not13 wholly explain why the UKrsquos drivers aged over 70 and who represent13 some 8 of all driversare involved in only 4 of accidents that13 cause injury This compares favourably with the15 of13 drivers aged between 17 and 29 who are involved in over a third of crashes that13 result13 in injury
By 2020 the number of drivers aged over 70 on UK roads is likely to increase to over 7million This will require a new national strategy perhaps involving support13 for olderdrivers further training raising awareness of issues and making more use of adaptivetechnologies to support13 the driver in avoiding collision or forgetting to check on the statusof their vehicle Poor eyesight13 could be enhanced by camera technologies rather thanforcing people off the road if they are unable to read a licence plate
The International Longevity Centre has found that13 one in four Britons thought13 driversshould be made to switch off the ignition for good somewhere between the ages of 70 and75 The numbers may decrease as the population ages and as cars become safer Forcing
40
older people off the road may be a natural consequence of providing free bus passes andsubsidised rail fares but13 the growth in the pavement13 scooter industry demonstrates that13 older people value their independence and will do almost13 anything to get13 out13 and aboutPerhaps legislation will result13 in more regulation of electric vehicles and where they cantravel
There can be no doubt13 that13 getting out13 will be associated with better quality of life andwell-shy‐being and this is likely to be supported in the future as evidence of improvedoutcomes emerges It is to be hoped that13 positive stories will be publicised so that13 publicattitudes arenrsquot13 hardened This may be supported by more in-shy‐car monitoring of drivers andthe linking of performance with on-shy‐line driving records and licences These could throughremotely monitored ignition systems prevent13 the use of motor vehicles by people without13 a licence or without13 insurance
313 Climate change
There is a general view that13 the emissions of carbon gases are contributing to globalwarming in a manner that13 will change the UK climate in such a way that13 the climate maybecome more Mediterranean However some scientists believe that13 manrsquos impact13 on theenvironment13 may be small compared with natural variations caused for example bycyclical changes in the sunrsquos energy output13 or by the effects of volcanoes and earthquakesRecent13 evidence has suggested that13 we are going through a phase of changing extremesand that13 this is more likely to cause storms periods of excessive rainfall and unusualseasonal trends with snow and frost13 in the spring and warmer winters Considerableuncertainty remains and it13 might13 be necessary to plan for a number of different13 scenariosand for the impact13 on vulnerable people
I Colder winters UK properties are poorly insulated resulting in excess mortalitiesduring cold spells due to an increased number of people suffering from stroke aswell as bronchitis and other pulmonary diseases The cost13 of heating continues toincrease putting more households into a state of fuel poverty Any further coolingduring the winter months will result13 in more people living in unhealthy coldconditions Winter fuel payments are likely to be restricted to the poorest13 peoplebut13 this might13 exclude people who live in larger properties that13 are more difficult13 toheat
II More storms excessive winds and rain can cause flooding at any time of the yearMany UK communities are built13 close to rivers and these can surge during heavyrainfall causing houses to be filled with water and furniture and carpets lostInsurance can be problematic for properties built13 on flood plains which can blight13 properties and prevent13 owners from being able to sell and move on High winds canrip off roofs causing injury and also causing families to be left13 homeless anddependent13 on social services
III Hot13 summers Europe suffered high temperatures during the summers of 2003 and2004 leading to heat13 stroke and hypothermia The UK has not13 previously sufferedfrom such problems but13 might13 be expected to experience days of extreme
41
temperature and humidity at times Older people may not13 be prepared for suchweather Street13 dwellers may be unable to find shade and supplies of drinkingwater
Irrespective of what13 combination of weather scenarios arise it13 must13 be concluded that13 any extremes will have a major negative impact13 on vulnerable people especially if theyare not13 prepared because they havenrsquot13 received the weather warnings and advice that13 can be broadcast13 using the TV radio and online services Once again the digitallyexcluded will suffer and will pay a high cost Society will continue to pick up the bill interms of demands on social care services unless preventive actions are taken in theform of connecting these people to each other and to formal services
42
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
s13 13
13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
n13 13
13 s13
r13 n13
e13 at13
e13 y13 e13 ld13
ly13
13 e13 t13 e13
s13 er13 e13
f13
rt13 13
13 13
13
r13 13
s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
e13 g13 13
e13
13 13 ial13
13
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d13 13
s13 y13
e13
13
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e13
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13
13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
Thus housing technologies are not likely to impact on social work13 within the next 20years13 though13 the use of information13 technology13 to ensure that people are aware of what13 is available is likely to be commonplace well before then
26
3 BEHAVIOUR AND ATTITUDE CHANGES DUE TO TECHNOLOGICALADVANCES
Technology is only one factor that13 will affect13 the way society changes in the next13 10 or 15years This chapter will consider the context13 in which the technological developmentsoutlined in the previous chapter will be supported (or held back) by societal factors
When the impact13 of such factors has been considered we can then apply theseassumptions to a number of case studies listed in Appendix13 A13
The headings selected for this chapter are not13 arbitrary as they reflect13 the context13 in whichtechnological changes must13 be considered They must13 include consideration of factors suchas demography and long-shy‐term conditions already addressed in the introduction to thesepapers together with the aspects of workforce and citizenship considered in the parallelpapers The additional elements here focus on trends that13 are already occurring and whichmay leave people struggling with the changes that13 occur
Finally there is a need to consider the attitudes of people to technology generally andespecially to the issues of privacy and social responsibility that13 could be radically changedby technology In some cases public opinion will prevent13 some forms of technology beingdeveloped if not13 commercialised In other cases some technologies will be fast-shy‐trackedeither at the request13 of government13 or because of a clear public demand for theopportunities that13 it13 can bring
Predictions13 about the13 future13 must inevitably be13 subject to considerable13 uncertainty butthat is no reason to stop thinking what might happen
31 The Welfare State
The UK can be rightly proud of the way that13 its welfare state has developed during the past13 100 years to provide a safety net13 of financial support13 to people and to their families whenthey are unemployed destitute homeless or challenged by crises and emergencies Therange of benefits received is considerable some are complex and many people struggle tounderstand their entitlements Some are universal some are discretionary some apply onlyto parents others to anyone
The total cost13 of providing these benefits continues to rise and when the economy isstagnating there is inevitably both political pressure often supported by popular publicopinion to introduce welfare reform so that13 people who do not13 work cannot13 be better offthan they would be if they were in full-shy‐time employment This strategy requires a universalbenefit13 to be introduced so that13 it13 is easier for claimants to access support13 but13 also easierfor agencies to identify the total benefits received The idea13 of a benefits cap then becomes
27
more practical to introduce especially if all the processes involved in making a claim arehandled electronically Indeed this encourages government13 to insist13 on applications forbenefits to be made on-shy‐line Unfortunately this will marginalise those people who haveneither a computer nor access to the internet thus emphasising the digital divide in amanner which works against13 some of the most13 disadvantaged people in society
There are currently few tangible links between digital technology and welfare provisionThe most13 obvious are universal benefits such as a free television licence (worth pound14550)13 for13 everyone aged 75 or older with blind and visually impaired people entitled to a 50discount13 irrespective of their age The significance of this position is that13 6 of revenuesgenerated through licence fees are to fund BBC on-shy‐line services13 such13 as websites and i-shy‐player In Scotland the BBCrsquos Alba Gaelic language television service is predominantlyfunded13 by MG Alba an organisation funded by the Scottish Government It is thereforeconceivable that13 in the future licence fees may be used to directly subsidise access toinformation and advice through the Internet13 for vulnerable people whether it13 is throughbroadband access or through a set-shy‐top box which removes the need for a computer in thehome to access particular websites or to use e-shy‐mail services
A second age-shy‐related benefit13 available in the UK is the winter fuel subsidy People whoreceive certain benefits receive the payments automatically while others must13 make aclaim Those who are not13 eligible for benefit13 due to a lack of an address for example missout13 on these payments and also on Cold Weather payments of pound25 for each seven dayperiod of very cold weather between 1 November and 31 March
The development13 of new warm home initiatives plus the complex of subsidies that13 theelectricity supply industry and government13 offer to people with solar cells further changesthe economic arguments Global warming may lead to greater variations in weatherextremes but13 might13 also increase the amount13 of electricity that13 can be generated byalternative (green) sources such as wind and solar cells It is estimated that13 energyconsumption in the UK increased by 17 between Christmas and Easter 2013 compared toprevious years as a result13 of cold weather but13 the above subsidy scheme did not13 benefit13 older people because two of the seven day cold periods were after 31st March It must13 beassumed that13 there will be more people living in fuel poverty in the future and this will leadto more cases of cold related illness including influenza13 and stroke
32 Management of long term conditions
The management13 of long term conditions will be improved for patients who are compliant13 with their medication regime so it13 is possible that13 there may be compulsion to adhere tothe prescription Such compulsion may be monitored using technology Indeed the remotemonitoring of vital signs using telehealthcare will become commonplace as the old boxesand sensors are replaced by devices that13 can be worn continuously or which can beembedded into the fabric of homes (including furniture and bedding) or can be worn asvests or patches They will wirelessly transmit13 data13 to smartphones or tablets and mobile
28
transmission and cloud technology will enable real-shy‐time data13 collection analysis andfeedback
One of the diseases which is projected to increase most13 significantly over the comingdecade is Type 2 diabetes Whilst13 there is a hereditary susceptibility to this condition formany people including those from the Middle East13 and the Asian sub-shy‐continent it13 is also adisease which tends to affect13 those people who are overweight13 andor have a sedentarylifestyle If untreated diabetes can lead to dizziness and collapse at any time but13 can alsohave more devastating long term consequences which include kidney failure strokeblindness and in extreme cases lower limb amputations Management13 therefore includesdaily monitoring of blood glucose levels and major dietary changes such as a significant13 reduction in the consumption of carbohydrates as well as a rigid exercise regime
Many newly diagnosed diabetics follow this advice closely and can lead normal lives for 40years or more but13 some struggle to accept13 the change in lifestyle required as well asremembering which foods are allowed and how much exercise they need to takeIndividual support13 plans are now forthcoming and over the next13 ten years best13 practicewill emerge in the form of smartphone apps that13 are personalised and which can becomean individualrsquos health coach This level of support13 will be fine for some people but13 otherswill need incentives so it13 is likely that13 gaming technologies will be introduced perhapsoffering rewards for good compliance There will be a temptation for some people tocheat perhaps allowing others to perform exercise for them or changing theirconsumption details
Many of these opportunities for cheating will be removed through the use of a uniquebiometric identifier a technology that13 will be mature enough to use in place of passwordson smartphones However the biggest13 challenge may be in encouraging older people to usethe technology Many older people have multiple morbidities Indeed a survey of Scottishpatients implied that13 42 of people aged over 80 will suffer from three long termconditions It will be essential for those people to comply with treatment13 regimes if they arenot13 to have the functional deficits that13 follow
33 Finding people who13 donrsquot fit
People who have low social capital are likely to have few relatives and friends with whomthey regularly communicate and are also unlikely to be part13 of community or faithorganisations such as clubs societies and church groups They also die several yearsyounger than most13 of the population often because they donrsquot13 engage with public healthinitiatives such as vaccinations against13 flu regular checks on their blood pressure bloodsugar levels or in the case of women smear tests or mammography The most13 likelyreason for disappearing beneath the radar of such initiatives is their mobility which leadsalmost13 inevitably to them having no fixed abode and no fixed telephone line It thenbecomes very difficult13 for them to be contacted because their mobile telephones are likelyto have Pay-shy‐As-shy‐You-shy‐Go contracts that13 donrsquot13 require validated names addresses and bankaccounts
29
It follows that13 some of the most13 vulnerable people in society including those who live onthe streets are effectively unknown to both the NHS and to social work departments untilthey are referred in a crisis This could be an emergency presentation to a hospital Accident13 and Emergency Department13 where they will come into contact13 with a social worker becausedischarge may be unsafe This often highlights the importance of the prevention agenda13 and the potential for avoiding admissions to hospital by intervening at an earlier stage
The advantages of being able to locate people who are vulnerable to specific diseases willincrease as genetic testing becomes more routine It is already possible to determine whomight13 be most13 at risk of breast13 cancer and prostate cancer as a result13 of family history Addto this the evidence that13 particular diet13 and exposure to environmental factors can furtherincrease risk then it13 is evident13 that13 individuals can be identified and offered treatmentsthat13 could save their lives many years before they become ill In the case of cancersperhaps only the individual is involved but13 for infectious diseases it13 is the whole of societythat13 is at risk if someone contracts one of the new strains of influenza or if someonechooses not13 to be vaccinated against13 rubella In Chinese airports all visitors are screenedfor fever and refused entry if they tested positive in cities the public are monitored in thesame way Similar approaches may be necessary in the UK if potential carriers cannot13 otherwise be identified
34 Volunteering
It is estimated that13 72 per cent13 of people volunteered to perform a charitable act13 at least13 once during 2012 a rise from 65 per cent13 the previous year About13 four out13 of every 10volunteers offer their services formally to one or more organisations The remaindervolunteer informally by helping out13 a friend or a neighbour Around 50 per cent13 volunteered at least13 once a month in the past13 year up from 41 per cent13 on the previous13 year Most13 have retired many of them before the statutory retirement13 age Those whodonrsquot13 feel able to offer time have offered their financial support13 at a time when the fundingavailable from sources such as the National Lottery has been decreasing Despite economicausterity donations to charities have been increasing 74 per cent13 said they had given tocharity at least13 once in the previous month up from 72 per cent13 the previous year
Strikingly 78 per cent13 of people strongly believe that13 they are part13 of their localneighbourhood an increase from 70 per cent13 10 years previously Community cohesion isstronger than ever 87 per cent13 of people believe their local area13 is a place where peoplefrom different13 backgrounds get13 on well together compared to 80 per cent13 in 2003
The role of volunteers in supporting vulnerable people is therefore likely to increase overthe next13 decade perhaps exploiting the success of the army of volunteers that13 was highlysuccessful in London during the Olympic and Paralympic games The greatest13 role for suchvolunteers may be in providing informal care for older people Already the UK has someseven million informal carers whose value in monetary terms has been calculated to be
30
more than the combined budgets of the NHS and social care Maintaining or extending thisprovision will help to support13 services in the future and may be supported by technology
Whilst13 there is ample evidence to suggest13 that13 telecare services support13 informal carers asmuch as (if not13 more than) the people that13 they are caring for it13 is the potential for utilisingthe internet13 and apps to make their role easier to coordinate and hence more effectivethat13 is likely to be most13 successful moving forward
Many of these focus on particular tasks that13 informal carers can help offer to older peoplesuch as organising their medication A pillbox program is just13 one feature of an app calledBalance It also includes sections for caregiving tips notes for the doctor and the patientsappointments plus a lsquolearning sectionrsquo with articles on aspects of Alzheimers and an RSSfeed for news about13 the disease Tyze is another multi-shy‐functional app it13 allows carers to
bull Organise appointmentsbull Plan outingsbull Share storiesbull Send updates to other family members
Another application is Rally Round which helps carers to organise someone to perform littlejobs often on a temporary basis when someone has dementia physical frailty or isrecovering from accident13 or illness Similar applications are MeMaxi and Finerday
35 The High13 Street
The shape and appearance of UK shopping centres have been changing for half a centuryPeople complain that13 centres are losing their identity with one town looking like everyother both in terms of the stores and in terms of the layout But13 there are three trendswhich are having a profound impact13 on many of the most13 vulnerable people in society
bull Centres lock their doors at 6pm or in some cases 10pm -shy‐ thus denying people whosuffer from claustrophobia13 from window shopping at times when other shoppershave left
bull Out13 of town shopping malls -shy‐ these US style centres are ideal for people in carsbecause they offer free parking which is essential for people who want13 to buy largeritems but13 difficult13 for people who have no transport13 and who must13 rely on publictransport13 that13 is often deficient
bull The rise of online shopping -shy‐ which means that13 many potential shoppers only visit13 High Street13 stores to check the prices before returning home to make a purchaseonline
It is the third of these effects that13 has the greatest13 potential for changing the High Street13 forever and it13 is making life for traditional retailers increasingly difficult13 at a time when highrents are crippling stores large and small It is difficult13 to see how this trend is likely tochange because consolidation in banking and estate agencies is already forcing the closure
31
of other High Street13 players while additional pressures on pubs has led to the closure ofthousands of pubs every year
Those figures however demonstrate that13 consumers still value what13 the high street13 canoffer -shy‐ the chance to inspect13 what13 theyrsquore thinking of buying -shy‐ as well as the new opennessof the internet Customer service makes a difference to people especially if there is aproblem and goods need to be returned One of the most13 common reasons for furniture tobe returned for example is that13 when a sofa13 or a wardrobe was delivered it13 couldnrsquot13 fit13 through the front13 door or up the stairs In the future people will be able to benefit from13 visualisation technology they will upload the floor plans of their homes enabling theretailer to inform them of the problem before they try to delivery Augmented reality viewwill similarly allow customers to see what13 a new item of furniture will look like in itsintended place so that13 they can be more informed about13 the effect13 of size and colour
In terms of improving the viability of the High Street stores will have to focus on theimportance of brand which could mean that13 individual independent13 retailers will have topartner with national suppliers to support13 a local tailored offering based on products that13 are designed for a more global market This is a lsquoconnected High Streetrsquo approach whichcould be enabled by the developments in internet13 availability and smart13 phone accessdescribed in the previous section
The overall effect13 of all these changes could mean that13 town centres become smaller but13 more vibrant13 areas They could thrive if people are attracted there in large numbers whichmeans that13 retail must13 be developed alongside restaurants pubs galleries and other leisureopportunities This is possible in new shopping centres which are already being integratedwith transport13 hubs including railway and bus stations but13 may be more of a design13 challenge for older towns and cities with large Victorian buildings To ensure that13 morepeople are welcomed into the new centres they should include attention to green spacesand areas where people can relax without13 feeling that13 they are second class citizensbecause they donrsquot13 have the same buying power
3513 Privacy
To some people privacy is their right13 to live their lives without13 interference they may seethe State as a potential lsquoBig Brotherrsquo spying on their every move and judging their actions13 and activities Other people have fewer concerns about13 the role of the State but13 great13 fearof individuals interfering with and invading their privacy Some embrace the concept13 of lsquomyspacersquo an area13 of a square metre or so into which nobody can enter without13 permissionThis allows them to avoid physical contact13 and to feel safe from any form of threateningbehaviour
Yet13 this idea13 of private space and its potential violation is merely the tip of the iceberg asfar as privacy is concerned more significant13 is the idea13 of personal (and private)information being shared with anyone and everyone This could be related to identityopinion or image for an individual who wants to remain anonymous or even secretive thisis going to become an increasing problem as technology provides the means of taking
32
photographs recording conversations and capturing environment13 with something as smalland ubiquitous as a mobile phone The fact13 that13 this information can then be shared withthe rest13 of the world using e-shy‐mail Twitter and Facebook makes the problem all the moredifficult So the threat13 is no longer solely from the long lenses of the Paparazzi but13 fromanyone (and that13 means everyone) who has even the most13 basic of mobile phones
This relates to the changing views of society on what13 information should remain privateand what13 should be shared with others The success of social media13 has been based on anattitude of lsquosharing everythingrsquo with either your friends or the world This has introduced anaiumlve idea13 in the minds of some younger people (especially those known as Millennials ieaged 18-shy‐30) that13 everyone can be their friends whilst13 perhaps failing to reinforce the bondsof genuine friendship with any form of test13 or restriction Technology could play a role indefining these friendships and allowing individuals to understand what13 makes a goodfriend but13 this approach has yet13 to be developed and may be slow to overcome the needfor some people to measure their own popularity simply as the number of people that13 theycan list13 as friends on their Facebook page
It follows that13 there may be a need for a new definition of privacy that13 is in keeping withthe web and its ability to display images and opinion in an unregulated manner This needsto embrace past13 concerns about13 the ability of an individual to live without13 the threat13 ofothers being able to watch them whilst13 offering some protection from random postingsabout13 them online Perhaps this could include a right13 to be able to edit13 or remove anythingrelating to themselves on the Web including images that13 are not13 news-shy‐worthy Theownership of image rights may be an associated issue that13 needs to be addressedespecially as modern technology can remove an individual from a group (or a background)13 view provide digital touch-shy‐up or air-shy‐brushing and then republish it13 in a different13 contextHowever there is general agreement13 that13 personal information (such as contact13 details andbank codes) should not13 have a place on the web Surprisingly few people take proactivemeasures to prevent13 tracking functions being activated
It follows that13 too much privacy could lead to younger people fearing that13 they maybecome lost13 in a digital world It is not13 surprising then that13 they are prepared to make lots13 of personal information available often with no fear of how it13 might13 be used by othersWhen Google glasses and similar technologies become available during the next13 few yearsthey will have the potential to identify a stranger walking down the street and to find manyof their secrets to present13 to the wearer in a fraction of a second They could know moreabout13 them than their genuine friends know -shy‐ so who will be their friends in the future
36 Data sharing and13 protection
By lsquodata13 sharingrsquo we mean the disclosure of data13 held by one organisation on an individualto a third party organisation(s) or the sharing of data13 between different13 parts of anorganisation Some data13 sharing doesnrsquot13 involve personal data13 because it13 has beenanonymised in such a way that13 the statistics can be used for the collective good without13 theidentification of the individual The Data13 Protection Act13 (DPA) is in place to provide a legal
33
framework that13 ensures that13 organisations that13 hold personal data13 must13 act13 responsibly atall times These principles adequately describe the position of public and government13 bodies especially social services departments who are responsible for the informationconcerning the health and well-shy‐being of individuals -shy‐ and hence by implication thesensitive data13 relating to their vulnerability
The legal framework that13 applies to private and third sector organisations differs from that13 which applies to public sector organisations which may only act13 within the defined limits oftheir statutory powers However all bodies must13 comply fully with the data13 protectionprinciples and this situation is unlikely to change within the next13 10 to 15 years In someprivate sector contexts there are legal constraints on the disclosure of personal dataHowever most13 private and third sector organisations have a general ability to shareinformation provided this does not13 breach the DPA or any other law It is advisable for acompany to check its constitutional documents such as its memorandum and articles13 ofassociation to make sure there are no restrictions that13 would prevent13 it13 from sharingpersonal data13 in a particular context The type of data13 held is therefore a subject13 ofconcern as it13 may be difficult13 for legislation to keep up with the additional layers of data13 created on-shy‐line and through the Internet13 of Things
Private and third sector organisations should have regard to any industry-shy‐specific regulationor guidance about13 handling individualsrsquo information as this may affect13 the organisationrsquosability to share information They should also be aware of the legal issues that13 can arisewhen sharing personal data13 with public sector bodies This becomes more of an issue asprivate and third sector bodies are carrying out13 a wider range of traditionally public sectorfunctions Opportunities for inappropriate sharing of sensitive data13 will therefore inevitablyincrease
Public authorities must13 comply with the Human Rights Act13 (HRA) legislation in theperformance of their functions The HRA also applies to organisations in the private sectorinsofar as they carry out13 functions of a public nature which could include delivering a socialcare activity Where the HRA applies organisations must13 not13 act13 in a way that13 would beincompatible with rights under the European Convention on Human Rights Article 8 of theConvention giving everyone the right13 to respect13 for their private and family life their homeand their correspondence is especially relevant13 to sharing personal data If personal data13 isdisclosed or shared in ways that13 comply with the DPA the sharing or disclosure of that13 information is also likely to comply with the HRA The problem may still be in policing theActs and the rights of an individual if they believe that13 their personal data13 has been sharedor accessed by an inappropriate organisation or individual
A legal industry may be born to deal with such matters but13 this is unlikely to benefit13 peoplewho cannot13 afford the fees involved They would require either legal aid or to employ13 more13 lsquono win no feersquo companies Public attitudes to such costs might13 become negative unlessthey prove successful in preventing breaches of data13 security There may need to belegislation to provide a stronger basis for forcing compliance with privacy laws
34
37 Connecting with13 people
We are social creatures most13 of us rely on our friendships and interactions with friendsand families to share our happiest13 moments and experiences Research suggests that13 thishappiness is infectious at all levels and leads to a 15 increase in the happiness of a closecontact 10 for a second degree contact13 such as the friendrsquos spouse and a 6 increase fora friend of a friend It is hardly surprising that13 the success of social media13 such as Facebookis intimately related to the ability of people to quickly share their happiest13 moments with asmany of their friends and connections as possible
All this has happened during the rise of the Internet13 and the corresponding increase inopportunities for connecting online ie this is a 21st Century phenomenon which has beenfacilitated by Information and Communications Technology But13 the Internet13 remains in itsinfancy and we are only beginning to understand and exploit13 its potential In terms ofaccessing the Internet there are now perhaps two billion people who have access with99 of them having gained this during the past13 decade This number will have doubled bythe period 2020 to 2025 It is likely that13 everyone who wants to be connected in the UK willby then be connected Turning this on its head only those who donrsquot13 want13 to be online willnot13 be on the Internet13 within a decade Connecting with the unconnected will therefore bea case of identifying those people who donrsquot13 want13 to be found unfortunately these mayinclude many people who need the support13 of social care organisations It means that13 theywill be looking for support13 only when they are in crisis unless other ways of finding andormonitoring them are found
While the number of people connected via the Internet13 has exploded this might13 bedwarfed by the number of connected lsquothingsrsquo During 2009 the number of thingsconnected to the Internet13 surpassed the number of connected people at which point13 webegan to experience what13 this report13 has described as the lsquoInternet13 of Thingsrsquo Yet 99 ofall physical objects that13 could join this network are not13 yet13 connected but13 the number couldgrow by 25 every year for the next13 decade so that13 there could be 100 billion connectedobjects by 2025 some of which will be owned or used by everyone in the UK includingthose people who donrsquot13 want13 to be connected themselves We will then have an Internet13 of Everything which will be the smart13 connection of people data events and actions
With each new person object or data13 that13 comes online the connection possibilitiesbetween all these elements grows exponentially The rise of big data mobile networkingcloud storage and data13 mining technologies will all play a critical role in the Internet13 ofEverything The result13 will be new capabilities richer experiences and unprecedentedvalue for individuals businesses communities and countries everywhere The lsquonetworkeffectrsquo of the Internet13 of Everything will be a very powerful thing the true impact13 of whichwe wonrsquot13 fully understand for several years As it13 develops however those who are not13 connected will feel even more digitally and socially excluded There will be a need to reachout13 to vulnerable people unless the process of claiming requires proof of online identityand the payments to be received can only be redeemed using a chipped card or adownloaded app onto a smartphone This is of course the way that13 welfare arrangementsare already developing thus it13 might13 prove impossible to make a successful claim without13
35
already being connected to lsquothe systemrsquo either through an online presence or through theInternet13 of Things
38 Downloading everything
Sixty years ago information was discovered by reading books often in a library wherenotes had to be made because the books or journals couldnrsquot13 be removed Then in theearly 1960s the first13 office photocopying machines were introduced into the UK theyimmediately meant13 that13 pages or articles from books could be copied and taken away to beread and summarised later Within a few years photocopying became a replacement13 forreading as researchers became less adept13 at selecting a few sentences and every deskbecame a depository for reams of printed paper Paper became the means of recordingeverything from bank statements through to music
We now appreciate that13 printing everything is a waste of both the ink (or toner) used tocreate the black print13 and of paper which requires trees to be chopped down and pulpedbefore it13 can be pressed into thin sheets Saving paper is therefore seen as green and goodfor the planet Fortunately we no longer need to print13 everything because computermemory is unlimited thanks to the cloud and we can then view pages and articles onportable or fixed screens
The internet13 has everything and it13 is all available instantly for downloading providing thereis a device available to accept13 it and there is sufficient13 communication bandwidth toperform the transfer of data13 sufficiently quickly Thus we can record all text13 articles that13 are relevant13 to us including digital records of birth certificates qualifications and passportsand the need for original printed versions will decline But13 we can also do this forphotographs Most13 handheld computing devices include at least13 one camera so they cangenerate enormous number of pictures which can be kept13 for posterity without13 having toconsume inks and special papers to print13 them
But13 the materials that13 can be downloaded donrsquot13 stop at pictures software is available that13 can grab TV shows after they air and movies as soon as theyre released In the same wayit13 is possible to schedule music comic books video games and practically anything else asa download with minimal effort People will need enormous hard drives if they want13 theirown digital copies of these files so will more than likely make use of cloud storage that13 willbe available from many organisations The location of the servers may become sensitivedue to border restrictions as will the security of the data13 and the way that13 it13 is backed up sothat13 it13 is resilient13 to failures
It may be evident13 that13 application forms for all types of welfare payment13 will be availableonly for downloading so that once digitised they can be processed by computer andrecords sent13 to various servers for subsequent13 storage and processing Some people maywant13 to keep their data13 on them once it13 has been downloaded Pen drives can already holdseveral GB of data so it13 is likely that13 people will be able to carry their downloaded data13 withthem at all times irrespective of the size and complexities of the information
36
39 Health13 and13 well-shy‐being
The general health of the population is unlikely to deteriorate noticeably within 10 to 20years Indeed expectations of the population are that13 things must13 improve as surgicaltechniques mature and as pharmaceutical interventions become more personalised andpowerful However the rising demand for health services due to an ageing population andthe increasing cost13 of providing sophisticated therapies will make delivering a free anduniversal health service difficult13 without13 substantial increases in taxation This is unlikely tohappen in the UK even though spending on health services will be protected against13 thecuts facing other services
There will have to be changes in how the NHS works For twenty years hospitals have beenclosed and replaced by fewer new facilities so that13 the bed count13 is reduced This has led toa significant13 shift13 in resources to primary care and community care supporting shorter staysin hospital and speedier transfer back home for people after surgery or illness This hasbeen13 successful but13 there remain problems with demand for GP services especially out-shy‐of-shy‐hours and at weekends Indeed despite the introduction of NHS24 and similar help-shy‐linesthe demand for GP appointments continues to increase Delays are inevitable and this willincrease system failures with more unnecessary deaths and a failure for people to access adiagnosis that13 might13 lead to early interventions and ultimately lower delivery costs Over250 more patients are added to waiting lists every day
This will lead to a new model of primary care consistent13 with existing changes which haveseen surgeries move from High Street13 locations to medical centres close to bus routes andwith more parking for patients The process of making an appointment13 is changing from atelephone-shy‐based interview process dominated by a medically-shy‐unqualified receptionist13 to achoose and book approach using an online process linked to electronic patient13 records Thiswill give patients more convenience but13 will allow priority for those who have Internet13 access at the expensive of those who are digitally excluded Making the process of bookingan appointment13 quick and easy may also increase demand from people who do not13 need tobe seen as it13 will fail to identify those in greatest13 need
A greater use of telehealth and telecare technologies will be inevitable beginning with thefirst13 contact13 as an encounter using the telephone e-shy‐mail or video conferencing -shy‐ a visit13 tothe GP surgery should be a last13 resort and should involve a nurse consultation in the first13 instance This would be consistent13 with three quarters of appointments currently involvinga chronic disease or long term condition which relates to improved self-shy‐care The support13 ofthese patients at home should be prioritised through tele-shy‐ and web-shy‐based technologies andshould involve training and coaching through a network of nurse practitioners Home visitsshould generally be unnecessary through the use of these technologies but13 could besupplemented by satellite surgeries manned by nursing in community premises or inpharmacies nurseries and Internet13 cafes
The homes13 of people who13 need13 closer monitoring can then become part13 of virtual wardswith real or electronic visits by health professionals University Hospital Southampton NHSFoundation Trust13 already looks after patients who have undergone surgery such as a hip orknee13 replacements in virtual wards with high levels of satisfaction The Royal Free London
37
NHS Foundation Trust13 offers a similar service but13 plans to add the possibility of videoconsultations between patient13 and consultant
310 Attitudes to public health issues ndash obesity smoking alcohol abuse drugs
As self-shy‐care becomes the focus of the NHS the public will increasingly understand that13 thecosts and availability of services are being harmed by the poor health behaviour ofrelatively small numbers of people The link between public health initiatives today andhealthcare needs and costs in the future will become increasingly evident13 as a result13 of theway that13 information is presented Thus the overweight13 smoker who currently attractsconcern and pity when they are diagnosed with diabetes and COPD is increasingly beingseen as the victim of their own stupidity or lack of self-shy‐discipline If they continue to neglect13 medical advice and continue with an unhealthy lifestyle then the way that13 they receivetreatment13 and consume resources will become a matter for the entire population
Obesity is seen as due to a combination of poor diet13 and a sedentary lifestyle No longer isthe idea13 that13 people are lsquobig bonedrsquo acceptable Governments will respond initially byrequiring manufacturers and food processors to provide nutritional information onpackaging and on menus in restaurants But13 people can choose not13 to read the data13 and toneglect13 both the importance of food quality content13 and quantity This will increasepressure to introduce fat13 or sugar taxes and these are likely to be in force within a decade
Although the high taxes on tobacco products has forced some smokers to reduce theirconsumption or to give up altogether the impact13 has been reduced by the smuggling ofproducts from overseas and by the availability of duty-shy‐free cigarettes for people returningfrom foreign holidays and business meetings Further measures are planned to changepackaging and to include even more graphic images and warnings on cigarette packages tomake smokers aware of the effects of smoking on their health and well-shy‐being There is asyet little evidence of how successful this might13 be More effective has been the banning ofsmoking in public places including trains and aircraft Expensive medical interventions suchas heart13 transplants will be denied to individuals until they change their lifestyle behaviourSmokers might13 therefore be increasingly ostracised leading to a loss of esteem This mayhave a particular impact13 on people who already suffer from mental health problems whoare more likely to smoke
The overuse of alcohol is being recognised as a major factor in hospital admissions withNHS figures showing an increase of over 40 in such admissions over the past13 decadeLinked to this has been a 75 increase in prescriptions to treat13 alcohol dependency Fewpeople have sympathy for those who waste their limited income on booze If they havechildren or other dependents they will be the ones who suffer and who may need thesupport13 of social care
Drug users are already significant13 users of social services as their habit13 is likely to makethem unemployable They receive little sympathy from the general public because they areseen as criminals and people who waste public resources Levels of drug abuse have been
38
slowly increasing over the years but13 this trend is slowly being reversed Indeed the numberof people using drugs during the past13 year has fallen to its lowest13 level for nearly 20 years(below 9) with cannabis being most13 likely often following excessive drinking Aselectronic noses and other technologies can detect13 traces of drugs it13 seems likely that13 success in overcoming addiction can be measured objectively This may become a two-shy‐edged sword rewarding those who can turn around their lives but13 further marginalisingthose who canrsquot13 or wont13 accept13 the lsquocold turkeyrsquo
311 Attitudes to surveillance
Issues associated with privacy confidentiality and data13 security have been discussedpreviously in the context13 of information technology the World Wide Web and the ease ofcollecting recording recalling analysing and displaying data The monitoring of individualsand their methods of using this information can be regarded as surveillance As thequantities of data13 increase along with the number of devices that13 can be used to access itthe surveillance tools will also increase in their sophistication Indeed the Big Data13 approaches described in the previous section will enable the combination of structureddata13 (such as the information held in databases) to be married with unstructured data13 fromimages in such a way that13 it13 can be mined
Whilst13 the lsquodigital surveillancersquo methods described above may cause most13 concern topeople because of its impact13 on anonymity it13 is the collection and analysis of images that13 are the major concern to people as they contemplate the ways that13 lsquoBig Brotherrsquo maydevelop to restrict13 freedom Every major UK city and town centre has an array of CCTVcameras that13 continually record activities from every angle If it13 used to be true that13 nobody in London was more than 10 yards from a rat it13 is certainly the case today that13 nobody can be more than this distance from being in view of a surveillance camera Yetthey receive so much positive publicity from TV programmes where their footage is used todetect13 vehicles close to a crime scene or to monitor the movements of suspects that13 theyare now accepted by the public as a deterrent13 in the same way as lsquobobbies on the beatrsquowere seen 25 years ago There is therefore little public reaction to the expansion in the useof video surveillance except13 for the practical observation of how so many views can beinspected and recorded
Looking to the future the tumbling cost13 of video technology will surely lead to anotherincrease in the number of devices The aerial views taken from towers will besupplemented by more local views taken by devices that13 are embedded in the fabric ofbuildings or carried by individuals either on their person (for example on clothing orspectacles) or in the bags that13 they carry The time and date-shy‐stamped images as Big Datawill be recorded to lsquothe Cloudrsquo where it13 can be added to other data It can then be usedwhen an incident13 has occurred or to provide further detail of night-shy‐time activities
It follows that13 there will be no hiding place for people who simply want13 to disappear Theymay respond by wearing clothing (such as hoodies) that13 hide their faces or which make it13 difficult13 to distinguish gait13 or mannerisms from which they might13 be identified New forms
39
of clothing may be designed to make shapes more difficult13 to analyse and these might13 become the uniforms of a class of person who wants to live in a way that13 they donrsquot13 interact13 with officials from any ministry or local government13 department If they also obstruct13 services then they will be considered to be anarchists of some form sparking protests fromother sectors of society
31213 Attitudes to driving
Motor cars have been a feature of UK roads for over a century but13 it13 is only during the past13 50 years that13 they have become a resource that13 most13 families have had access to enablingthem to travel without13 the restrictions imposed by a limited railway network and non-shy‐integrated bus transport People who have had a car throughout13 their lives often see theircars as an important13 factor in enabling them to remain independent13 and to exercise choicesrelating to where they shop and where they spend their leisure time This extends to theirspouse and to friends and neighbours that13 they might13 take with them on their variousexpeditions
Unfortunately there are incidents involving older drivers who perhaps go down amotorway in the wrong direction who are taken ill at the wheel or who are involved in anaccident13 involving no other vehicles These are small in number but13 often lead to a reactionthat13 they shouldnrsquot13 be allowed to drive lsquoat13 their agersquo Age itself is not13 an indicator ofdriving quality but13 because old age also brings more chance of having limited long termconditions and other illnesses it13 is easy to make a link between driving ability and age Thelicensing system does require continued driving to be linked with medical advice andforbids people with poor eyesight epilepsy and other conditions to hold a licence in oldage
Yet13 statistically older drivers cause far fewer accidents than younger drivers The reasonsfor this may be complex and are likely to include the fact13 that13 they drive less often covershorter distances and donrsquot13 go out13 in the dark or in poor weather However it13 does not13 wholly explain why the UKrsquos drivers aged over 70 and who represent13 some 8 of all driversare involved in only 4 of accidents that13 cause injury This compares favourably with the15 of13 drivers aged between 17 and 29 who are involved in over a third of crashes that13 result13 in injury
By 2020 the number of drivers aged over 70 on UK roads is likely to increase to over 7million This will require a new national strategy perhaps involving support13 for olderdrivers further training raising awareness of issues and making more use of adaptivetechnologies to support13 the driver in avoiding collision or forgetting to check on the statusof their vehicle Poor eyesight13 could be enhanced by camera technologies rather thanforcing people off the road if they are unable to read a licence plate
The International Longevity Centre has found that13 one in four Britons thought13 driversshould be made to switch off the ignition for good somewhere between the ages of 70 and75 The numbers may decrease as the population ages and as cars become safer Forcing
40
older people off the road may be a natural consequence of providing free bus passes andsubsidised rail fares but13 the growth in the pavement13 scooter industry demonstrates that13 older people value their independence and will do almost13 anything to get13 out13 and aboutPerhaps legislation will result13 in more regulation of electric vehicles and where they cantravel
There can be no doubt13 that13 getting out13 will be associated with better quality of life andwell-shy‐being and this is likely to be supported in the future as evidence of improvedoutcomes emerges It is to be hoped that13 positive stories will be publicised so that13 publicattitudes arenrsquot13 hardened This may be supported by more in-shy‐car monitoring of drivers andthe linking of performance with on-shy‐line driving records and licences These could throughremotely monitored ignition systems prevent13 the use of motor vehicles by people without13 a licence or without13 insurance
313 Climate change
There is a general view that13 the emissions of carbon gases are contributing to globalwarming in a manner that13 will change the UK climate in such a way that13 the climate maybecome more Mediterranean However some scientists believe that13 manrsquos impact13 on theenvironment13 may be small compared with natural variations caused for example bycyclical changes in the sunrsquos energy output13 or by the effects of volcanoes and earthquakesRecent13 evidence has suggested that13 we are going through a phase of changing extremesand that13 this is more likely to cause storms periods of excessive rainfall and unusualseasonal trends with snow and frost13 in the spring and warmer winters Considerableuncertainty remains and it13 might13 be necessary to plan for a number of different13 scenariosand for the impact13 on vulnerable people
I Colder winters UK properties are poorly insulated resulting in excess mortalitiesduring cold spells due to an increased number of people suffering from stroke aswell as bronchitis and other pulmonary diseases The cost13 of heating continues toincrease putting more households into a state of fuel poverty Any further coolingduring the winter months will result13 in more people living in unhealthy coldconditions Winter fuel payments are likely to be restricted to the poorest13 peoplebut13 this might13 exclude people who live in larger properties that13 are more difficult13 toheat
II More storms excessive winds and rain can cause flooding at any time of the yearMany UK communities are built13 close to rivers and these can surge during heavyrainfall causing houses to be filled with water and furniture and carpets lostInsurance can be problematic for properties built13 on flood plains which can blight13 properties and prevent13 owners from being able to sell and move on High winds canrip off roofs causing injury and also causing families to be left13 homeless anddependent13 on social services
III Hot13 summers Europe suffered high temperatures during the summers of 2003 and2004 leading to heat13 stroke and hypothermia The UK has not13 previously sufferedfrom such problems but13 might13 be expected to experience days of extreme
41
temperature and humidity at times Older people may not13 be prepared for suchweather Street13 dwellers may be unable to find shade and supplies of drinkingwater
Irrespective of what13 combination of weather scenarios arise it13 must13 be concluded that13 any extremes will have a major negative impact13 on vulnerable people especially if theyare not13 prepared because they havenrsquot13 received the weather warnings and advice that13 can be broadcast13 using the TV radio and online services Once again the digitallyexcluded will suffer and will pay a high cost Society will continue to pick up the bill interms of demands on social care services unless preventive actions are taken in theform of connecting these people to each other and to formal services
42
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
s13 13
13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
n13 13
13 s13
r13 n13
e13 at13
e13 y13 e13 ld13
ly13
13 e13 t13 e13
s13 er13 e13
f13
rt13 13
13 13
13
r13 13
s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
e13 g13 13
e13
13 13 ial13
13
d13
13 d13 h13 r13
d13 13
s13 y13
e13
13
rd13 r13 e13
13
13
13
e13
e13
d13 13
13
13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
3 BEHAVIOUR AND ATTITUDE CHANGES DUE TO TECHNOLOGICALADVANCES
Technology is only one factor that13 will affect13 the way society changes in the next13 10 or 15years This chapter will consider the context13 in which the technological developmentsoutlined in the previous chapter will be supported (or held back) by societal factors
When the impact13 of such factors has been considered we can then apply theseassumptions to a number of case studies listed in Appendix13 A13
The headings selected for this chapter are not13 arbitrary as they reflect13 the context13 in whichtechnological changes must13 be considered They must13 include consideration of factors suchas demography and long-shy‐term conditions already addressed in the introduction to thesepapers together with the aspects of workforce and citizenship considered in the parallelpapers The additional elements here focus on trends that13 are already occurring and whichmay leave people struggling with the changes that13 occur
Finally there is a need to consider the attitudes of people to technology generally andespecially to the issues of privacy and social responsibility that13 could be radically changedby technology In some cases public opinion will prevent13 some forms of technology beingdeveloped if not13 commercialised In other cases some technologies will be fast-shy‐trackedeither at the request13 of government13 or because of a clear public demand for theopportunities that13 it13 can bring
Predictions13 about the13 future13 must inevitably be13 subject to considerable13 uncertainty butthat is no reason to stop thinking what might happen
31 The Welfare State
The UK can be rightly proud of the way that13 its welfare state has developed during the past13 100 years to provide a safety net13 of financial support13 to people and to their families whenthey are unemployed destitute homeless or challenged by crises and emergencies Therange of benefits received is considerable some are complex and many people struggle tounderstand their entitlements Some are universal some are discretionary some apply onlyto parents others to anyone
The total cost13 of providing these benefits continues to rise and when the economy isstagnating there is inevitably both political pressure often supported by popular publicopinion to introduce welfare reform so that13 people who do not13 work cannot13 be better offthan they would be if they were in full-shy‐time employment This strategy requires a universalbenefit13 to be introduced so that13 it13 is easier for claimants to access support13 but13 also easierfor agencies to identify the total benefits received The idea13 of a benefits cap then becomes
27
more practical to introduce especially if all the processes involved in making a claim arehandled electronically Indeed this encourages government13 to insist13 on applications forbenefits to be made on-shy‐line Unfortunately this will marginalise those people who haveneither a computer nor access to the internet thus emphasising the digital divide in amanner which works against13 some of the most13 disadvantaged people in society
There are currently few tangible links between digital technology and welfare provisionThe most13 obvious are universal benefits such as a free television licence (worth pound14550)13 for13 everyone aged 75 or older with blind and visually impaired people entitled to a 50discount13 irrespective of their age The significance of this position is that13 6 of revenuesgenerated through licence fees are to fund BBC on-shy‐line services13 such13 as websites and i-shy‐player In Scotland the BBCrsquos Alba Gaelic language television service is predominantlyfunded13 by MG Alba an organisation funded by the Scottish Government It is thereforeconceivable that13 in the future licence fees may be used to directly subsidise access toinformation and advice through the Internet13 for vulnerable people whether it13 is throughbroadband access or through a set-shy‐top box which removes the need for a computer in thehome to access particular websites or to use e-shy‐mail services
A second age-shy‐related benefit13 available in the UK is the winter fuel subsidy People whoreceive certain benefits receive the payments automatically while others must13 make aclaim Those who are not13 eligible for benefit13 due to a lack of an address for example missout13 on these payments and also on Cold Weather payments of pound25 for each seven dayperiod of very cold weather between 1 November and 31 March
The development13 of new warm home initiatives plus the complex of subsidies that13 theelectricity supply industry and government13 offer to people with solar cells further changesthe economic arguments Global warming may lead to greater variations in weatherextremes but13 might13 also increase the amount13 of electricity that13 can be generated byalternative (green) sources such as wind and solar cells It is estimated that13 energyconsumption in the UK increased by 17 between Christmas and Easter 2013 compared toprevious years as a result13 of cold weather but13 the above subsidy scheme did not13 benefit13 older people because two of the seven day cold periods were after 31st March It must13 beassumed that13 there will be more people living in fuel poverty in the future and this will leadto more cases of cold related illness including influenza13 and stroke
32 Management of long term conditions
The management13 of long term conditions will be improved for patients who are compliant13 with their medication regime so it13 is possible that13 there may be compulsion to adhere tothe prescription Such compulsion may be monitored using technology Indeed the remotemonitoring of vital signs using telehealthcare will become commonplace as the old boxesand sensors are replaced by devices that13 can be worn continuously or which can beembedded into the fabric of homes (including furniture and bedding) or can be worn asvests or patches They will wirelessly transmit13 data13 to smartphones or tablets and mobile
28
transmission and cloud technology will enable real-shy‐time data13 collection analysis andfeedback
One of the diseases which is projected to increase most13 significantly over the comingdecade is Type 2 diabetes Whilst13 there is a hereditary susceptibility to this condition formany people including those from the Middle East13 and the Asian sub-shy‐continent it13 is also adisease which tends to affect13 those people who are overweight13 andor have a sedentarylifestyle If untreated diabetes can lead to dizziness and collapse at any time but13 can alsohave more devastating long term consequences which include kidney failure strokeblindness and in extreme cases lower limb amputations Management13 therefore includesdaily monitoring of blood glucose levels and major dietary changes such as a significant13 reduction in the consumption of carbohydrates as well as a rigid exercise regime
Many newly diagnosed diabetics follow this advice closely and can lead normal lives for 40years or more but13 some struggle to accept13 the change in lifestyle required as well asremembering which foods are allowed and how much exercise they need to takeIndividual support13 plans are now forthcoming and over the next13 ten years best13 practicewill emerge in the form of smartphone apps that13 are personalised and which can becomean individualrsquos health coach This level of support13 will be fine for some people but13 otherswill need incentives so it13 is likely that13 gaming technologies will be introduced perhapsoffering rewards for good compliance There will be a temptation for some people tocheat perhaps allowing others to perform exercise for them or changing theirconsumption details
Many of these opportunities for cheating will be removed through the use of a uniquebiometric identifier a technology that13 will be mature enough to use in place of passwordson smartphones However the biggest13 challenge may be in encouraging older people to usethe technology Many older people have multiple morbidities Indeed a survey of Scottishpatients implied that13 42 of people aged over 80 will suffer from three long termconditions It will be essential for those people to comply with treatment13 regimes if they arenot13 to have the functional deficits that13 follow
33 Finding people who13 donrsquot fit
People who have low social capital are likely to have few relatives and friends with whomthey regularly communicate and are also unlikely to be part13 of community or faithorganisations such as clubs societies and church groups They also die several yearsyounger than most13 of the population often because they donrsquot13 engage with public healthinitiatives such as vaccinations against13 flu regular checks on their blood pressure bloodsugar levels or in the case of women smear tests or mammography The most13 likelyreason for disappearing beneath the radar of such initiatives is their mobility which leadsalmost13 inevitably to them having no fixed abode and no fixed telephone line It thenbecomes very difficult13 for them to be contacted because their mobile telephones are likelyto have Pay-shy‐As-shy‐You-shy‐Go contracts that13 donrsquot13 require validated names addresses and bankaccounts
29
It follows that13 some of the most13 vulnerable people in society including those who live onthe streets are effectively unknown to both the NHS and to social work departments untilthey are referred in a crisis This could be an emergency presentation to a hospital Accident13 and Emergency Department13 where they will come into contact13 with a social worker becausedischarge may be unsafe This often highlights the importance of the prevention agenda13 and the potential for avoiding admissions to hospital by intervening at an earlier stage
The advantages of being able to locate people who are vulnerable to specific diseases willincrease as genetic testing becomes more routine It is already possible to determine whomight13 be most13 at risk of breast13 cancer and prostate cancer as a result13 of family history Addto this the evidence that13 particular diet13 and exposure to environmental factors can furtherincrease risk then it13 is evident13 that13 individuals can be identified and offered treatmentsthat13 could save their lives many years before they become ill In the case of cancersperhaps only the individual is involved but13 for infectious diseases it13 is the whole of societythat13 is at risk if someone contracts one of the new strains of influenza or if someonechooses not13 to be vaccinated against13 rubella In Chinese airports all visitors are screenedfor fever and refused entry if they tested positive in cities the public are monitored in thesame way Similar approaches may be necessary in the UK if potential carriers cannot13 otherwise be identified
34 Volunteering
It is estimated that13 72 per cent13 of people volunteered to perform a charitable act13 at least13 once during 2012 a rise from 65 per cent13 the previous year About13 four out13 of every 10volunteers offer their services formally to one or more organisations The remaindervolunteer informally by helping out13 a friend or a neighbour Around 50 per cent13 volunteered at least13 once a month in the past13 year up from 41 per cent13 on the previous13 year Most13 have retired many of them before the statutory retirement13 age Those whodonrsquot13 feel able to offer time have offered their financial support13 at a time when the fundingavailable from sources such as the National Lottery has been decreasing Despite economicausterity donations to charities have been increasing 74 per cent13 said they had given tocharity at least13 once in the previous month up from 72 per cent13 the previous year
Strikingly 78 per cent13 of people strongly believe that13 they are part13 of their localneighbourhood an increase from 70 per cent13 10 years previously Community cohesion isstronger than ever 87 per cent13 of people believe their local area13 is a place where peoplefrom different13 backgrounds get13 on well together compared to 80 per cent13 in 2003
The role of volunteers in supporting vulnerable people is therefore likely to increase overthe next13 decade perhaps exploiting the success of the army of volunteers that13 was highlysuccessful in London during the Olympic and Paralympic games The greatest13 role for suchvolunteers may be in providing informal care for older people Already the UK has someseven million informal carers whose value in monetary terms has been calculated to be
30
more than the combined budgets of the NHS and social care Maintaining or extending thisprovision will help to support13 services in the future and may be supported by technology
Whilst13 there is ample evidence to suggest13 that13 telecare services support13 informal carers asmuch as (if not13 more than) the people that13 they are caring for it13 is the potential for utilisingthe internet13 and apps to make their role easier to coordinate and hence more effectivethat13 is likely to be most13 successful moving forward
Many of these focus on particular tasks that13 informal carers can help offer to older peoplesuch as organising their medication A pillbox program is just13 one feature of an app calledBalance It also includes sections for caregiving tips notes for the doctor and the patientsappointments plus a lsquolearning sectionrsquo with articles on aspects of Alzheimers and an RSSfeed for news about13 the disease Tyze is another multi-shy‐functional app it13 allows carers to
bull Organise appointmentsbull Plan outingsbull Share storiesbull Send updates to other family members
Another application is Rally Round which helps carers to organise someone to perform littlejobs often on a temporary basis when someone has dementia physical frailty or isrecovering from accident13 or illness Similar applications are MeMaxi and Finerday
35 The High13 Street
The shape and appearance of UK shopping centres have been changing for half a centuryPeople complain that13 centres are losing their identity with one town looking like everyother both in terms of the stores and in terms of the layout But13 there are three trendswhich are having a profound impact13 on many of the most13 vulnerable people in society
bull Centres lock their doors at 6pm or in some cases 10pm -shy‐ thus denying people whosuffer from claustrophobia13 from window shopping at times when other shoppershave left
bull Out13 of town shopping malls -shy‐ these US style centres are ideal for people in carsbecause they offer free parking which is essential for people who want13 to buy largeritems but13 difficult13 for people who have no transport13 and who must13 rely on publictransport13 that13 is often deficient
bull The rise of online shopping -shy‐ which means that13 many potential shoppers only visit13 High Street13 stores to check the prices before returning home to make a purchaseonline
It is the third of these effects that13 has the greatest13 potential for changing the High Street13 forever and it13 is making life for traditional retailers increasingly difficult13 at a time when highrents are crippling stores large and small It is difficult13 to see how this trend is likely tochange because consolidation in banking and estate agencies is already forcing the closure
31
of other High Street13 players while additional pressures on pubs has led to the closure ofthousands of pubs every year
Those figures however demonstrate that13 consumers still value what13 the high street13 canoffer -shy‐ the chance to inspect13 what13 theyrsquore thinking of buying -shy‐ as well as the new opennessof the internet Customer service makes a difference to people especially if there is aproblem and goods need to be returned One of the most13 common reasons for furniture tobe returned for example is that13 when a sofa13 or a wardrobe was delivered it13 couldnrsquot13 fit13 through the front13 door or up the stairs In the future people will be able to benefit from13 visualisation technology they will upload the floor plans of their homes enabling theretailer to inform them of the problem before they try to delivery Augmented reality viewwill similarly allow customers to see what13 a new item of furniture will look like in itsintended place so that13 they can be more informed about13 the effect13 of size and colour
In terms of improving the viability of the High Street stores will have to focus on theimportance of brand which could mean that13 individual independent13 retailers will have topartner with national suppliers to support13 a local tailored offering based on products that13 are designed for a more global market This is a lsquoconnected High Streetrsquo approach whichcould be enabled by the developments in internet13 availability and smart13 phone accessdescribed in the previous section
The overall effect13 of all these changes could mean that13 town centres become smaller but13 more vibrant13 areas They could thrive if people are attracted there in large numbers whichmeans that13 retail must13 be developed alongside restaurants pubs galleries and other leisureopportunities This is possible in new shopping centres which are already being integratedwith transport13 hubs including railway and bus stations but13 may be more of a design13 challenge for older towns and cities with large Victorian buildings To ensure that13 morepeople are welcomed into the new centres they should include attention to green spacesand areas where people can relax without13 feeling that13 they are second class citizensbecause they donrsquot13 have the same buying power
3513 Privacy
To some people privacy is their right13 to live their lives without13 interference they may seethe State as a potential lsquoBig Brotherrsquo spying on their every move and judging their actions13 and activities Other people have fewer concerns about13 the role of the State but13 great13 fearof individuals interfering with and invading their privacy Some embrace the concept13 of lsquomyspacersquo an area13 of a square metre or so into which nobody can enter without13 permissionThis allows them to avoid physical contact13 and to feel safe from any form of threateningbehaviour
Yet13 this idea13 of private space and its potential violation is merely the tip of the iceberg asfar as privacy is concerned more significant13 is the idea13 of personal (and private)information being shared with anyone and everyone This could be related to identityopinion or image for an individual who wants to remain anonymous or even secretive thisis going to become an increasing problem as technology provides the means of taking
32
photographs recording conversations and capturing environment13 with something as smalland ubiquitous as a mobile phone The fact13 that13 this information can then be shared withthe rest13 of the world using e-shy‐mail Twitter and Facebook makes the problem all the moredifficult So the threat13 is no longer solely from the long lenses of the Paparazzi but13 fromanyone (and that13 means everyone) who has even the most13 basic of mobile phones
This relates to the changing views of society on what13 information should remain privateand what13 should be shared with others The success of social media13 has been based on anattitude of lsquosharing everythingrsquo with either your friends or the world This has introduced anaiumlve idea13 in the minds of some younger people (especially those known as Millennials ieaged 18-shy‐30) that13 everyone can be their friends whilst13 perhaps failing to reinforce the bondsof genuine friendship with any form of test13 or restriction Technology could play a role indefining these friendships and allowing individuals to understand what13 makes a goodfriend but13 this approach has yet13 to be developed and may be slow to overcome the needfor some people to measure their own popularity simply as the number of people that13 theycan list13 as friends on their Facebook page
It follows that13 there may be a need for a new definition of privacy that13 is in keeping withthe web and its ability to display images and opinion in an unregulated manner This needsto embrace past13 concerns about13 the ability of an individual to live without13 the threat13 ofothers being able to watch them whilst13 offering some protection from random postingsabout13 them online Perhaps this could include a right13 to be able to edit13 or remove anythingrelating to themselves on the Web including images that13 are not13 news-shy‐worthy Theownership of image rights may be an associated issue that13 needs to be addressedespecially as modern technology can remove an individual from a group (or a background)13 view provide digital touch-shy‐up or air-shy‐brushing and then republish it13 in a different13 contextHowever there is general agreement13 that13 personal information (such as contact13 details andbank codes) should not13 have a place on the web Surprisingly few people take proactivemeasures to prevent13 tracking functions being activated
It follows that13 too much privacy could lead to younger people fearing that13 they maybecome lost13 in a digital world It is not13 surprising then that13 they are prepared to make lots13 of personal information available often with no fear of how it13 might13 be used by othersWhen Google glasses and similar technologies become available during the next13 few yearsthey will have the potential to identify a stranger walking down the street and to find manyof their secrets to present13 to the wearer in a fraction of a second They could know moreabout13 them than their genuine friends know -shy‐ so who will be their friends in the future
36 Data sharing and13 protection
By lsquodata13 sharingrsquo we mean the disclosure of data13 held by one organisation on an individualto a third party organisation(s) or the sharing of data13 between different13 parts of anorganisation Some data13 sharing doesnrsquot13 involve personal data13 because it13 has beenanonymised in such a way that13 the statistics can be used for the collective good without13 theidentification of the individual The Data13 Protection Act13 (DPA) is in place to provide a legal
33
framework that13 ensures that13 organisations that13 hold personal data13 must13 act13 responsibly atall times These principles adequately describe the position of public and government13 bodies especially social services departments who are responsible for the informationconcerning the health and well-shy‐being of individuals -shy‐ and hence by implication thesensitive data13 relating to their vulnerability
The legal framework that13 applies to private and third sector organisations differs from that13 which applies to public sector organisations which may only act13 within the defined limits oftheir statutory powers However all bodies must13 comply fully with the data13 protectionprinciples and this situation is unlikely to change within the next13 10 to 15 years In someprivate sector contexts there are legal constraints on the disclosure of personal dataHowever most13 private and third sector organisations have a general ability to shareinformation provided this does not13 breach the DPA or any other law It is advisable for acompany to check its constitutional documents such as its memorandum and articles13 ofassociation to make sure there are no restrictions that13 would prevent13 it13 from sharingpersonal data13 in a particular context The type of data13 held is therefore a subject13 ofconcern as it13 may be difficult13 for legislation to keep up with the additional layers of data13 created on-shy‐line and through the Internet13 of Things
Private and third sector organisations should have regard to any industry-shy‐specific regulationor guidance about13 handling individualsrsquo information as this may affect13 the organisationrsquosability to share information They should also be aware of the legal issues that13 can arisewhen sharing personal data13 with public sector bodies This becomes more of an issue asprivate and third sector bodies are carrying out13 a wider range of traditionally public sectorfunctions Opportunities for inappropriate sharing of sensitive data13 will therefore inevitablyincrease
Public authorities must13 comply with the Human Rights Act13 (HRA) legislation in theperformance of their functions The HRA also applies to organisations in the private sectorinsofar as they carry out13 functions of a public nature which could include delivering a socialcare activity Where the HRA applies organisations must13 not13 act13 in a way that13 would beincompatible with rights under the European Convention on Human Rights Article 8 of theConvention giving everyone the right13 to respect13 for their private and family life their homeand their correspondence is especially relevant13 to sharing personal data If personal data13 isdisclosed or shared in ways that13 comply with the DPA the sharing or disclosure of that13 information is also likely to comply with the HRA The problem may still be in policing theActs and the rights of an individual if they believe that13 their personal data13 has been sharedor accessed by an inappropriate organisation or individual
A legal industry may be born to deal with such matters but13 this is unlikely to benefit13 peoplewho cannot13 afford the fees involved They would require either legal aid or to employ13 more13 lsquono win no feersquo companies Public attitudes to such costs might13 become negative unlessthey prove successful in preventing breaches of data13 security There may need to belegislation to provide a stronger basis for forcing compliance with privacy laws
34
37 Connecting with13 people
We are social creatures most13 of us rely on our friendships and interactions with friendsand families to share our happiest13 moments and experiences Research suggests that13 thishappiness is infectious at all levels and leads to a 15 increase in the happiness of a closecontact 10 for a second degree contact13 such as the friendrsquos spouse and a 6 increase fora friend of a friend It is hardly surprising that13 the success of social media13 such as Facebookis intimately related to the ability of people to quickly share their happiest13 moments with asmany of their friends and connections as possible
All this has happened during the rise of the Internet13 and the corresponding increase inopportunities for connecting online ie this is a 21st Century phenomenon which has beenfacilitated by Information and Communications Technology But13 the Internet13 remains in itsinfancy and we are only beginning to understand and exploit13 its potential In terms ofaccessing the Internet there are now perhaps two billion people who have access with99 of them having gained this during the past13 decade This number will have doubled bythe period 2020 to 2025 It is likely that13 everyone who wants to be connected in the UK willby then be connected Turning this on its head only those who donrsquot13 want13 to be online willnot13 be on the Internet13 within a decade Connecting with the unconnected will therefore bea case of identifying those people who donrsquot13 want13 to be found unfortunately these mayinclude many people who need the support13 of social care organisations It means that13 theywill be looking for support13 only when they are in crisis unless other ways of finding andormonitoring them are found
While the number of people connected via the Internet13 has exploded this might13 bedwarfed by the number of connected lsquothingsrsquo During 2009 the number of thingsconnected to the Internet13 surpassed the number of connected people at which point13 webegan to experience what13 this report13 has described as the lsquoInternet13 of Thingsrsquo Yet 99 ofall physical objects that13 could join this network are not13 yet13 connected but13 the number couldgrow by 25 every year for the next13 decade so that13 there could be 100 billion connectedobjects by 2025 some of which will be owned or used by everyone in the UK includingthose people who donrsquot13 want13 to be connected themselves We will then have an Internet13 of Everything which will be the smart13 connection of people data events and actions
With each new person object or data13 that13 comes online the connection possibilitiesbetween all these elements grows exponentially The rise of big data mobile networkingcloud storage and data13 mining technologies will all play a critical role in the Internet13 ofEverything The result13 will be new capabilities richer experiences and unprecedentedvalue for individuals businesses communities and countries everywhere The lsquonetworkeffectrsquo of the Internet13 of Everything will be a very powerful thing the true impact13 of whichwe wonrsquot13 fully understand for several years As it13 develops however those who are not13 connected will feel even more digitally and socially excluded There will be a need to reachout13 to vulnerable people unless the process of claiming requires proof of online identityand the payments to be received can only be redeemed using a chipped card or adownloaded app onto a smartphone This is of course the way that13 welfare arrangementsare already developing thus it13 might13 prove impossible to make a successful claim without13
35
already being connected to lsquothe systemrsquo either through an online presence or through theInternet13 of Things
38 Downloading everything
Sixty years ago information was discovered by reading books often in a library wherenotes had to be made because the books or journals couldnrsquot13 be removed Then in theearly 1960s the first13 office photocopying machines were introduced into the UK theyimmediately meant13 that13 pages or articles from books could be copied and taken away to beread and summarised later Within a few years photocopying became a replacement13 forreading as researchers became less adept13 at selecting a few sentences and every deskbecame a depository for reams of printed paper Paper became the means of recordingeverything from bank statements through to music
We now appreciate that13 printing everything is a waste of both the ink (or toner) used tocreate the black print13 and of paper which requires trees to be chopped down and pulpedbefore it13 can be pressed into thin sheets Saving paper is therefore seen as green and goodfor the planet Fortunately we no longer need to print13 everything because computermemory is unlimited thanks to the cloud and we can then view pages and articles onportable or fixed screens
The internet13 has everything and it13 is all available instantly for downloading providing thereis a device available to accept13 it and there is sufficient13 communication bandwidth toperform the transfer of data13 sufficiently quickly Thus we can record all text13 articles that13 are relevant13 to us including digital records of birth certificates qualifications and passportsand the need for original printed versions will decline But13 we can also do this forphotographs Most13 handheld computing devices include at least13 one camera so they cangenerate enormous number of pictures which can be kept13 for posterity without13 having toconsume inks and special papers to print13 them
But13 the materials that13 can be downloaded donrsquot13 stop at pictures software is available that13 can grab TV shows after they air and movies as soon as theyre released In the same wayit13 is possible to schedule music comic books video games and practically anything else asa download with minimal effort People will need enormous hard drives if they want13 theirown digital copies of these files so will more than likely make use of cloud storage that13 willbe available from many organisations The location of the servers may become sensitivedue to border restrictions as will the security of the data13 and the way that13 it13 is backed up sothat13 it13 is resilient13 to failures
It may be evident13 that13 application forms for all types of welfare payment13 will be availableonly for downloading so that once digitised they can be processed by computer andrecords sent13 to various servers for subsequent13 storage and processing Some people maywant13 to keep their data13 on them once it13 has been downloaded Pen drives can already holdseveral GB of data so it13 is likely that13 people will be able to carry their downloaded data13 withthem at all times irrespective of the size and complexities of the information
36
39 Health13 and13 well-shy‐being
The general health of the population is unlikely to deteriorate noticeably within 10 to 20years Indeed expectations of the population are that13 things must13 improve as surgicaltechniques mature and as pharmaceutical interventions become more personalised andpowerful However the rising demand for health services due to an ageing population andthe increasing cost13 of providing sophisticated therapies will make delivering a free anduniversal health service difficult13 without13 substantial increases in taxation This is unlikely tohappen in the UK even though spending on health services will be protected against13 thecuts facing other services
There will have to be changes in how the NHS works For twenty years hospitals have beenclosed and replaced by fewer new facilities so that13 the bed count13 is reduced This has led toa significant13 shift13 in resources to primary care and community care supporting shorter staysin hospital and speedier transfer back home for people after surgery or illness This hasbeen13 successful but13 there remain problems with demand for GP services especially out-shy‐of-shy‐hours and at weekends Indeed despite the introduction of NHS24 and similar help-shy‐linesthe demand for GP appointments continues to increase Delays are inevitable and this willincrease system failures with more unnecessary deaths and a failure for people to access adiagnosis that13 might13 lead to early interventions and ultimately lower delivery costs Over250 more patients are added to waiting lists every day
This will lead to a new model of primary care consistent13 with existing changes which haveseen surgeries move from High Street13 locations to medical centres close to bus routes andwith more parking for patients The process of making an appointment13 is changing from atelephone-shy‐based interview process dominated by a medically-shy‐unqualified receptionist13 to achoose and book approach using an online process linked to electronic patient13 records Thiswill give patients more convenience but13 will allow priority for those who have Internet13 access at the expensive of those who are digitally excluded Making the process of bookingan appointment13 quick and easy may also increase demand from people who do not13 need tobe seen as it13 will fail to identify those in greatest13 need
A greater use of telehealth and telecare technologies will be inevitable beginning with thefirst13 contact13 as an encounter using the telephone e-shy‐mail or video conferencing -shy‐ a visit13 tothe GP surgery should be a last13 resort and should involve a nurse consultation in the first13 instance This would be consistent13 with three quarters of appointments currently involvinga chronic disease or long term condition which relates to improved self-shy‐care The support13 ofthese patients at home should be prioritised through tele-shy‐ and web-shy‐based technologies andshould involve training and coaching through a network of nurse practitioners Home visitsshould generally be unnecessary through the use of these technologies but13 could besupplemented by satellite surgeries manned by nursing in community premises or inpharmacies nurseries and Internet13 cafes
The homes13 of people who13 need13 closer monitoring can then become part13 of virtual wardswith real or electronic visits by health professionals University Hospital Southampton NHSFoundation Trust13 already looks after patients who have undergone surgery such as a hip orknee13 replacements in virtual wards with high levels of satisfaction The Royal Free London
37
NHS Foundation Trust13 offers a similar service but13 plans to add the possibility of videoconsultations between patient13 and consultant
310 Attitudes to public health issues ndash obesity smoking alcohol abuse drugs
As self-shy‐care becomes the focus of the NHS the public will increasingly understand that13 thecosts and availability of services are being harmed by the poor health behaviour ofrelatively small numbers of people The link between public health initiatives today andhealthcare needs and costs in the future will become increasingly evident13 as a result13 of theway that13 information is presented Thus the overweight13 smoker who currently attractsconcern and pity when they are diagnosed with diabetes and COPD is increasingly beingseen as the victim of their own stupidity or lack of self-shy‐discipline If they continue to neglect13 medical advice and continue with an unhealthy lifestyle then the way that13 they receivetreatment13 and consume resources will become a matter for the entire population
Obesity is seen as due to a combination of poor diet13 and a sedentary lifestyle No longer isthe idea13 that13 people are lsquobig bonedrsquo acceptable Governments will respond initially byrequiring manufacturers and food processors to provide nutritional information onpackaging and on menus in restaurants But13 people can choose not13 to read the data13 and toneglect13 both the importance of food quality content13 and quantity This will increasepressure to introduce fat13 or sugar taxes and these are likely to be in force within a decade
Although the high taxes on tobacco products has forced some smokers to reduce theirconsumption or to give up altogether the impact13 has been reduced by the smuggling ofproducts from overseas and by the availability of duty-shy‐free cigarettes for people returningfrom foreign holidays and business meetings Further measures are planned to changepackaging and to include even more graphic images and warnings on cigarette packages tomake smokers aware of the effects of smoking on their health and well-shy‐being There is asyet little evidence of how successful this might13 be More effective has been the banning ofsmoking in public places including trains and aircraft Expensive medical interventions suchas heart13 transplants will be denied to individuals until they change their lifestyle behaviourSmokers might13 therefore be increasingly ostracised leading to a loss of esteem This mayhave a particular impact13 on people who already suffer from mental health problems whoare more likely to smoke
The overuse of alcohol is being recognised as a major factor in hospital admissions withNHS figures showing an increase of over 40 in such admissions over the past13 decadeLinked to this has been a 75 increase in prescriptions to treat13 alcohol dependency Fewpeople have sympathy for those who waste their limited income on booze If they havechildren or other dependents they will be the ones who suffer and who may need thesupport13 of social care
Drug users are already significant13 users of social services as their habit13 is likely to makethem unemployable They receive little sympathy from the general public because they areseen as criminals and people who waste public resources Levels of drug abuse have been
38
slowly increasing over the years but13 this trend is slowly being reversed Indeed the numberof people using drugs during the past13 year has fallen to its lowest13 level for nearly 20 years(below 9) with cannabis being most13 likely often following excessive drinking Aselectronic noses and other technologies can detect13 traces of drugs it13 seems likely that13 success in overcoming addiction can be measured objectively This may become a two-shy‐edged sword rewarding those who can turn around their lives but13 further marginalisingthose who canrsquot13 or wont13 accept13 the lsquocold turkeyrsquo
311 Attitudes to surveillance
Issues associated with privacy confidentiality and data13 security have been discussedpreviously in the context13 of information technology the World Wide Web and the ease ofcollecting recording recalling analysing and displaying data The monitoring of individualsand their methods of using this information can be regarded as surveillance As thequantities of data13 increase along with the number of devices that13 can be used to access itthe surveillance tools will also increase in their sophistication Indeed the Big Data13 approaches described in the previous section will enable the combination of structureddata13 (such as the information held in databases) to be married with unstructured data13 fromimages in such a way that13 it13 can be mined
Whilst13 the lsquodigital surveillancersquo methods described above may cause most13 concern topeople because of its impact13 on anonymity it13 is the collection and analysis of images that13 are the major concern to people as they contemplate the ways that13 lsquoBig Brotherrsquo maydevelop to restrict13 freedom Every major UK city and town centre has an array of CCTVcameras that13 continually record activities from every angle If it13 used to be true that13 nobody in London was more than 10 yards from a rat it13 is certainly the case today that13 nobody can be more than this distance from being in view of a surveillance camera Yetthey receive so much positive publicity from TV programmes where their footage is used todetect13 vehicles close to a crime scene or to monitor the movements of suspects that13 theyare now accepted by the public as a deterrent13 in the same way as lsquobobbies on the beatrsquowere seen 25 years ago There is therefore little public reaction to the expansion in the useof video surveillance except13 for the practical observation of how so many views can beinspected and recorded
Looking to the future the tumbling cost13 of video technology will surely lead to anotherincrease in the number of devices The aerial views taken from towers will besupplemented by more local views taken by devices that13 are embedded in the fabric ofbuildings or carried by individuals either on their person (for example on clothing orspectacles) or in the bags that13 they carry The time and date-shy‐stamped images as Big Datawill be recorded to lsquothe Cloudrsquo where it13 can be added to other data It can then be usedwhen an incident13 has occurred or to provide further detail of night-shy‐time activities
It follows that13 there will be no hiding place for people who simply want13 to disappear Theymay respond by wearing clothing (such as hoodies) that13 hide their faces or which make it13 difficult13 to distinguish gait13 or mannerisms from which they might13 be identified New forms
39
of clothing may be designed to make shapes more difficult13 to analyse and these might13 become the uniforms of a class of person who wants to live in a way that13 they donrsquot13 interact13 with officials from any ministry or local government13 department If they also obstruct13 services then they will be considered to be anarchists of some form sparking protests fromother sectors of society
31213 Attitudes to driving
Motor cars have been a feature of UK roads for over a century but13 it13 is only during the past13 50 years that13 they have become a resource that13 most13 families have had access to enablingthem to travel without13 the restrictions imposed by a limited railway network and non-shy‐integrated bus transport People who have had a car throughout13 their lives often see theircars as an important13 factor in enabling them to remain independent13 and to exercise choicesrelating to where they shop and where they spend their leisure time This extends to theirspouse and to friends and neighbours that13 they might13 take with them on their variousexpeditions
Unfortunately there are incidents involving older drivers who perhaps go down amotorway in the wrong direction who are taken ill at the wheel or who are involved in anaccident13 involving no other vehicles These are small in number but13 often lead to a reactionthat13 they shouldnrsquot13 be allowed to drive lsquoat13 their agersquo Age itself is not13 an indicator ofdriving quality but13 because old age also brings more chance of having limited long termconditions and other illnesses it13 is easy to make a link between driving ability and age Thelicensing system does require continued driving to be linked with medical advice andforbids people with poor eyesight epilepsy and other conditions to hold a licence in oldage
Yet13 statistically older drivers cause far fewer accidents than younger drivers The reasonsfor this may be complex and are likely to include the fact13 that13 they drive less often covershorter distances and donrsquot13 go out13 in the dark or in poor weather However it13 does not13 wholly explain why the UKrsquos drivers aged over 70 and who represent13 some 8 of all driversare involved in only 4 of accidents that13 cause injury This compares favourably with the15 of13 drivers aged between 17 and 29 who are involved in over a third of crashes that13 result13 in injury
By 2020 the number of drivers aged over 70 on UK roads is likely to increase to over 7million This will require a new national strategy perhaps involving support13 for olderdrivers further training raising awareness of issues and making more use of adaptivetechnologies to support13 the driver in avoiding collision or forgetting to check on the statusof their vehicle Poor eyesight13 could be enhanced by camera technologies rather thanforcing people off the road if they are unable to read a licence plate
The International Longevity Centre has found that13 one in four Britons thought13 driversshould be made to switch off the ignition for good somewhere between the ages of 70 and75 The numbers may decrease as the population ages and as cars become safer Forcing
40
older people off the road may be a natural consequence of providing free bus passes andsubsidised rail fares but13 the growth in the pavement13 scooter industry demonstrates that13 older people value their independence and will do almost13 anything to get13 out13 and aboutPerhaps legislation will result13 in more regulation of electric vehicles and where they cantravel
There can be no doubt13 that13 getting out13 will be associated with better quality of life andwell-shy‐being and this is likely to be supported in the future as evidence of improvedoutcomes emerges It is to be hoped that13 positive stories will be publicised so that13 publicattitudes arenrsquot13 hardened This may be supported by more in-shy‐car monitoring of drivers andthe linking of performance with on-shy‐line driving records and licences These could throughremotely monitored ignition systems prevent13 the use of motor vehicles by people without13 a licence or without13 insurance
313 Climate change
There is a general view that13 the emissions of carbon gases are contributing to globalwarming in a manner that13 will change the UK climate in such a way that13 the climate maybecome more Mediterranean However some scientists believe that13 manrsquos impact13 on theenvironment13 may be small compared with natural variations caused for example bycyclical changes in the sunrsquos energy output13 or by the effects of volcanoes and earthquakesRecent13 evidence has suggested that13 we are going through a phase of changing extremesand that13 this is more likely to cause storms periods of excessive rainfall and unusualseasonal trends with snow and frost13 in the spring and warmer winters Considerableuncertainty remains and it13 might13 be necessary to plan for a number of different13 scenariosand for the impact13 on vulnerable people
I Colder winters UK properties are poorly insulated resulting in excess mortalitiesduring cold spells due to an increased number of people suffering from stroke aswell as bronchitis and other pulmonary diseases The cost13 of heating continues toincrease putting more households into a state of fuel poverty Any further coolingduring the winter months will result13 in more people living in unhealthy coldconditions Winter fuel payments are likely to be restricted to the poorest13 peoplebut13 this might13 exclude people who live in larger properties that13 are more difficult13 toheat
II More storms excessive winds and rain can cause flooding at any time of the yearMany UK communities are built13 close to rivers and these can surge during heavyrainfall causing houses to be filled with water and furniture and carpets lostInsurance can be problematic for properties built13 on flood plains which can blight13 properties and prevent13 owners from being able to sell and move on High winds canrip off roofs causing injury and also causing families to be left13 homeless anddependent13 on social services
III Hot13 summers Europe suffered high temperatures during the summers of 2003 and2004 leading to heat13 stroke and hypothermia The UK has not13 previously sufferedfrom such problems but13 might13 be expected to experience days of extreme
41
temperature and humidity at times Older people may not13 be prepared for suchweather Street13 dwellers may be unable to find shade and supplies of drinkingwater
Irrespective of what13 combination of weather scenarios arise it13 must13 be concluded that13 any extremes will have a major negative impact13 on vulnerable people especially if theyare not13 prepared because they havenrsquot13 received the weather warnings and advice that13 can be broadcast13 using the TV radio and online services Once again the digitallyexcluded will suffer and will pay a high cost Society will continue to pick up the bill interms of demands on social care services unless preventive actions are taken in theform of connecting these people to each other and to formal services
42
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
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13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
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13
at13
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d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
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13
13 r13 13
13 13
13 13
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13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
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s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
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b13 13
n13 13
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ly13
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13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
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13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
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r13
13
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13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
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proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
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13
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13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
more practical to introduce especially if all the processes involved in making a claim arehandled electronically Indeed this encourages government13 to insist13 on applications forbenefits to be made on-shy‐line Unfortunately this will marginalise those people who haveneither a computer nor access to the internet thus emphasising the digital divide in amanner which works against13 some of the most13 disadvantaged people in society
There are currently few tangible links between digital technology and welfare provisionThe most13 obvious are universal benefits such as a free television licence (worth pound14550)13 for13 everyone aged 75 or older with blind and visually impaired people entitled to a 50discount13 irrespective of their age The significance of this position is that13 6 of revenuesgenerated through licence fees are to fund BBC on-shy‐line services13 such13 as websites and i-shy‐player In Scotland the BBCrsquos Alba Gaelic language television service is predominantlyfunded13 by MG Alba an organisation funded by the Scottish Government It is thereforeconceivable that13 in the future licence fees may be used to directly subsidise access toinformation and advice through the Internet13 for vulnerable people whether it13 is throughbroadband access or through a set-shy‐top box which removes the need for a computer in thehome to access particular websites or to use e-shy‐mail services
A second age-shy‐related benefit13 available in the UK is the winter fuel subsidy People whoreceive certain benefits receive the payments automatically while others must13 make aclaim Those who are not13 eligible for benefit13 due to a lack of an address for example missout13 on these payments and also on Cold Weather payments of pound25 for each seven dayperiod of very cold weather between 1 November and 31 March
The development13 of new warm home initiatives plus the complex of subsidies that13 theelectricity supply industry and government13 offer to people with solar cells further changesthe economic arguments Global warming may lead to greater variations in weatherextremes but13 might13 also increase the amount13 of electricity that13 can be generated byalternative (green) sources such as wind and solar cells It is estimated that13 energyconsumption in the UK increased by 17 between Christmas and Easter 2013 compared toprevious years as a result13 of cold weather but13 the above subsidy scheme did not13 benefit13 older people because two of the seven day cold periods were after 31st March It must13 beassumed that13 there will be more people living in fuel poverty in the future and this will leadto more cases of cold related illness including influenza13 and stroke
32 Management of long term conditions
The management13 of long term conditions will be improved for patients who are compliant13 with their medication regime so it13 is possible that13 there may be compulsion to adhere tothe prescription Such compulsion may be monitored using technology Indeed the remotemonitoring of vital signs using telehealthcare will become commonplace as the old boxesand sensors are replaced by devices that13 can be worn continuously or which can beembedded into the fabric of homes (including furniture and bedding) or can be worn asvests or patches They will wirelessly transmit13 data13 to smartphones or tablets and mobile
28
transmission and cloud technology will enable real-shy‐time data13 collection analysis andfeedback
One of the diseases which is projected to increase most13 significantly over the comingdecade is Type 2 diabetes Whilst13 there is a hereditary susceptibility to this condition formany people including those from the Middle East13 and the Asian sub-shy‐continent it13 is also adisease which tends to affect13 those people who are overweight13 andor have a sedentarylifestyle If untreated diabetes can lead to dizziness and collapse at any time but13 can alsohave more devastating long term consequences which include kidney failure strokeblindness and in extreme cases lower limb amputations Management13 therefore includesdaily monitoring of blood glucose levels and major dietary changes such as a significant13 reduction in the consumption of carbohydrates as well as a rigid exercise regime
Many newly diagnosed diabetics follow this advice closely and can lead normal lives for 40years or more but13 some struggle to accept13 the change in lifestyle required as well asremembering which foods are allowed and how much exercise they need to takeIndividual support13 plans are now forthcoming and over the next13 ten years best13 practicewill emerge in the form of smartphone apps that13 are personalised and which can becomean individualrsquos health coach This level of support13 will be fine for some people but13 otherswill need incentives so it13 is likely that13 gaming technologies will be introduced perhapsoffering rewards for good compliance There will be a temptation for some people tocheat perhaps allowing others to perform exercise for them or changing theirconsumption details
Many of these opportunities for cheating will be removed through the use of a uniquebiometric identifier a technology that13 will be mature enough to use in place of passwordson smartphones However the biggest13 challenge may be in encouraging older people to usethe technology Many older people have multiple morbidities Indeed a survey of Scottishpatients implied that13 42 of people aged over 80 will suffer from three long termconditions It will be essential for those people to comply with treatment13 regimes if they arenot13 to have the functional deficits that13 follow
33 Finding people who13 donrsquot fit
People who have low social capital are likely to have few relatives and friends with whomthey regularly communicate and are also unlikely to be part13 of community or faithorganisations such as clubs societies and church groups They also die several yearsyounger than most13 of the population often because they donrsquot13 engage with public healthinitiatives such as vaccinations against13 flu regular checks on their blood pressure bloodsugar levels or in the case of women smear tests or mammography The most13 likelyreason for disappearing beneath the radar of such initiatives is their mobility which leadsalmost13 inevitably to them having no fixed abode and no fixed telephone line It thenbecomes very difficult13 for them to be contacted because their mobile telephones are likelyto have Pay-shy‐As-shy‐You-shy‐Go contracts that13 donrsquot13 require validated names addresses and bankaccounts
29
It follows that13 some of the most13 vulnerable people in society including those who live onthe streets are effectively unknown to both the NHS and to social work departments untilthey are referred in a crisis This could be an emergency presentation to a hospital Accident13 and Emergency Department13 where they will come into contact13 with a social worker becausedischarge may be unsafe This often highlights the importance of the prevention agenda13 and the potential for avoiding admissions to hospital by intervening at an earlier stage
The advantages of being able to locate people who are vulnerable to specific diseases willincrease as genetic testing becomes more routine It is already possible to determine whomight13 be most13 at risk of breast13 cancer and prostate cancer as a result13 of family history Addto this the evidence that13 particular diet13 and exposure to environmental factors can furtherincrease risk then it13 is evident13 that13 individuals can be identified and offered treatmentsthat13 could save their lives many years before they become ill In the case of cancersperhaps only the individual is involved but13 for infectious diseases it13 is the whole of societythat13 is at risk if someone contracts one of the new strains of influenza or if someonechooses not13 to be vaccinated against13 rubella In Chinese airports all visitors are screenedfor fever and refused entry if they tested positive in cities the public are monitored in thesame way Similar approaches may be necessary in the UK if potential carriers cannot13 otherwise be identified
34 Volunteering
It is estimated that13 72 per cent13 of people volunteered to perform a charitable act13 at least13 once during 2012 a rise from 65 per cent13 the previous year About13 four out13 of every 10volunteers offer their services formally to one or more organisations The remaindervolunteer informally by helping out13 a friend or a neighbour Around 50 per cent13 volunteered at least13 once a month in the past13 year up from 41 per cent13 on the previous13 year Most13 have retired many of them before the statutory retirement13 age Those whodonrsquot13 feel able to offer time have offered their financial support13 at a time when the fundingavailable from sources such as the National Lottery has been decreasing Despite economicausterity donations to charities have been increasing 74 per cent13 said they had given tocharity at least13 once in the previous month up from 72 per cent13 the previous year
Strikingly 78 per cent13 of people strongly believe that13 they are part13 of their localneighbourhood an increase from 70 per cent13 10 years previously Community cohesion isstronger than ever 87 per cent13 of people believe their local area13 is a place where peoplefrom different13 backgrounds get13 on well together compared to 80 per cent13 in 2003
The role of volunteers in supporting vulnerable people is therefore likely to increase overthe next13 decade perhaps exploiting the success of the army of volunteers that13 was highlysuccessful in London during the Olympic and Paralympic games The greatest13 role for suchvolunteers may be in providing informal care for older people Already the UK has someseven million informal carers whose value in monetary terms has been calculated to be
30
more than the combined budgets of the NHS and social care Maintaining or extending thisprovision will help to support13 services in the future and may be supported by technology
Whilst13 there is ample evidence to suggest13 that13 telecare services support13 informal carers asmuch as (if not13 more than) the people that13 they are caring for it13 is the potential for utilisingthe internet13 and apps to make their role easier to coordinate and hence more effectivethat13 is likely to be most13 successful moving forward
Many of these focus on particular tasks that13 informal carers can help offer to older peoplesuch as organising their medication A pillbox program is just13 one feature of an app calledBalance It also includes sections for caregiving tips notes for the doctor and the patientsappointments plus a lsquolearning sectionrsquo with articles on aspects of Alzheimers and an RSSfeed for news about13 the disease Tyze is another multi-shy‐functional app it13 allows carers to
bull Organise appointmentsbull Plan outingsbull Share storiesbull Send updates to other family members
Another application is Rally Round which helps carers to organise someone to perform littlejobs often on a temporary basis when someone has dementia physical frailty or isrecovering from accident13 or illness Similar applications are MeMaxi and Finerday
35 The High13 Street
The shape and appearance of UK shopping centres have been changing for half a centuryPeople complain that13 centres are losing their identity with one town looking like everyother both in terms of the stores and in terms of the layout But13 there are three trendswhich are having a profound impact13 on many of the most13 vulnerable people in society
bull Centres lock their doors at 6pm or in some cases 10pm -shy‐ thus denying people whosuffer from claustrophobia13 from window shopping at times when other shoppershave left
bull Out13 of town shopping malls -shy‐ these US style centres are ideal for people in carsbecause they offer free parking which is essential for people who want13 to buy largeritems but13 difficult13 for people who have no transport13 and who must13 rely on publictransport13 that13 is often deficient
bull The rise of online shopping -shy‐ which means that13 many potential shoppers only visit13 High Street13 stores to check the prices before returning home to make a purchaseonline
It is the third of these effects that13 has the greatest13 potential for changing the High Street13 forever and it13 is making life for traditional retailers increasingly difficult13 at a time when highrents are crippling stores large and small It is difficult13 to see how this trend is likely tochange because consolidation in banking and estate agencies is already forcing the closure
31
of other High Street13 players while additional pressures on pubs has led to the closure ofthousands of pubs every year
Those figures however demonstrate that13 consumers still value what13 the high street13 canoffer -shy‐ the chance to inspect13 what13 theyrsquore thinking of buying -shy‐ as well as the new opennessof the internet Customer service makes a difference to people especially if there is aproblem and goods need to be returned One of the most13 common reasons for furniture tobe returned for example is that13 when a sofa13 or a wardrobe was delivered it13 couldnrsquot13 fit13 through the front13 door or up the stairs In the future people will be able to benefit from13 visualisation technology they will upload the floor plans of their homes enabling theretailer to inform them of the problem before they try to delivery Augmented reality viewwill similarly allow customers to see what13 a new item of furniture will look like in itsintended place so that13 they can be more informed about13 the effect13 of size and colour
In terms of improving the viability of the High Street stores will have to focus on theimportance of brand which could mean that13 individual independent13 retailers will have topartner with national suppliers to support13 a local tailored offering based on products that13 are designed for a more global market This is a lsquoconnected High Streetrsquo approach whichcould be enabled by the developments in internet13 availability and smart13 phone accessdescribed in the previous section
The overall effect13 of all these changes could mean that13 town centres become smaller but13 more vibrant13 areas They could thrive if people are attracted there in large numbers whichmeans that13 retail must13 be developed alongside restaurants pubs galleries and other leisureopportunities This is possible in new shopping centres which are already being integratedwith transport13 hubs including railway and bus stations but13 may be more of a design13 challenge for older towns and cities with large Victorian buildings To ensure that13 morepeople are welcomed into the new centres they should include attention to green spacesand areas where people can relax without13 feeling that13 they are second class citizensbecause they donrsquot13 have the same buying power
3513 Privacy
To some people privacy is their right13 to live their lives without13 interference they may seethe State as a potential lsquoBig Brotherrsquo spying on their every move and judging their actions13 and activities Other people have fewer concerns about13 the role of the State but13 great13 fearof individuals interfering with and invading their privacy Some embrace the concept13 of lsquomyspacersquo an area13 of a square metre or so into which nobody can enter without13 permissionThis allows them to avoid physical contact13 and to feel safe from any form of threateningbehaviour
Yet13 this idea13 of private space and its potential violation is merely the tip of the iceberg asfar as privacy is concerned more significant13 is the idea13 of personal (and private)information being shared with anyone and everyone This could be related to identityopinion or image for an individual who wants to remain anonymous or even secretive thisis going to become an increasing problem as technology provides the means of taking
32
photographs recording conversations and capturing environment13 with something as smalland ubiquitous as a mobile phone The fact13 that13 this information can then be shared withthe rest13 of the world using e-shy‐mail Twitter and Facebook makes the problem all the moredifficult So the threat13 is no longer solely from the long lenses of the Paparazzi but13 fromanyone (and that13 means everyone) who has even the most13 basic of mobile phones
This relates to the changing views of society on what13 information should remain privateand what13 should be shared with others The success of social media13 has been based on anattitude of lsquosharing everythingrsquo with either your friends or the world This has introduced anaiumlve idea13 in the minds of some younger people (especially those known as Millennials ieaged 18-shy‐30) that13 everyone can be their friends whilst13 perhaps failing to reinforce the bondsof genuine friendship with any form of test13 or restriction Technology could play a role indefining these friendships and allowing individuals to understand what13 makes a goodfriend but13 this approach has yet13 to be developed and may be slow to overcome the needfor some people to measure their own popularity simply as the number of people that13 theycan list13 as friends on their Facebook page
It follows that13 there may be a need for a new definition of privacy that13 is in keeping withthe web and its ability to display images and opinion in an unregulated manner This needsto embrace past13 concerns about13 the ability of an individual to live without13 the threat13 ofothers being able to watch them whilst13 offering some protection from random postingsabout13 them online Perhaps this could include a right13 to be able to edit13 or remove anythingrelating to themselves on the Web including images that13 are not13 news-shy‐worthy Theownership of image rights may be an associated issue that13 needs to be addressedespecially as modern technology can remove an individual from a group (or a background)13 view provide digital touch-shy‐up or air-shy‐brushing and then republish it13 in a different13 contextHowever there is general agreement13 that13 personal information (such as contact13 details andbank codes) should not13 have a place on the web Surprisingly few people take proactivemeasures to prevent13 tracking functions being activated
It follows that13 too much privacy could lead to younger people fearing that13 they maybecome lost13 in a digital world It is not13 surprising then that13 they are prepared to make lots13 of personal information available often with no fear of how it13 might13 be used by othersWhen Google glasses and similar technologies become available during the next13 few yearsthey will have the potential to identify a stranger walking down the street and to find manyof their secrets to present13 to the wearer in a fraction of a second They could know moreabout13 them than their genuine friends know -shy‐ so who will be their friends in the future
36 Data sharing and13 protection
By lsquodata13 sharingrsquo we mean the disclosure of data13 held by one organisation on an individualto a third party organisation(s) or the sharing of data13 between different13 parts of anorganisation Some data13 sharing doesnrsquot13 involve personal data13 because it13 has beenanonymised in such a way that13 the statistics can be used for the collective good without13 theidentification of the individual The Data13 Protection Act13 (DPA) is in place to provide a legal
33
framework that13 ensures that13 organisations that13 hold personal data13 must13 act13 responsibly atall times These principles adequately describe the position of public and government13 bodies especially social services departments who are responsible for the informationconcerning the health and well-shy‐being of individuals -shy‐ and hence by implication thesensitive data13 relating to their vulnerability
The legal framework that13 applies to private and third sector organisations differs from that13 which applies to public sector organisations which may only act13 within the defined limits oftheir statutory powers However all bodies must13 comply fully with the data13 protectionprinciples and this situation is unlikely to change within the next13 10 to 15 years In someprivate sector contexts there are legal constraints on the disclosure of personal dataHowever most13 private and third sector organisations have a general ability to shareinformation provided this does not13 breach the DPA or any other law It is advisable for acompany to check its constitutional documents such as its memorandum and articles13 ofassociation to make sure there are no restrictions that13 would prevent13 it13 from sharingpersonal data13 in a particular context The type of data13 held is therefore a subject13 ofconcern as it13 may be difficult13 for legislation to keep up with the additional layers of data13 created on-shy‐line and through the Internet13 of Things
Private and third sector organisations should have regard to any industry-shy‐specific regulationor guidance about13 handling individualsrsquo information as this may affect13 the organisationrsquosability to share information They should also be aware of the legal issues that13 can arisewhen sharing personal data13 with public sector bodies This becomes more of an issue asprivate and third sector bodies are carrying out13 a wider range of traditionally public sectorfunctions Opportunities for inappropriate sharing of sensitive data13 will therefore inevitablyincrease
Public authorities must13 comply with the Human Rights Act13 (HRA) legislation in theperformance of their functions The HRA also applies to organisations in the private sectorinsofar as they carry out13 functions of a public nature which could include delivering a socialcare activity Where the HRA applies organisations must13 not13 act13 in a way that13 would beincompatible with rights under the European Convention on Human Rights Article 8 of theConvention giving everyone the right13 to respect13 for their private and family life their homeand their correspondence is especially relevant13 to sharing personal data If personal data13 isdisclosed or shared in ways that13 comply with the DPA the sharing or disclosure of that13 information is also likely to comply with the HRA The problem may still be in policing theActs and the rights of an individual if they believe that13 their personal data13 has been sharedor accessed by an inappropriate organisation or individual
A legal industry may be born to deal with such matters but13 this is unlikely to benefit13 peoplewho cannot13 afford the fees involved They would require either legal aid or to employ13 more13 lsquono win no feersquo companies Public attitudes to such costs might13 become negative unlessthey prove successful in preventing breaches of data13 security There may need to belegislation to provide a stronger basis for forcing compliance with privacy laws
34
37 Connecting with13 people
We are social creatures most13 of us rely on our friendships and interactions with friendsand families to share our happiest13 moments and experiences Research suggests that13 thishappiness is infectious at all levels and leads to a 15 increase in the happiness of a closecontact 10 for a second degree contact13 such as the friendrsquos spouse and a 6 increase fora friend of a friend It is hardly surprising that13 the success of social media13 such as Facebookis intimately related to the ability of people to quickly share their happiest13 moments with asmany of their friends and connections as possible
All this has happened during the rise of the Internet13 and the corresponding increase inopportunities for connecting online ie this is a 21st Century phenomenon which has beenfacilitated by Information and Communications Technology But13 the Internet13 remains in itsinfancy and we are only beginning to understand and exploit13 its potential In terms ofaccessing the Internet there are now perhaps two billion people who have access with99 of them having gained this during the past13 decade This number will have doubled bythe period 2020 to 2025 It is likely that13 everyone who wants to be connected in the UK willby then be connected Turning this on its head only those who donrsquot13 want13 to be online willnot13 be on the Internet13 within a decade Connecting with the unconnected will therefore bea case of identifying those people who donrsquot13 want13 to be found unfortunately these mayinclude many people who need the support13 of social care organisations It means that13 theywill be looking for support13 only when they are in crisis unless other ways of finding andormonitoring them are found
While the number of people connected via the Internet13 has exploded this might13 bedwarfed by the number of connected lsquothingsrsquo During 2009 the number of thingsconnected to the Internet13 surpassed the number of connected people at which point13 webegan to experience what13 this report13 has described as the lsquoInternet13 of Thingsrsquo Yet 99 ofall physical objects that13 could join this network are not13 yet13 connected but13 the number couldgrow by 25 every year for the next13 decade so that13 there could be 100 billion connectedobjects by 2025 some of which will be owned or used by everyone in the UK includingthose people who donrsquot13 want13 to be connected themselves We will then have an Internet13 of Everything which will be the smart13 connection of people data events and actions
With each new person object or data13 that13 comes online the connection possibilitiesbetween all these elements grows exponentially The rise of big data mobile networkingcloud storage and data13 mining technologies will all play a critical role in the Internet13 ofEverything The result13 will be new capabilities richer experiences and unprecedentedvalue for individuals businesses communities and countries everywhere The lsquonetworkeffectrsquo of the Internet13 of Everything will be a very powerful thing the true impact13 of whichwe wonrsquot13 fully understand for several years As it13 develops however those who are not13 connected will feel even more digitally and socially excluded There will be a need to reachout13 to vulnerable people unless the process of claiming requires proof of online identityand the payments to be received can only be redeemed using a chipped card or adownloaded app onto a smartphone This is of course the way that13 welfare arrangementsare already developing thus it13 might13 prove impossible to make a successful claim without13
35
already being connected to lsquothe systemrsquo either through an online presence or through theInternet13 of Things
38 Downloading everything
Sixty years ago information was discovered by reading books often in a library wherenotes had to be made because the books or journals couldnrsquot13 be removed Then in theearly 1960s the first13 office photocopying machines were introduced into the UK theyimmediately meant13 that13 pages or articles from books could be copied and taken away to beread and summarised later Within a few years photocopying became a replacement13 forreading as researchers became less adept13 at selecting a few sentences and every deskbecame a depository for reams of printed paper Paper became the means of recordingeverything from bank statements through to music
We now appreciate that13 printing everything is a waste of both the ink (or toner) used tocreate the black print13 and of paper which requires trees to be chopped down and pulpedbefore it13 can be pressed into thin sheets Saving paper is therefore seen as green and goodfor the planet Fortunately we no longer need to print13 everything because computermemory is unlimited thanks to the cloud and we can then view pages and articles onportable or fixed screens
The internet13 has everything and it13 is all available instantly for downloading providing thereis a device available to accept13 it and there is sufficient13 communication bandwidth toperform the transfer of data13 sufficiently quickly Thus we can record all text13 articles that13 are relevant13 to us including digital records of birth certificates qualifications and passportsand the need for original printed versions will decline But13 we can also do this forphotographs Most13 handheld computing devices include at least13 one camera so they cangenerate enormous number of pictures which can be kept13 for posterity without13 having toconsume inks and special papers to print13 them
But13 the materials that13 can be downloaded donrsquot13 stop at pictures software is available that13 can grab TV shows after they air and movies as soon as theyre released In the same wayit13 is possible to schedule music comic books video games and practically anything else asa download with minimal effort People will need enormous hard drives if they want13 theirown digital copies of these files so will more than likely make use of cloud storage that13 willbe available from many organisations The location of the servers may become sensitivedue to border restrictions as will the security of the data13 and the way that13 it13 is backed up sothat13 it13 is resilient13 to failures
It may be evident13 that13 application forms for all types of welfare payment13 will be availableonly for downloading so that once digitised they can be processed by computer andrecords sent13 to various servers for subsequent13 storage and processing Some people maywant13 to keep their data13 on them once it13 has been downloaded Pen drives can already holdseveral GB of data so it13 is likely that13 people will be able to carry their downloaded data13 withthem at all times irrespective of the size and complexities of the information
36
39 Health13 and13 well-shy‐being
The general health of the population is unlikely to deteriorate noticeably within 10 to 20years Indeed expectations of the population are that13 things must13 improve as surgicaltechniques mature and as pharmaceutical interventions become more personalised andpowerful However the rising demand for health services due to an ageing population andthe increasing cost13 of providing sophisticated therapies will make delivering a free anduniversal health service difficult13 without13 substantial increases in taxation This is unlikely tohappen in the UK even though spending on health services will be protected against13 thecuts facing other services
There will have to be changes in how the NHS works For twenty years hospitals have beenclosed and replaced by fewer new facilities so that13 the bed count13 is reduced This has led toa significant13 shift13 in resources to primary care and community care supporting shorter staysin hospital and speedier transfer back home for people after surgery or illness This hasbeen13 successful but13 there remain problems with demand for GP services especially out-shy‐of-shy‐hours and at weekends Indeed despite the introduction of NHS24 and similar help-shy‐linesthe demand for GP appointments continues to increase Delays are inevitable and this willincrease system failures with more unnecessary deaths and a failure for people to access adiagnosis that13 might13 lead to early interventions and ultimately lower delivery costs Over250 more patients are added to waiting lists every day
This will lead to a new model of primary care consistent13 with existing changes which haveseen surgeries move from High Street13 locations to medical centres close to bus routes andwith more parking for patients The process of making an appointment13 is changing from atelephone-shy‐based interview process dominated by a medically-shy‐unqualified receptionist13 to achoose and book approach using an online process linked to electronic patient13 records Thiswill give patients more convenience but13 will allow priority for those who have Internet13 access at the expensive of those who are digitally excluded Making the process of bookingan appointment13 quick and easy may also increase demand from people who do not13 need tobe seen as it13 will fail to identify those in greatest13 need
A greater use of telehealth and telecare technologies will be inevitable beginning with thefirst13 contact13 as an encounter using the telephone e-shy‐mail or video conferencing -shy‐ a visit13 tothe GP surgery should be a last13 resort and should involve a nurse consultation in the first13 instance This would be consistent13 with three quarters of appointments currently involvinga chronic disease or long term condition which relates to improved self-shy‐care The support13 ofthese patients at home should be prioritised through tele-shy‐ and web-shy‐based technologies andshould involve training and coaching through a network of nurse practitioners Home visitsshould generally be unnecessary through the use of these technologies but13 could besupplemented by satellite surgeries manned by nursing in community premises or inpharmacies nurseries and Internet13 cafes
The homes13 of people who13 need13 closer monitoring can then become part13 of virtual wardswith real or electronic visits by health professionals University Hospital Southampton NHSFoundation Trust13 already looks after patients who have undergone surgery such as a hip orknee13 replacements in virtual wards with high levels of satisfaction The Royal Free London
37
NHS Foundation Trust13 offers a similar service but13 plans to add the possibility of videoconsultations between patient13 and consultant
310 Attitudes to public health issues ndash obesity smoking alcohol abuse drugs
As self-shy‐care becomes the focus of the NHS the public will increasingly understand that13 thecosts and availability of services are being harmed by the poor health behaviour ofrelatively small numbers of people The link between public health initiatives today andhealthcare needs and costs in the future will become increasingly evident13 as a result13 of theway that13 information is presented Thus the overweight13 smoker who currently attractsconcern and pity when they are diagnosed with diabetes and COPD is increasingly beingseen as the victim of their own stupidity or lack of self-shy‐discipline If they continue to neglect13 medical advice and continue with an unhealthy lifestyle then the way that13 they receivetreatment13 and consume resources will become a matter for the entire population
Obesity is seen as due to a combination of poor diet13 and a sedentary lifestyle No longer isthe idea13 that13 people are lsquobig bonedrsquo acceptable Governments will respond initially byrequiring manufacturers and food processors to provide nutritional information onpackaging and on menus in restaurants But13 people can choose not13 to read the data13 and toneglect13 both the importance of food quality content13 and quantity This will increasepressure to introduce fat13 or sugar taxes and these are likely to be in force within a decade
Although the high taxes on tobacco products has forced some smokers to reduce theirconsumption or to give up altogether the impact13 has been reduced by the smuggling ofproducts from overseas and by the availability of duty-shy‐free cigarettes for people returningfrom foreign holidays and business meetings Further measures are planned to changepackaging and to include even more graphic images and warnings on cigarette packages tomake smokers aware of the effects of smoking on their health and well-shy‐being There is asyet little evidence of how successful this might13 be More effective has been the banning ofsmoking in public places including trains and aircraft Expensive medical interventions suchas heart13 transplants will be denied to individuals until they change their lifestyle behaviourSmokers might13 therefore be increasingly ostracised leading to a loss of esteem This mayhave a particular impact13 on people who already suffer from mental health problems whoare more likely to smoke
The overuse of alcohol is being recognised as a major factor in hospital admissions withNHS figures showing an increase of over 40 in such admissions over the past13 decadeLinked to this has been a 75 increase in prescriptions to treat13 alcohol dependency Fewpeople have sympathy for those who waste their limited income on booze If they havechildren or other dependents they will be the ones who suffer and who may need thesupport13 of social care
Drug users are already significant13 users of social services as their habit13 is likely to makethem unemployable They receive little sympathy from the general public because they areseen as criminals and people who waste public resources Levels of drug abuse have been
38
slowly increasing over the years but13 this trend is slowly being reversed Indeed the numberof people using drugs during the past13 year has fallen to its lowest13 level for nearly 20 years(below 9) with cannabis being most13 likely often following excessive drinking Aselectronic noses and other technologies can detect13 traces of drugs it13 seems likely that13 success in overcoming addiction can be measured objectively This may become a two-shy‐edged sword rewarding those who can turn around their lives but13 further marginalisingthose who canrsquot13 or wont13 accept13 the lsquocold turkeyrsquo
311 Attitudes to surveillance
Issues associated with privacy confidentiality and data13 security have been discussedpreviously in the context13 of information technology the World Wide Web and the ease ofcollecting recording recalling analysing and displaying data The monitoring of individualsand their methods of using this information can be regarded as surveillance As thequantities of data13 increase along with the number of devices that13 can be used to access itthe surveillance tools will also increase in their sophistication Indeed the Big Data13 approaches described in the previous section will enable the combination of structureddata13 (such as the information held in databases) to be married with unstructured data13 fromimages in such a way that13 it13 can be mined
Whilst13 the lsquodigital surveillancersquo methods described above may cause most13 concern topeople because of its impact13 on anonymity it13 is the collection and analysis of images that13 are the major concern to people as they contemplate the ways that13 lsquoBig Brotherrsquo maydevelop to restrict13 freedom Every major UK city and town centre has an array of CCTVcameras that13 continually record activities from every angle If it13 used to be true that13 nobody in London was more than 10 yards from a rat it13 is certainly the case today that13 nobody can be more than this distance from being in view of a surveillance camera Yetthey receive so much positive publicity from TV programmes where their footage is used todetect13 vehicles close to a crime scene or to monitor the movements of suspects that13 theyare now accepted by the public as a deterrent13 in the same way as lsquobobbies on the beatrsquowere seen 25 years ago There is therefore little public reaction to the expansion in the useof video surveillance except13 for the practical observation of how so many views can beinspected and recorded
Looking to the future the tumbling cost13 of video technology will surely lead to anotherincrease in the number of devices The aerial views taken from towers will besupplemented by more local views taken by devices that13 are embedded in the fabric ofbuildings or carried by individuals either on their person (for example on clothing orspectacles) or in the bags that13 they carry The time and date-shy‐stamped images as Big Datawill be recorded to lsquothe Cloudrsquo where it13 can be added to other data It can then be usedwhen an incident13 has occurred or to provide further detail of night-shy‐time activities
It follows that13 there will be no hiding place for people who simply want13 to disappear Theymay respond by wearing clothing (such as hoodies) that13 hide their faces or which make it13 difficult13 to distinguish gait13 or mannerisms from which they might13 be identified New forms
39
of clothing may be designed to make shapes more difficult13 to analyse and these might13 become the uniforms of a class of person who wants to live in a way that13 they donrsquot13 interact13 with officials from any ministry or local government13 department If they also obstruct13 services then they will be considered to be anarchists of some form sparking protests fromother sectors of society
31213 Attitudes to driving
Motor cars have been a feature of UK roads for over a century but13 it13 is only during the past13 50 years that13 they have become a resource that13 most13 families have had access to enablingthem to travel without13 the restrictions imposed by a limited railway network and non-shy‐integrated bus transport People who have had a car throughout13 their lives often see theircars as an important13 factor in enabling them to remain independent13 and to exercise choicesrelating to where they shop and where they spend their leisure time This extends to theirspouse and to friends and neighbours that13 they might13 take with them on their variousexpeditions
Unfortunately there are incidents involving older drivers who perhaps go down amotorway in the wrong direction who are taken ill at the wheel or who are involved in anaccident13 involving no other vehicles These are small in number but13 often lead to a reactionthat13 they shouldnrsquot13 be allowed to drive lsquoat13 their agersquo Age itself is not13 an indicator ofdriving quality but13 because old age also brings more chance of having limited long termconditions and other illnesses it13 is easy to make a link between driving ability and age Thelicensing system does require continued driving to be linked with medical advice andforbids people with poor eyesight epilepsy and other conditions to hold a licence in oldage
Yet13 statistically older drivers cause far fewer accidents than younger drivers The reasonsfor this may be complex and are likely to include the fact13 that13 they drive less often covershorter distances and donrsquot13 go out13 in the dark or in poor weather However it13 does not13 wholly explain why the UKrsquos drivers aged over 70 and who represent13 some 8 of all driversare involved in only 4 of accidents that13 cause injury This compares favourably with the15 of13 drivers aged between 17 and 29 who are involved in over a third of crashes that13 result13 in injury
By 2020 the number of drivers aged over 70 on UK roads is likely to increase to over 7million This will require a new national strategy perhaps involving support13 for olderdrivers further training raising awareness of issues and making more use of adaptivetechnologies to support13 the driver in avoiding collision or forgetting to check on the statusof their vehicle Poor eyesight13 could be enhanced by camera technologies rather thanforcing people off the road if they are unable to read a licence plate
The International Longevity Centre has found that13 one in four Britons thought13 driversshould be made to switch off the ignition for good somewhere between the ages of 70 and75 The numbers may decrease as the population ages and as cars become safer Forcing
40
older people off the road may be a natural consequence of providing free bus passes andsubsidised rail fares but13 the growth in the pavement13 scooter industry demonstrates that13 older people value their independence and will do almost13 anything to get13 out13 and aboutPerhaps legislation will result13 in more regulation of electric vehicles and where they cantravel
There can be no doubt13 that13 getting out13 will be associated with better quality of life andwell-shy‐being and this is likely to be supported in the future as evidence of improvedoutcomes emerges It is to be hoped that13 positive stories will be publicised so that13 publicattitudes arenrsquot13 hardened This may be supported by more in-shy‐car monitoring of drivers andthe linking of performance with on-shy‐line driving records and licences These could throughremotely monitored ignition systems prevent13 the use of motor vehicles by people without13 a licence or without13 insurance
313 Climate change
There is a general view that13 the emissions of carbon gases are contributing to globalwarming in a manner that13 will change the UK climate in such a way that13 the climate maybecome more Mediterranean However some scientists believe that13 manrsquos impact13 on theenvironment13 may be small compared with natural variations caused for example bycyclical changes in the sunrsquos energy output13 or by the effects of volcanoes and earthquakesRecent13 evidence has suggested that13 we are going through a phase of changing extremesand that13 this is more likely to cause storms periods of excessive rainfall and unusualseasonal trends with snow and frost13 in the spring and warmer winters Considerableuncertainty remains and it13 might13 be necessary to plan for a number of different13 scenariosand for the impact13 on vulnerable people
I Colder winters UK properties are poorly insulated resulting in excess mortalitiesduring cold spells due to an increased number of people suffering from stroke aswell as bronchitis and other pulmonary diseases The cost13 of heating continues toincrease putting more households into a state of fuel poverty Any further coolingduring the winter months will result13 in more people living in unhealthy coldconditions Winter fuel payments are likely to be restricted to the poorest13 peoplebut13 this might13 exclude people who live in larger properties that13 are more difficult13 toheat
II More storms excessive winds and rain can cause flooding at any time of the yearMany UK communities are built13 close to rivers and these can surge during heavyrainfall causing houses to be filled with water and furniture and carpets lostInsurance can be problematic for properties built13 on flood plains which can blight13 properties and prevent13 owners from being able to sell and move on High winds canrip off roofs causing injury and also causing families to be left13 homeless anddependent13 on social services
III Hot13 summers Europe suffered high temperatures during the summers of 2003 and2004 leading to heat13 stroke and hypothermia The UK has not13 previously sufferedfrom such problems but13 might13 be expected to experience days of extreme
41
temperature and humidity at times Older people may not13 be prepared for suchweather Street13 dwellers may be unable to find shade and supplies of drinkingwater
Irrespective of what13 combination of weather scenarios arise it13 must13 be concluded that13 any extremes will have a major negative impact13 on vulnerable people especially if theyare not13 prepared because they havenrsquot13 received the weather warnings and advice that13 can be broadcast13 using the TV radio and online services Once again the digitallyexcluded will suffer and will pay a high cost Society will continue to pick up the bill interms of demands on social care services unless preventive actions are taken in theform of connecting these people to each other and to formal services
42
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
s13 13
13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
n13 13
13 s13
r13 n13
e13 at13
e13 y13 e13 ld13
ly13
13 e13 t13 e13
s13 er13 e13
f13
rt13 13
13 13
13
r13 13
s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
e13 g13 13
e13
13 13 ial13
13
d13
13 d13 h13 r13
d13 13
s13 y13
e13
13
rd13 r13 e13
13
13
13
e13
e13
d13 13
13
13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
transmission and cloud technology will enable real-shy‐time data13 collection analysis andfeedback
One of the diseases which is projected to increase most13 significantly over the comingdecade is Type 2 diabetes Whilst13 there is a hereditary susceptibility to this condition formany people including those from the Middle East13 and the Asian sub-shy‐continent it13 is also adisease which tends to affect13 those people who are overweight13 andor have a sedentarylifestyle If untreated diabetes can lead to dizziness and collapse at any time but13 can alsohave more devastating long term consequences which include kidney failure strokeblindness and in extreme cases lower limb amputations Management13 therefore includesdaily monitoring of blood glucose levels and major dietary changes such as a significant13 reduction in the consumption of carbohydrates as well as a rigid exercise regime
Many newly diagnosed diabetics follow this advice closely and can lead normal lives for 40years or more but13 some struggle to accept13 the change in lifestyle required as well asremembering which foods are allowed and how much exercise they need to takeIndividual support13 plans are now forthcoming and over the next13 ten years best13 practicewill emerge in the form of smartphone apps that13 are personalised and which can becomean individualrsquos health coach This level of support13 will be fine for some people but13 otherswill need incentives so it13 is likely that13 gaming technologies will be introduced perhapsoffering rewards for good compliance There will be a temptation for some people tocheat perhaps allowing others to perform exercise for them or changing theirconsumption details
Many of these opportunities for cheating will be removed through the use of a uniquebiometric identifier a technology that13 will be mature enough to use in place of passwordson smartphones However the biggest13 challenge may be in encouraging older people to usethe technology Many older people have multiple morbidities Indeed a survey of Scottishpatients implied that13 42 of people aged over 80 will suffer from three long termconditions It will be essential for those people to comply with treatment13 regimes if they arenot13 to have the functional deficits that13 follow
33 Finding people who13 donrsquot fit
People who have low social capital are likely to have few relatives and friends with whomthey regularly communicate and are also unlikely to be part13 of community or faithorganisations such as clubs societies and church groups They also die several yearsyounger than most13 of the population often because they donrsquot13 engage with public healthinitiatives such as vaccinations against13 flu regular checks on their blood pressure bloodsugar levels or in the case of women smear tests or mammography The most13 likelyreason for disappearing beneath the radar of such initiatives is their mobility which leadsalmost13 inevitably to them having no fixed abode and no fixed telephone line It thenbecomes very difficult13 for them to be contacted because their mobile telephones are likelyto have Pay-shy‐As-shy‐You-shy‐Go contracts that13 donrsquot13 require validated names addresses and bankaccounts
29
It follows that13 some of the most13 vulnerable people in society including those who live onthe streets are effectively unknown to both the NHS and to social work departments untilthey are referred in a crisis This could be an emergency presentation to a hospital Accident13 and Emergency Department13 where they will come into contact13 with a social worker becausedischarge may be unsafe This often highlights the importance of the prevention agenda13 and the potential for avoiding admissions to hospital by intervening at an earlier stage
The advantages of being able to locate people who are vulnerable to specific diseases willincrease as genetic testing becomes more routine It is already possible to determine whomight13 be most13 at risk of breast13 cancer and prostate cancer as a result13 of family history Addto this the evidence that13 particular diet13 and exposure to environmental factors can furtherincrease risk then it13 is evident13 that13 individuals can be identified and offered treatmentsthat13 could save their lives many years before they become ill In the case of cancersperhaps only the individual is involved but13 for infectious diseases it13 is the whole of societythat13 is at risk if someone contracts one of the new strains of influenza or if someonechooses not13 to be vaccinated against13 rubella In Chinese airports all visitors are screenedfor fever and refused entry if they tested positive in cities the public are monitored in thesame way Similar approaches may be necessary in the UK if potential carriers cannot13 otherwise be identified
34 Volunteering
It is estimated that13 72 per cent13 of people volunteered to perform a charitable act13 at least13 once during 2012 a rise from 65 per cent13 the previous year About13 four out13 of every 10volunteers offer their services formally to one or more organisations The remaindervolunteer informally by helping out13 a friend or a neighbour Around 50 per cent13 volunteered at least13 once a month in the past13 year up from 41 per cent13 on the previous13 year Most13 have retired many of them before the statutory retirement13 age Those whodonrsquot13 feel able to offer time have offered their financial support13 at a time when the fundingavailable from sources such as the National Lottery has been decreasing Despite economicausterity donations to charities have been increasing 74 per cent13 said they had given tocharity at least13 once in the previous month up from 72 per cent13 the previous year
Strikingly 78 per cent13 of people strongly believe that13 they are part13 of their localneighbourhood an increase from 70 per cent13 10 years previously Community cohesion isstronger than ever 87 per cent13 of people believe their local area13 is a place where peoplefrom different13 backgrounds get13 on well together compared to 80 per cent13 in 2003
The role of volunteers in supporting vulnerable people is therefore likely to increase overthe next13 decade perhaps exploiting the success of the army of volunteers that13 was highlysuccessful in London during the Olympic and Paralympic games The greatest13 role for suchvolunteers may be in providing informal care for older people Already the UK has someseven million informal carers whose value in monetary terms has been calculated to be
30
more than the combined budgets of the NHS and social care Maintaining or extending thisprovision will help to support13 services in the future and may be supported by technology
Whilst13 there is ample evidence to suggest13 that13 telecare services support13 informal carers asmuch as (if not13 more than) the people that13 they are caring for it13 is the potential for utilisingthe internet13 and apps to make their role easier to coordinate and hence more effectivethat13 is likely to be most13 successful moving forward
Many of these focus on particular tasks that13 informal carers can help offer to older peoplesuch as organising their medication A pillbox program is just13 one feature of an app calledBalance It also includes sections for caregiving tips notes for the doctor and the patientsappointments plus a lsquolearning sectionrsquo with articles on aspects of Alzheimers and an RSSfeed for news about13 the disease Tyze is another multi-shy‐functional app it13 allows carers to
bull Organise appointmentsbull Plan outingsbull Share storiesbull Send updates to other family members
Another application is Rally Round which helps carers to organise someone to perform littlejobs often on a temporary basis when someone has dementia physical frailty or isrecovering from accident13 or illness Similar applications are MeMaxi and Finerday
35 The High13 Street
The shape and appearance of UK shopping centres have been changing for half a centuryPeople complain that13 centres are losing their identity with one town looking like everyother both in terms of the stores and in terms of the layout But13 there are three trendswhich are having a profound impact13 on many of the most13 vulnerable people in society
bull Centres lock their doors at 6pm or in some cases 10pm -shy‐ thus denying people whosuffer from claustrophobia13 from window shopping at times when other shoppershave left
bull Out13 of town shopping malls -shy‐ these US style centres are ideal for people in carsbecause they offer free parking which is essential for people who want13 to buy largeritems but13 difficult13 for people who have no transport13 and who must13 rely on publictransport13 that13 is often deficient
bull The rise of online shopping -shy‐ which means that13 many potential shoppers only visit13 High Street13 stores to check the prices before returning home to make a purchaseonline
It is the third of these effects that13 has the greatest13 potential for changing the High Street13 forever and it13 is making life for traditional retailers increasingly difficult13 at a time when highrents are crippling stores large and small It is difficult13 to see how this trend is likely tochange because consolidation in banking and estate agencies is already forcing the closure
31
of other High Street13 players while additional pressures on pubs has led to the closure ofthousands of pubs every year
Those figures however demonstrate that13 consumers still value what13 the high street13 canoffer -shy‐ the chance to inspect13 what13 theyrsquore thinking of buying -shy‐ as well as the new opennessof the internet Customer service makes a difference to people especially if there is aproblem and goods need to be returned One of the most13 common reasons for furniture tobe returned for example is that13 when a sofa13 or a wardrobe was delivered it13 couldnrsquot13 fit13 through the front13 door or up the stairs In the future people will be able to benefit from13 visualisation technology they will upload the floor plans of their homes enabling theretailer to inform them of the problem before they try to delivery Augmented reality viewwill similarly allow customers to see what13 a new item of furniture will look like in itsintended place so that13 they can be more informed about13 the effect13 of size and colour
In terms of improving the viability of the High Street stores will have to focus on theimportance of brand which could mean that13 individual independent13 retailers will have topartner with national suppliers to support13 a local tailored offering based on products that13 are designed for a more global market This is a lsquoconnected High Streetrsquo approach whichcould be enabled by the developments in internet13 availability and smart13 phone accessdescribed in the previous section
The overall effect13 of all these changes could mean that13 town centres become smaller but13 more vibrant13 areas They could thrive if people are attracted there in large numbers whichmeans that13 retail must13 be developed alongside restaurants pubs galleries and other leisureopportunities This is possible in new shopping centres which are already being integratedwith transport13 hubs including railway and bus stations but13 may be more of a design13 challenge for older towns and cities with large Victorian buildings To ensure that13 morepeople are welcomed into the new centres they should include attention to green spacesand areas where people can relax without13 feeling that13 they are second class citizensbecause they donrsquot13 have the same buying power
3513 Privacy
To some people privacy is their right13 to live their lives without13 interference they may seethe State as a potential lsquoBig Brotherrsquo spying on their every move and judging their actions13 and activities Other people have fewer concerns about13 the role of the State but13 great13 fearof individuals interfering with and invading their privacy Some embrace the concept13 of lsquomyspacersquo an area13 of a square metre or so into which nobody can enter without13 permissionThis allows them to avoid physical contact13 and to feel safe from any form of threateningbehaviour
Yet13 this idea13 of private space and its potential violation is merely the tip of the iceberg asfar as privacy is concerned more significant13 is the idea13 of personal (and private)information being shared with anyone and everyone This could be related to identityopinion or image for an individual who wants to remain anonymous or even secretive thisis going to become an increasing problem as technology provides the means of taking
32
photographs recording conversations and capturing environment13 with something as smalland ubiquitous as a mobile phone The fact13 that13 this information can then be shared withthe rest13 of the world using e-shy‐mail Twitter and Facebook makes the problem all the moredifficult So the threat13 is no longer solely from the long lenses of the Paparazzi but13 fromanyone (and that13 means everyone) who has even the most13 basic of mobile phones
This relates to the changing views of society on what13 information should remain privateand what13 should be shared with others The success of social media13 has been based on anattitude of lsquosharing everythingrsquo with either your friends or the world This has introduced anaiumlve idea13 in the minds of some younger people (especially those known as Millennials ieaged 18-shy‐30) that13 everyone can be their friends whilst13 perhaps failing to reinforce the bondsof genuine friendship with any form of test13 or restriction Technology could play a role indefining these friendships and allowing individuals to understand what13 makes a goodfriend but13 this approach has yet13 to be developed and may be slow to overcome the needfor some people to measure their own popularity simply as the number of people that13 theycan list13 as friends on their Facebook page
It follows that13 there may be a need for a new definition of privacy that13 is in keeping withthe web and its ability to display images and opinion in an unregulated manner This needsto embrace past13 concerns about13 the ability of an individual to live without13 the threat13 ofothers being able to watch them whilst13 offering some protection from random postingsabout13 them online Perhaps this could include a right13 to be able to edit13 or remove anythingrelating to themselves on the Web including images that13 are not13 news-shy‐worthy Theownership of image rights may be an associated issue that13 needs to be addressedespecially as modern technology can remove an individual from a group (or a background)13 view provide digital touch-shy‐up or air-shy‐brushing and then republish it13 in a different13 contextHowever there is general agreement13 that13 personal information (such as contact13 details andbank codes) should not13 have a place on the web Surprisingly few people take proactivemeasures to prevent13 tracking functions being activated
It follows that13 too much privacy could lead to younger people fearing that13 they maybecome lost13 in a digital world It is not13 surprising then that13 they are prepared to make lots13 of personal information available often with no fear of how it13 might13 be used by othersWhen Google glasses and similar technologies become available during the next13 few yearsthey will have the potential to identify a stranger walking down the street and to find manyof their secrets to present13 to the wearer in a fraction of a second They could know moreabout13 them than their genuine friends know -shy‐ so who will be their friends in the future
36 Data sharing and13 protection
By lsquodata13 sharingrsquo we mean the disclosure of data13 held by one organisation on an individualto a third party organisation(s) or the sharing of data13 between different13 parts of anorganisation Some data13 sharing doesnrsquot13 involve personal data13 because it13 has beenanonymised in such a way that13 the statistics can be used for the collective good without13 theidentification of the individual The Data13 Protection Act13 (DPA) is in place to provide a legal
33
framework that13 ensures that13 organisations that13 hold personal data13 must13 act13 responsibly atall times These principles adequately describe the position of public and government13 bodies especially social services departments who are responsible for the informationconcerning the health and well-shy‐being of individuals -shy‐ and hence by implication thesensitive data13 relating to their vulnerability
The legal framework that13 applies to private and third sector organisations differs from that13 which applies to public sector organisations which may only act13 within the defined limits oftheir statutory powers However all bodies must13 comply fully with the data13 protectionprinciples and this situation is unlikely to change within the next13 10 to 15 years In someprivate sector contexts there are legal constraints on the disclosure of personal dataHowever most13 private and third sector organisations have a general ability to shareinformation provided this does not13 breach the DPA or any other law It is advisable for acompany to check its constitutional documents such as its memorandum and articles13 ofassociation to make sure there are no restrictions that13 would prevent13 it13 from sharingpersonal data13 in a particular context The type of data13 held is therefore a subject13 ofconcern as it13 may be difficult13 for legislation to keep up with the additional layers of data13 created on-shy‐line and through the Internet13 of Things
Private and third sector organisations should have regard to any industry-shy‐specific regulationor guidance about13 handling individualsrsquo information as this may affect13 the organisationrsquosability to share information They should also be aware of the legal issues that13 can arisewhen sharing personal data13 with public sector bodies This becomes more of an issue asprivate and third sector bodies are carrying out13 a wider range of traditionally public sectorfunctions Opportunities for inappropriate sharing of sensitive data13 will therefore inevitablyincrease
Public authorities must13 comply with the Human Rights Act13 (HRA) legislation in theperformance of their functions The HRA also applies to organisations in the private sectorinsofar as they carry out13 functions of a public nature which could include delivering a socialcare activity Where the HRA applies organisations must13 not13 act13 in a way that13 would beincompatible with rights under the European Convention on Human Rights Article 8 of theConvention giving everyone the right13 to respect13 for their private and family life their homeand their correspondence is especially relevant13 to sharing personal data If personal data13 isdisclosed or shared in ways that13 comply with the DPA the sharing or disclosure of that13 information is also likely to comply with the HRA The problem may still be in policing theActs and the rights of an individual if they believe that13 their personal data13 has been sharedor accessed by an inappropriate organisation or individual
A legal industry may be born to deal with such matters but13 this is unlikely to benefit13 peoplewho cannot13 afford the fees involved They would require either legal aid or to employ13 more13 lsquono win no feersquo companies Public attitudes to such costs might13 become negative unlessthey prove successful in preventing breaches of data13 security There may need to belegislation to provide a stronger basis for forcing compliance with privacy laws
34
37 Connecting with13 people
We are social creatures most13 of us rely on our friendships and interactions with friendsand families to share our happiest13 moments and experiences Research suggests that13 thishappiness is infectious at all levels and leads to a 15 increase in the happiness of a closecontact 10 for a second degree contact13 such as the friendrsquos spouse and a 6 increase fora friend of a friend It is hardly surprising that13 the success of social media13 such as Facebookis intimately related to the ability of people to quickly share their happiest13 moments with asmany of their friends and connections as possible
All this has happened during the rise of the Internet13 and the corresponding increase inopportunities for connecting online ie this is a 21st Century phenomenon which has beenfacilitated by Information and Communications Technology But13 the Internet13 remains in itsinfancy and we are only beginning to understand and exploit13 its potential In terms ofaccessing the Internet there are now perhaps two billion people who have access with99 of them having gained this during the past13 decade This number will have doubled bythe period 2020 to 2025 It is likely that13 everyone who wants to be connected in the UK willby then be connected Turning this on its head only those who donrsquot13 want13 to be online willnot13 be on the Internet13 within a decade Connecting with the unconnected will therefore bea case of identifying those people who donrsquot13 want13 to be found unfortunately these mayinclude many people who need the support13 of social care organisations It means that13 theywill be looking for support13 only when they are in crisis unless other ways of finding andormonitoring them are found
While the number of people connected via the Internet13 has exploded this might13 bedwarfed by the number of connected lsquothingsrsquo During 2009 the number of thingsconnected to the Internet13 surpassed the number of connected people at which point13 webegan to experience what13 this report13 has described as the lsquoInternet13 of Thingsrsquo Yet 99 ofall physical objects that13 could join this network are not13 yet13 connected but13 the number couldgrow by 25 every year for the next13 decade so that13 there could be 100 billion connectedobjects by 2025 some of which will be owned or used by everyone in the UK includingthose people who donrsquot13 want13 to be connected themselves We will then have an Internet13 of Everything which will be the smart13 connection of people data events and actions
With each new person object or data13 that13 comes online the connection possibilitiesbetween all these elements grows exponentially The rise of big data mobile networkingcloud storage and data13 mining technologies will all play a critical role in the Internet13 ofEverything The result13 will be new capabilities richer experiences and unprecedentedvalue for individuals businesses communities and countries everywhere The lsquonetworkeffectrsquo of the Internet13 of Everything will be a very powerful thing the true impact13 of whichwe wonrsquot13 fully understand for several years As it13 develops however those who are not13 connected will feel even more digitally and socially excluded There will be a need to reachout13 to vulnerable people unless the process of claiming requires proof of online identityand the payments to be received can only be redeemed using a chipped card or adownloaded app onto a smartphone This is of course the way that13 welfare arrangementsare already developing thus it13 might13 prove impossible to make a successful claim without13
35
already being connected to lsquothe systemrsquo either through an online presence or through theInternet13 of Things
38 Downloading everything
Sixty years ago information was discovered by reading books often in a library wherenotes had to be made because the books or journals couldnrsquot13 be removed Then in theearly 1960s the first13 office photocopying machines were introduced into the UK theyimmediately meant13 that13 pages or articles from books could be copied and taken away to beread and summarised later Within a few years photocopying became a replacement13 forreading as researchers became less adept13 at selecting a few sentences and every deskbecame a depository for reams of printed paper Paper became the means of recordingeverything from bank statements through to music
We now appreciate that13 printing everything is a waste of both the ink (or toner) used tocreate the black print13 and of paper which requires trees to be chopped down and pulpedbefore it13 can be pressed into thin sheets Saving paper is therefore seen as green and goodfor the planet Fortunately we no longer need to print13 everything because computermemory is unlimited thanks to the cloud and we can then view pages and articles onportable or fixed screens
The internet13 has everything and it13 is all available instantly for downloading providing thereis a device available to accept13 it and there is sufficient13 communication bandwidth toperform the transfer of data13 sufficiently quickly Thus we can record all text13 articles that13 are relevant13 to us including digital records of birth certificates qualifications and passportsand the need for original printed versions will decline But13 we can also do this forphotographs Most13 handheld computing devices include at least13 one camera so they cangenerate enormous number of pictures which can be kept13 for posterity without13 having toconsume inks and special papers to print13 them
But13 the materials that13 can be downloaded donrsquot13 stop at pictures software is available that13 can grab TV shows after they air and movies as soon as theyre released In the same wayit13 is possible to schedule music comic books video games and practically anything else asa download with minimal effort People will need enormous hard drives if they want13 theirown digital copies of these files so will more than likely make use of cloud storage that13 willbe available from many organisations The location of the servers may become sensitivedue to border restrictions as will the security of the data13 and the way that13 it13 is backed up sothat13 it13 is resilient13 to failures
It may be evident13 that13 application forms for all types of welfare payment13 will be availableonly for downloading so that once digitised they can be processed by computer andrecords sent13 to various servers for subsequent13 storage and processing Some people maywant13 to keep their data13 on them once it13 has been downloaded Pen drives can already holdseveral GB of data so it13 is likely that13 people will be able to carry their downloaded data13 withthem at all times irrespective of the size and complexities of the information
36
39 Health13 and13 well-shy‐being
The general health of the population is unlikely to deteriorate noticeably within 10 to 20years Indeed expectations of the population are that13 things must13 improve as surgicaltechniques mature and as pharmaceutical interventions become more personalised andpowerful However the rising demand for health services due to an ageing population andthe increasing cost13 of providing sophisticated therapies will make delivering a free anduniversal health service difficult13 without13 substantial increases in taxation This is unlikely tohappen in the UK even though spending on health services will be protected against13 thecuts facing other services
There will have to be changes in how the NHS works For twenty years hospitals have beenclosed and replaced by fewer new facilities so that13 the bed count13 is reduced This has led toa significant13 shift13 in resources to primary care and community care supporting shorter staysin hospital and speedier transfer back home for people after surgery or illness This hasbeen13 successful but13 there remain problems with demand for GP services especially out-shy‐of-shy‐hours and at weekends Indeed despite the introduction of NHS24 and similar help-shy‐linesthe demand for GP appointments continues to increase Delays are inevitable and this willincrease system failures with more unnecessary deaths and a failure for people to access adiagnosis that13 might13 lead to early interventions and ultimately lower delivery costs Over250 more patients are added to waiting lists every day
This will lead to a new model of primary care consistent13 with existing changes which haveseen surgeries move from High Street13 locations to medical centres close to bus routes andwith more parking for patients The process of making an appointment13 is changing from atelephone-shy‐based interview process dominated by a medically-shy‐unqualified receptionist13 to achoose and book approach using an online process linked to electronic patient13 records Thiswill give patients more convenience but13 will allow priority for those who have Internet13 access at the expensive of those who are digitally excluded Making the process of bookingan appointment13 quick and easy may also increase demand from people who do not13 need tobe seen as it13 will fail to identify those in greatest13 need
A greater use of telehealth and telecare technologies will be inevitable beginning with thefirst13 contact13 as an encounter using the telephone e-shy‐mail or video conferencing -shy‐ a visit13 tothe GP surgery should be a last13 resort and should involve a nurse consultation in the first13 instance This would be consistent13 with three quarters of appointments currently involvinga chronic disease or long term condition which relates to improved self-shy‐care The support13 ofthese patients at home should be prioritised through tele-shy‐ and web-shy‐based technologies andshould involve training and coaching through a network of nurse practitioners Home visitsshould generally be unnecessary through the use of these technologies but13 could besupplemented by satellite surgeries manned by nursing in community premises or inpharmacies nurseries and Internet13 cafes
The homes13 of people who13 need13 closer monitoring can then become part13 of virtual wardswith real or electronic visits by health professionals University Hospital Southampton NHSFoundation Trust13 already looks after patients who have undergone surgery such as a hip orknee13 replacements in virtual wards with high levels of satisfaction The Royal Free London
37
NHS Foundation Trust13 offers a similar service but13 plans to add the possibility of videoconsultations between patient13 and consultant
310 Attitudes to public health issues ndash obesity smoking alcohol abuse drugs
As self-shy‐care becomes the focus of the NHS the public will increasingly understand that13 thecosts and availability of services are being harmed by the poor health behaviour ofrelatively small numbers of people The link between public health initiatives today andhealthcare needs and costs in the future will become increasingly evident13 as a result13 of theway that13 information is presented Thus the overweight13 smoker who currently attractsconcern and pity when they are diagnosed with diabetes and COPD is increasingly beingseen as the victim of their own stupidity or lack of self-shy‐discipline If they continue to neglect13 medical advice and continue with an unhealthy lifestyle then the way that13 they receivetreatment13 and consume resources will become a matter for the entire population
Obesity is seen as due to a combination of poor diet13 and a sedentary lifestyle No longer isthe idea13 that13 people are lsquobig bonedrsquo acceptable Governments will respond initially byrequiring manufacturers and food processors to provide nutritional information onpackaging and on menus in restaurants But13 people can choose not13 to read the data13 and toneglect13 both the importance of food quality content13 and quantity This will increasepressure to introduce fat13 or sugar taxes and these are likely to be in force within a decade
Although the high taxes on tobacco products has forced some smokers to reduce theirconsumption or to give up altogether the impact13 has been reduced by the smuggling ofproducts from overseas and by the availability of duty-shy‐free cigarettes for people returningfrom foreign holidays and business meetings Further measures are planned to changepackaging and to include even more graphic images and warnings on cigarette packages tomake smokers aware of the effects of smoking on their health and well-shy‐being There is asyet little evidence of how successful this might13 be More effective has been the banning ofsmoking in public places including trains and aircraft Expensive medical interventions suchas heart13 transplants will be denied to individuals until they change their lifestyle behaviourSmokers might13 therefore be increasingly ostracised leading to a loss of esteem This mayhave a particular impact13 on people who already suffer from mental health problems whoare more likely to smoke
The overuse of alcohol is being recognised as a major factor in hospital admissions withNHS figures showing an increase of over 40 in such admissions over the past13 decadeLinked to this has been a 75 increase in prescriptions to treat13 alcohol dependency Fewpeople have sympathy for those who waste their limited income on booze If they havechildren or other dependents they will be the ones who suffer and who may need thesupport13 of social care
Drug users are already significant13 users of social services as their habit13 is likely to makethem unemployable They receive little sympathy from the general public because they areseen as criminals and people who waste public resources Levels of drug abuse have been
38
slowly increasing over the years but13 this trend is slowly being reversed Indeed the numberof people using drugs during the past13 year has fallen to its lowest13 level for nearly 20 years(below 9) with cannabis being most13 likely often following excessive drinking Aselectronic noses and other technologies can detect13 traces of drugs it13 seems likely that13 success in overcoming addiction can be measured objectively This may become a two-shy‐edged sword rewarding those who can turn around their lives but13 further marginalisingthose who canrsquot13 or wont13 accept13 the lsquocold turkeyrsquo
311 Attitudes to surveillance
Issues associated with privacy confidentiality and data13 security have been discussedpreviously in the context13 of information technology the World Wide Web and the ease ofcollecting recording recalling analysing and displaying data The monitoring of individualsand their methods of using this information can be regarded as surveillance As thequantities of data13 increase along with the number of devices that13 can be used to access itthe surveillance tools will also increase in their sophistication Indeed the Big Data13 approaches described in the previous section will enable the combination of structureddata13 (such as the information held in databases) to be married with unstructured data13 fromimages in such a way that13 it13 can be mined
Whilst13 the lsquodigital surveillancersquo methods described above may cause most13 concern topeople because of its impact13 on anonymity it13 is the collection and analysis of images that13 are the major concern to people as they contemplate the ways that13 lsquoBig Brotherrsquo maydevelop to restrict13 freedom Every major UK city and town centre has an array of CCTVcameras that13 continually record activities from every angle If it13 used to be true that13 nobody in London was more than 10 yards from a rat it13 is certainly the case today that13 nobody can be more than this distance from being in view of a surveillance camera Yetthey receive so much positive publicity from TV programmes where their footage is used todetect13 vehicles close to a crime scene or to monitor the movements of suspects that13 theyare now accepted by the public as a deterrent13 in the same way as lsquobobbies on the beatrsquowere seen 25 years ago There is therefore little public reaction to the expansion in the useof video surveillance except13 for the practical observation of how so many views can beinspected and recorded
Looking to the future the tumbling cost13 of video technology will surely lead to anotherincrease in the number of devices The aerial views taken from towers will besupplemented by more local views taken by devices that13 are embedded in the fabric ofbuildings or carried by individuals either on their person (for example on clothing orspectacles) or in the bags that13 they carry The time and date-shy‐stamped images as Big Datawill be recorded to lsquothe Cloudrsquo where it13 can be added to other data It can then be usedwhen an incident13 has occurred or to provide further detail of night-shy‐time activities
It follows that13 there will be no hiding place for people who simply want13 to disappear Theymay respond by wearing clothing (such as hoodies) that13 hide their faces or which make it13 difficult13 to distinguish gait13 or mannerisms from which they might13 be identified New forms
39
of clothing may be designed to make shapes more difficult13 to analyse and these might13 become the uniforms of a class of person who wants to live in a way that13 they donrsquot13 interact13 with officials from any ministry or local government13 department If they also obstruct13 services then they will be considered to be anarchists of some form sparking protests fromother sectors of society
31213 Attitudes to driving
Motor cars have been a feature of UK roads for over a century but13 it13 is only during the past13 50 years that13 they have become a resource that13 most13 families have had access to enablingthem to travel without13 the restrictions imposed by a limited railway network and non-shy‐integrated bus transport People who have had a car throughout13 their lives often see theircars as an important13 factor in enabling them to remain independent13 and to exercise choicesrelating to where they shop and where they spend their leisure time This extends to theirspouse and to friends and neighbours that13 they might13 take with them on their variousexpeditions
Unfortunately there are incidents involving older drivers who perhaps go down amotorway in the wrong direction who are taken ill at the wheel or who are involved in anaccident13 involving no other vehicles These are small in number but13 often lead to a reactionthat13 they shouldnrsquot13 be allowed to drive lsquoat13 their agersquo Age itself is not13 an indicator ofdriving quality but13 because old age also brings more chance of having limited long termconditions and other illnesses it13 is easy to make a link between driving ability and age Thelicensing system does require continued driving to be linked with medical advice andforbids people with poor eyesight epilepsy and other conditions to hold a licence in oldage
Yet13 statistically older drivers cause far fewer accidents than younger drivers The reasonsfor this may be complex and are likely to include the fact13 that13 they drive less often covershorter distances and donrsquot13 go out13 in the dark or in poor weather However it13 does not13 wholly explain why the UKrsquos drivers aged over 70 and who represent13 some 8 of all driversare involved in only 4 of accidents that13 cause injury This compares favourably with the15 of13 drivers aged between 17 and 29 who are involved in over a third of crashes that13 result13 in injury
By 2020 the number of drivers aged over 70 on UK roads is likely to increase to over 7million This will require a new national strategy perhaps involving support13 for olderdrivers further training raising awareness of issues and making more use of adaptivetechnologies to support13 the driver in avoiding collision or forgetting to check on the statusof their vehicle Poor eyesight13 could be enhanced by camera technologies rather thanforcing people off the road if they are unable to read a licence plate
The International Longevity Centre has found that13 one in four Britons thought13 driversshould be made to switch off the ignition for good somewhere between the ages of 70 and75 The numbers may decrease as the population ages and as cars become safer Forcing
40
older people off the road may be a natural consequence of providing free bus passes andsubsidised rail fares but13 the growth in the pavement13 scooter industry demonstrates that13 older people value their independence and will do almost13 anything to get13 out13 and aboutPerhaps legislation will result13 in more regulation of electric vehicles and where they cantravel
There can be no doubt13 that13 getting out13 will be associated with better quality of life andwell-shy‐being and this is likely to be supported in the future as evidence of improvedoutcomes emerges It is to be hoped that13 positive stories will be publicised so that13 publicattitudes arenrsquot13 hardened This may be supported by more in-shy‐car monitoring of drivers andthe linking of performance with on-shy‐line driving records and licences These could throughremotely monitored ignition systems prevent13 the use of motor vehicles by people without13 a licence or without13 insurance
313 Climate change
There is a general view that13 the emissions of carbon gases are contributing to globalwarming in a manner that13 will change the UK climate in such a way that13 the climate maybecome more Mediterranean However some scientists believe that13 manrsquos impact13 on theenvironment13 may be small compared with natural variations caused for example bycyclical changes in the sunrsquos energy output13 or by the effects of volcanoes and earthquakesRecent13 evidence has suggested that13 we are going through a phase of changing extremesand that13 this is more likely to cause storms periods of excessive rainfall and unusualseasonal trends with snow and frost13 in the spring and warmer winters Considerableuncertainty remains and it13 might13 be necessary to plan for a number of different13 scenariosand for the impact13 on vulnerable people
I Colder winters UK properties are poorly insulated resulting in excess mortalitiesduring cold spells due to an increased number of people suffering from stroke aswell as bronchitis and other pulmonary diseases The cost13 of heating continues toincrease putting more households into a state of fuel poverty Any further coolingduring the winter months will result13 in more people living in unhealthy coldconditions Winter fuel payments are likely to be restricted to the poorest13 peoplebut13 this might13 exclude people who live in larger properties that13 are more difficult13 toheat
II More storms excessive winds and rain can cause flooding at any time of the yearMany UK communities are built13 close to rivers and these can surge during heavyrainfall causing houses to be filled with water and furniture and carpets lostInsurance can be problematic for properties built13 on flood plains which can blight13 properties and prevent13 owners from being able to sell and move on High winds canrip off roofs causing injury and also causing families to be left13 homeless anddependent13 on social services
III Hot13 summers Europe suffered high temperatures during the summers of 2003 and2004 leading to heat13 stroke and hypothermia The UK has not13 previously sufferedfrom such problems but13 might13 be expected to experience days of extreme
41
temperature and humidity at times Older people may not13 be prepared for suchweather Street13 dwellers may be unable to find shade and supplies of drinkingwater
Irrespective of what13 combination of weather scenarios arise it13 must13 be concluded that13 any extremes will have a major negative impact13 on vulnerable people especially if theyare not13 prepared because they havenrsquot13 received the weather warnings and advice that13 can be broadcast13 using the TV radio and online services Once again the digitallyexcluded will suffer and will pay a high cost Society will continue to pick up the bill interms of demands on social care services unless preventive actions are taken in theform of connecting these people to each other and to formal services
42
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
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13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
n13 13
13 s13
r13 n13
e13 at13
e13 y13 e13 ld13
ly13
13 e13 t13 e13
s13 er13 e13
f13
rt13 13
13 13
13
r13 13
s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
e13 g13 13
e13
13 13 ial13
13
d13
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d13 13
s13 y13
e13
13
rd13 r13 e13
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e13
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13
13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
It follows that13 some of the most13 vulnerable people in society including those who live onthe streets are effectively unknown to both the NHS and to social work departments untilthey are referred in a crisis This could be an emergency presentation to a hospital Accident13 and Emergency Department13 where they will come into contact13 with a social worker becausedischarge may be unsafe This often highlights the importance of the prevention agenda13 and the potential for avoiding admissions to hospital by intervening at an earlier stage
The advantages of being able to locate people who are vulnerable to specific diseases willincrease as genetic testing becomes more routine It is already possible to determine whomight13 be most13 at risk of breast13 cancer and prostate cancer as a result13 of family history Addto this the evidence that13 particular diet13 and exposure to environmental factors can furtherincrease risk then it13 is evident13 that13 individuals can be identified and offered treatmentsthat13 could save their lives many years before they become ill In the case of cancersperhaps only the individual is involved but13 for infectious diseases it13 is the whole of societythat13 is at risk if someone contracts one of the new strains of influenza or if someonechooses not13 to be vaccinated against13 rubella In Chinese airports all visitors are screenedfor fever and refused entry if they tested positive in cities the public are monitored in thesame way Similar approaches may be necessary in the UK if potential carriers cannot13 otherwise be identified
34 Volunteering
It is estimated that13 72 per cent13 of people volunteered to perform a charitable act13 at least13 once during 2012 a rise from 65 per cent13 the previous year About13 four out13 of every 10volunteers offer their services formally to one or more organisations The remaindervolunteer informally by helping out13 a friend or a neighbour Around 50 per cent13 volunteered at least13 once a month in the past13 year up from 41 per cent13 on the previous13 year Most13 have retired many of them before the statutory retirement13 age Those whodonrsquot13 feel able to offer time have offered their financial support13 at a time when the fundingavailable from sources such as the National Lottery has been decreasing Despite economicausterity donations to charities have been increasing 74 per cent13 said they had given tocharity at least13 once in the previous month up from 72 per cent13 the previous year
Strikingly 78 per cent13 of people strongly believe that13 they are part13 of their localneighbourhood an increase from 70 per cent13 10 years previously Community cohesion isstronger than ever 87 per cent13 of people believe their local area13 is a place where peoplefrom different13 backgrounds get13 on well together compared to 80 per cent13 in 2003
The role of volunteers in supporting vulnerable people is therefore likely to increase overthe next13 decade perhaps exploiting the success of the army of volunteers that13 was highlysuccessful in London during the Olympic and Paralympic games The greatest13 role for suchvolunteers may be in providing informal care for older people Already the UK has someseven million informal carers whose value in monetary terms has been calculated to be
30
more than the combined budgets of the NHS and social care Maintaining or extending thisprovision will help to support13 services in the future and may be supported by technology
Whilst13 there is ample evidence to suggest13 that13 telecare services support13 informal carers asmuch as (if not13 more than) the people that13 they are caring for it13 is the potential for utilisingthe internet13 and apps to make their role easier to coordinate and hence more effectivethat13 is likely to be most13 successful moving forward
Many of these focus on particular tasks that13 informal carers can help offer to older peoplesuch as organising their medication A pillbox program is just13 one feature of an app calledBalance It also includes sections for caregiving tips notes for the doctor and the patientsappointments plus a lsquolearning sectionrsquo with articles on aspects of Alzheimers and an RSSfeed for news about13 the disease Tyze is another multi-shy‐functional app it13 allows carers to
bull Organise appointmentsbull Plan outingsbull Share storiesbull Send updates to other family members
Another application is Rally Round which helps carers to organise someone to perform littlejobs often on a temporary basis when someone has dementia physical frailty or isrecovering from accident13 or illness Similar applications are MeMaxi and Finerday
35 The High13 Street
The shape and appearance of UK shopping centres have been changing for half a centuryPeople complain that13 centres are losing their identity with one town looking like everyother both in terms of the stores and in terms of the layout But13 there are three trendswhich are having a profound impact13 on many of the most13 vulnerable people in society
bull Centres lock their doors at 6pm or in some cases 10pm -shy‐ thus denying people whosuffer from claustrophobia13 from window shopping at times when other shoppershave left
bull Out13 of town shopping malls -shy‐ these US style centres are ideal for people in carsbecause they offer free parking which is essential for people who want13 to buy largeritems but13 difficult13 for people who have no transport13 and who must13 rely on publictransport13 that13 is often deficient
bull The rise of online shopping -shy‐ which means that13 many potential shoppers only visit13 High Street13 stores to check the prices before returning home to make a purchaseonline
It is the third of these effects that13 has the greatest13 potential for changing the High Street13 forever and it13 is making life for traditional retailers increasingly difficult13 at a time when highrents are crippling stores large and small It is difficult13 to see how this trend is likely tochange because consolidation in banking and estate agencies is already forcing the closure
31
of other High Street13 players while additional pressures on pubs has led to the closure ofthousands of pubs every year
Those figures however demonstrate that13 consumers still value what13 the high street13 canoffer -shy‐ the chance to inspect13 what13 theyrsquore thinking of buying -shy‐ as well as the new opennessof the internet Customer service makes a difference to people especially if there is aproblem and goods need to be returned One of the most13 common reasons for furniture tobe returned for example is that13 when a sofa13 or a wardrobe was delivered it13 couldnrsquot13 fit13 through the front13 door or up the stairs In the future people will be able to benefit from13 visualisation technology they will upload the floor plans of their homes enabling theretailer to inform them of the problem before they try to delivery Augmented reality viewwill similarly allow customers to see what13 a new item of furniture will look like in itsintended place so that13 they can be more informed about13 the effect13 of size and colour
In terms of improving the viability of the High Street stores will have to focus on theimportance of brand which could mean that13 individual independent13 retailers will have topartner with national suppliers to support13 a local tailored offering based on products that13 are designed for a more global market This is a lsquoconnected High Streetrsquo approach whichcould be enabled by the developments in internet13 availability and smart13 phone accessdescribed in the previous section
The overall effect13 of all these changes could mean that13 town centres become smaller but13 more vibrant13 areas They could thrive if people are attracted there in large numbers whichmeans that13 retail must13 be developed alongside restaurants pubs galleries and other leisureopportunities This is possible in new shopping centres which are already being integratedwith transport13 hubs including railway and bus stations but13 may be more of a design13 challenge for older towns and cities with large Victorian buildings To ensure that13 morepeople are welcomed into the new centres they should include attention to green spacesand areas where people can relax without13 feeling that13 they are second class citizensbecause they donrsquot13 have the same buying power
3513 Privacy
To some people privacy is their right13 to live their lives without13 interference they may seethe State as a potential lsquoBig Brotherrsquo spying on their every move and judging their actions13 and activities Other people have fewer concerns about13 the role of the State but13 great13 fearof individuals interfering with and invading their privacy Some embrace the concept13 of lsquomyspacersquo an area13 of a square metre or so into which nobody can enter without13 permissionThis allows them to avoid physical contact13 and to feel safe from any form of threateningbehaviour
Yet13 this idea13 of private space and its potential violation is merely the tip of the iceberg asfar as privacy is concerned more significant13 is the idea13 of personal (and private)information being shared with anyone and everyone This could be related to identityopinion or image for an individual who wants to remain anonymous or even secretive thisis going to become an increasing problem as technology provides the means of taking
32
photographs recording conversations and capturing environment13 with something as smalland ubiquitous as a mobile phone The fact13 that13 this information can then be shared withthe rest13 of the world using e-shy‐mail Twitter and Facebook makes the problem all the moredifficult So the threat13 is no longer solely from the long lenses of the Paparazzi but13 fromanyone (and that13 means everyone) who has even the most13 basic of mobile phones
This relates to the changing views of society on what13 information should remain privateand what13 should be shared with others The success of social media13 has been based on anattitude of lsquosharing everythingrsquo with either your friends or the world This has introduced anaiumlve idea13 in the minds of some younger people (especially those known as Millennials ieaged 18-shy‐30) that13 everyone can be their friends whilst13 perhaps failing to reinforce the bondsof genuine friendship with any form of test13 or restriction Technology could play a role indefining these friendships and allowing individuals to understand what13 makes a goodfriend but13 this approach has yet13 to be developed and may be slow to overcome the needfor some people to measure their own popularity simply as the number of people that13 theycan list13 as friends on their Facebook page
It follows that13 there may be a need for a new definition of privacy that13 is in keeping withthe web and its ability to display images and opinion in an unregulated manner This needsto embrace past13 concerns about13 the ability of an individual to live without13 the threat13 ofothers being able to watch them whilst13 offering some protection from random postingsabout13 them online Perhaps this could include a right13 to be able to edit13 or remove anythingrelating to themselves on the Web including images that13 are not13 news-shy‐worthy Theownership of image rights may be an associated issue that13 needs to be addressedespecially as modern technology can remove an individual from a group (or a background)13 view provide digital touch-shy‐up or air-shy‐brushing and then republish it13 in a different13 contextHowever there is general agreement13 that13 personal information (such as contact13 details andbank codes) should not13 have a place on the web Surprisingly few people take proactivemeasures to prevent13 tracking functions being activated
It follows that13 too much privacy could lead to younger people fearing that13 they maybecome lost13 in a digital world It is not13 surprising then that13 they are prepared to make lots13 of personal information available often with no fear of how it13 might13 be used by othersWhen Google glasses and similar technologies become available during the next13 few yearsthey will have the potential to identify a stranger walking down the street and to find manyof their secrets to present13 to the wearer in a fraction of a second They could know moreabout13 them than their genuine friends know -shy‐ so who will be their friends in the future
36 Data sharing and13 protection
By lsquodata13 sharingrsquo we mean the disclosure of data13 held by one organisation on an individualto a third party organisation(s) or the sharing of data13 between different13 parts of anorganisation Some data13 sharing doesnrsquot13 involve personal data13 because it13 has beenanonymised in such a way that13 the statistics can be used for the collective good without13 theidentification of the individual The Data13 Protection Act13 (DPA) is in place to provide a legal
33
framework that13 ensures that13 organisations that13 hold personal data13 must13 act13 responsibly atall times These principles adequately describe the position of public and government13 bodies especially social services departments who are responsible for the informationconcerning the health and well-shy‐being of individuals -shy‐ and hence by implication thesensitive data13 relating to their vulnerability
The legal framework that13 applies to private and third sector organisations differs from that13 which applies to public sector organisations which may only act13 within the defined limits oftheir statutory powers However all bodies must13 comply fully with the data13 protectionprinciples and this situation is unlikely to change within the next13 10 to 15 years In someprivate sector contexts there are legal constraints on the disclosure of personal dataHowever most13 private and third sector organisations have a general ability to shareinformation provided this does not13 breach the DPA or any other law It is advisable for acompany to check its constitutional documents such as its memorandum and articles13 ofassociation to make sure there are no restrictions that13 would prevent13 it13 from sharingpersonal data13 in a particular context The type of data13 held is therefore a subject13 ofconcern as it13 may be difficult13 for legislation to keep up with the additional layers of data13 created on-shy‐line and through the Internet13 of Things
Private and third sector organisations should have regard to any industry-shy‐specific regulationor guidance about13 handling individualsrsquo information as this may affect13 the organisationrsquosability to share information They should also be aware of the legal issues that13 can arisewhen sharing personal data13 with public sector bodies This becomes more of an issue asprivate and third sector bodies are carrying out13 a wider range of traditionally public sectorfunctions Opportunities for inappropriate sharing of sensitive data13 will therefore inevitablyincrease
Public authorities must13 comply with the Human Rights Act13 (HRA) legislation in theperformance of their functions The HRA also applies to organisations in the private sectorinsofar as they carry out13 functions of a public nature which could include delivering a socialcare activity Where the HRA applies organisations must13 not13 act13 in a way that13 would beincompatible with rights under the European Convention on Human Rights Article 8 of theConvention giving everyone the right13 to respect13 for their private and family life their homeand their correspondence is especially relevant13 to sharing personal data If personal data13 isdisclosed or shared in ways that13 comply with the DPA the sharing or disclosure of that13 information is also likely to comply with the HRA The problem may still be in policing theActs and the rights of an individual if they believe that13 their personal data13 has been sharedor accessed by an inappropriate organisation or individual
A legal industry may be born to deal with such matters but13 this is unlikely to benefit13 peoplewho cannot13 afford the fees involved They would require either legal aid or to employ13 more13 lsquono win no feersquo companies Public attitudes to such costs might13 become negative unlessthey prove successful in preventing breaches of data13 security There may need to belegislation to provide a stronger basis for forcing compliance with privacy laws
34
37 Connecting with13 people
We are social creatures most13 of us rely on our friendships and interactions with friendsand families to share our happiest13 moments and experiences Research suggests that13 thishappiness is infectious at all levels and leads to a 15 increase in the happiness of a closecontact 10 for a second degree contact13 such as the friendrsquos spouse and a 6 increase fora friend of a friend It is hardly surprising that13 the success of social media13 such as Facebookis intimately related to the ability of people to quickly share their happiest13 moments with asmany of their friends and connections as possible
All this has happened during the rise of the Internet13 and the corresponding increase inopportunities for connecting online ie this is a 21st Century phenomenon which has beenfacilitated by Information and Communications Technology But13 the Internet13 remains in itsinfancy and we are only beginning to understand and exploit13 its potential In terms ofaccessing the Internet there are now perhaps two billion people who have access with99 of them having gained this during the past13 decade This number will have doubled bythe period 2020 to 2025 It is likely that13 everyone who wants to be connected in the UK willby then be connected Turning this on its head only those who donrsquot13 want13 to be online willnot13 be on the Internet13 within a decade Connecting with the unconnected will therefore bea case of identifying those people who donrsquot13 want13 to be found unfortunately these mayinclude many people who need the support13 of social care organisations It means that13 theywill be looking for support13 only when they are in crisis unless other ways of finding andormonitoring them are found
While the number of people connected via the Internet13 has exploded this might13 bedwarfed by the number of connected lsquothingsrsquo During 2009 the number of thingsconnected to the Internet13 surpassed the number of connected people at which point13 webegan to experience what13 this report13 has described as the lsquoInternet13 of Thingsrsquo Yet 99 ofall physical objects that13 could join this network are not13 yet13 connected but13 the number couldgrow by 25 every year for the next13 decade so that13 there could be 100 billion connectedobjects by 2025 some of which will be owned or used by everyone in the UK includingthose people who donrsquot13 want13 to be connected themselves We will then have an Internet13 of Everything which will be the smart13 connection of people data events and actions
With each new person object or data13 that13 comes online the connection possibilitiesbetween all these elements grows exponentially The rise of big data mobile networkingcloud storage and data13 mining technologies will all play a critical role in the Internet13 ofEverything The result13 will be new capabilities richer experiences and unprecedentedvalue for individuals businesses communities and countries everywhere The lsquonetworkeffectrsquo of the Internet13 of Everything will be a very powerful thing the true impact13 of whichwe wonrsquot13 fully understand for several years As it13 develops however those who are not13 connected will feel even more digitally and socially excluded There will be a need to reachout13 to vulnerable people unless the process of claiming requires proof of online identityand the payments to be received can only be redeemed using a chipped card or adownloaded app onto a smartphone This is of course the way that13 welfare arrangementsare already developing thus it13 might13 prove impossible to make a successful claim without13
35
already being connected to lsquothe systemrsquo either through an online presence or through theInternet13 of Things
38 Downloading everything
Sixty years ago information was discovered by reading books often in a library wherenotes had to be made because the books or journals couldnrsquot13 be removed Then in theearly 1960s the first13 office photocopying machines were introduced into the UK theyimmediately meant13 that13 pages or articles from books could be copied and taken away to beread and summarised later Within a few years photocopying became a replacement13 forreading as researchers became less adept13 at selecting a few sentences and every deskbecame a depository for reams of printed paper Paper became the means of recordingeverything from bank statements through to music
We now appreciate that13 printing everything is a waste of both the ink (or toner) used tocreate the black print13 and of paper which requires trees to be chopped down and pulpedbefore it13 can be pressed into thin sheets Saving paper is therefore seen as green and goodfor the planet Fortunately we no longer need to print13 everything because computermemory is unlimited thanks to the cloud and we can then view pages and articles onportable or fixed screens
The internet13 has everything and it13 is all available instantly for downloading providing thereis a device available to accept13 it and there is sufficient13 communication bandwidth toperform the transfer of data13 sufficiently quickly Thus we can record all text13 articles that13 are relevant13 to us including digital records of birth certificates qualifications and passportsand the need for original printed versions will decline But13 we can also do this forphotographs Most13 handheld computing devices include at least13 one camera so they cangenerate enormous number of pictures which can be kept13 for posterity without13 having toconsume inks and special papers to print13 them
But13 the materials that13 can be downloaded donrsquot13 stop at pictures software is available that13 can grab TV shows after they air and movies as soon as theyre released In the same wayit13 is possible to schedule music comic books video games and practically anything else asa download with minimal effort People will need enormous hard drives if they want13 theirown digital copies of these files so will more than likely make use of cloud storage that13 willbe available from many organisations The location of the servers may become sensitivedue to border restrictions as will the security of the data13 and the way that13 it13 is backed up sothat13 it13 is resilient13 to failures
It may be evident13 that13 application forms for all types of welfare payment13 will be availableonly for downloading so that once digitised they can be processed by computer andrecords sent13 to various servers for subsequent13 storage and processing Some people maywant13 to keep their data13 on them once it13 has been downloaded Pen drives can already holdseveral GB of data so it13 is likely that13 people will be able to carry their downloaded data13 withthem at all times irrespective of the size and complexities of the information
36
39 Health13 and13 well-shy‐being
The general health of the population is unlikely to deteriorate noticeably within 10 to 20years Indeed expectations of the population are that13 things must13 improve as surgicaltechniques mature and as pharmaceutical interventions become more personalised andpowerful However the rising demand for health services due to an ageing population andthe increasing cost13 of providing sophisticated therapies will make delivering a free anduniversal health service difficult13 without13 substantial increases in taxation This is unlikely tohappen in the UK even though spending on health services will be protected against13 thecuts facing other services
There will have to be changes in how the NHS works For twenty years hospitals have beenclosed and replaced by fewer new facilities so that13 the bed count13 is reduced This has led toa significant13 shift13 in resources to primary care and community care supporting shorter staysin hospital and speedier transfer back home for people after surgery or illness This hasbeen13 successful but13 there remain problems with demand for GP services especially out-shy‐of-shy‐hours and at weekends Indeed despite the introduction of NHS24 and similar help-shy‐linesthe demand for GP appointments continues to increase Delays are inevitable and this willincrease system failures with more unnecessary deaths and a failure for people to access adiagnosis that13 might13 lead to early interventions and ultimately lower delivery costs Over250 more patients are added to waiting lists every day
This will lead to a new model of primary care consistent13 with existing changes which haveseen surgeries move from High Street13 locations to medical centres close to bus routes andwith more parking for patients The process of making an appointment13 is changing from atelephone-shy‐based interview process dominated by a medically-shy‐unqualified receptionist13 to achoose and book approach using an online process linked to electronic patient13 records Thiswill give patients more convenience but13 will allow priority for those who have Internet13 access at the expensive of those who are digitally excluded Making the process of bookingan appointment13 quick and easy may also increase demand from people who do not13 need tobe seen as it13 will fail to identify those in greatest13 need
A greater use of telehealth and telecare technologies will be inevitable beginning with thefirst13 contact13 as an encounter using the telephone e-shy‐mail or video conferencing -shy‐ a visit13 tothe GP surgery should be a last13 resort and should involve a nurse consultation in the first13 instance This would be consistent13 with three quarters of appointments currently involvinga chronic disease or long term condition which relates to improved self-shy‐care The support13 ofthese patients at home should be prioritised through tele-shy‐ and web-shy‐based technologies andshould involve training and coaching through a network of nurse practitioners Home visitsshould generally be unnecessary through the use of these technologies but13 could besupplemented by satellite surgeries manned by nursing in community premises or inpharmacies nurseries and Internet13 cafes
The homes13 of people who13 need13 closer monitoring can then become part13 of virtual wardswith real or electronic visits by health professionals University Hospital Southampton NHSFoundation Trust13 already looks after patients who have undergone surgery such as a hip orknee13 replacements in virtual wards with high levels of satisfaction The Royal Free London
37
NHS Foundation Trust13 offers a similar service but13 plans to add the possibility of videoconsultations between patient13 and consultant
310 Attitudes to public health issues ndash obesity smoking alcohol abuse drugs
As self-shy‐care becomes the focus of the NHS the public will increasingly understand that13 thecosts and availability of services are being harmed by the poor health behaviour ofrelatively small numbers of people The link between public health initiatives today andhealthcare needs and costs in the future will become increasingly evident13 as a result13 of theway that13 information is presented Thus the overweight13 smoker who currently attractsconcern and pity when they are diagnosed with diabetes and COPD is increasingly beingseen as the victim of their own stupidity or lack of self-shy‐discipline If they continue to neglect13 medical advice and continue with an unhealthy lifestyle then the way that13 they receivetreatment13 and consume resources will become a matter for the entire population
Obesity is seen as due to a combination of poor diet13 and a sedentary lifestyle No longer isthe idea13 that13 people are lsquobig bonedrsquo acceptable Governments will respond initially byrequiring manufacturers and food processors to provide nutritional information onpackaging and on menus in restaurants But13 people can choose not13 to read the data13 and toneglect13 both the importance of food quality content13 and quantity This will increasepressure to introduce fat13 or sugar taxes and these are likely to be in force within a decade
Although the high taxes on tobacco products has forced some smokers to reduce theirconsumption or to give up altogether the impact13 has been reduced by the smuggling ofproducts from overseas and by the availability of duty-shy‐free cigarettes for people returningfrom foreign holidays and business meetings Further measures are planned to changepackaging and to include even more graphic images and warnings on cigarette packages tomake smokers aware of the effects of smoking on their health and well-shy‐being There is asyet little evidence of how successful this might13 be More effective has been the banning ofsmoking in public places including trains and aircraft Expensive medical interventions suchas heart13 transplants will be denied to individuals until they change their lifestyle behaviourSmokers might13 therefore be increasingly ostracised leading to a loss of esteem This mayhave a particular impact13 on people who already suffer from mental health problems whoare more likely to smoke
The overuse of alcohol is being recognised as a major factor in hospital admissions withNHS figures showing an increase of over 40 in such admissions over the past13 decadeLinked to this has been a 75 increase in prescriptions to treat13 alcohol dependency Fewpeople have sympathy for those who waste their limited income on booze If they havechildren or other dependents they will be the ones who suffer and who may need thesupport13 of social care
Drug users are already significant13 users of social services as their habit13 is likely to makethem unemployable They receive little sympathy from the general public because they areseen as criminals and people who waste public resources Levels of drug abuse have been
38
slowly increasing over the years but13 this trend is slowly being reversed Indeed the numberof people using drugs during the past13 year has fallen to its lowest13 level for nearly 20 years(below 9) with cannabis being most13 likely often following excessive drinking Aselectronic noses and other technologies can detect13 traces of drugs it13 seems likely that13 success in overcoming addiction can be measured objectively This may become a two-shy‐edged sword rewarding those who can turn around their lives but13 further marginalisingthose who canrsquot13 or wont13 accept13 the lsquocold turkeyrsquo
311 Attitudes to surveillance
Issues associated with privacy confidentiality and data13 security have been discussedpreviously in the context13 of information technology the World Wide Web and the ease ofcollecting recording recalling analysing and displaying data The monitoring of individualsand their methods of using this information can be regarded as surveillance As thequantities of data13 increase along with the number of devices that13 can be used to access itthe surveillance tools will also increase in their sophistication Indeed the Big Data13 approaches described in the previous section will enable the combination of structureddata13 (such as the information held in databases) to be married with unstructured data13 fromimages in such a way that13 it13 can be mined
Whilst13 the lsquodigital surveillancersquo methods described above may cause most13 concern topeople because of its impact13 on anonymity it13 is the collection and analysis of images that13 are the major concern to people as they contemplate the ways that13 lsquoBig Brotherrsquo maydevelop to restrict13 freedom Every major UK city and town centre has an array of CCTVcameras that13 continually record activities from every angle If it13 used to be true that13 nobody in London was more than 10 yards from a rat it13 is certainly the case today that13 nobody can be more than this distance from being in view of a surveillance camera Yetthey receive so much positive publicity from TV programmes where their footage is used todetect13 vehicles close to a crime scene or to monitor the movements of suspects that13 theyare now accepted by the public as a deterrent13 in the same way as lsquobobbies on the beatrsquowere seen 25 years ago There is therefore little public reaction to the expansion in the useof video surveillance except13 for the practical observation of how so many views can beinspected and recorded
Looking to the future the tumbling cost13 of video technology will surely lead to anotherincrease in the number of devices The aerial views taken from towers will besupplemented by more local views taken by devices that13 are embedded in the fabric ofbuildings or carried by individuals either on their person (for example on clothing orspectacles) or in the bags that13 they carry The time and date-shy‐stamped images as Big Datawill be recorded to lsquothe Cloudrsquo where it13 can be added to other data It can then be usedwhen an incident13 has occurred or to provide further detail of night-shy‐time activities
It follows that13 there will be no hiding place for people who simply want13 to disappear Theymay respond by wearing clothing (such as hoodies) that13 hide their faces or which make it13 difficult13 to distinguish gait13 or mannerisms from which they might13 be identified New forms
39
of clothing may be designed to make shapes more difficult13 to analyse and these might13 become the uniforms of a class of person who wants to live in a way that13 they donrsquot13 interact13 with officials from any ministry or local government13 department If they also obstruct13 services then they will be considered to be anarchists of some form sparking protests fromother sectors of society
31213 Attitudes to driving
Motor cars have been a feature of UK roads for over a century but13 it13 is only during the past13 50 years that13 they have become a resource that13 most13 families have had access to enablingthem to travel without13 the restrictions imposed by a limited railway network and non-shy‐integrated bus transport People who have had a car throughout13 their lives often see theircars as an important13 factor in enabling them to remain independent13 and to exercise choicesrelating to where they shop and where they spend their leisure time This extends to theirspouse and to friends and neighbours that13 they might13 take with them on their variousexpeditions
Unfortunately there are incidents involving older drivers who perhaps go down amotorway in the wrong direction who are taken ill at the wheel or who are involved in anaccident13 involving no other vehicles These are small in number but13 often lead to a reactionthat13 they shouldnrsquot13 be allowed to drive lsquoat13 their agersquo Age itself is not13 an indicator ofdriving quality but13 because old age also brings more chance of having limited long termconditions and other illnesses it13 is easy to make a link between driving ability and age Thelicensing system does require continued driving to be linked with medical advice andforbids people with poor eyesight epilepsy and other conditions to hold a licence in oldage
Yet13 statistically older drivers cause far fewer accidents than younger drivers The reasonsfor this may be complex and are likely to include the fact13 that13 they drive less often covershorter distances and donrsquot13 go out13 in the dark or in poor weather However it13 does not13 wholly explain why the UKrsquos drivers aged over 70 and who represent13 some 8 of all driversare involved in only 4 of accidents that13 cause injury This compares favourably with the15 of13 drivers aged between 17 and 29 who are involved in over a third of crashes that13 result13 in injury
By 2020 the number of drivers aged over 70 on UK roads is likely to increase to over 7million This will require a new national strategy perhaps involving support13 for olderdrivers further training raising awareness of issues and making more use of adaptivetechnologies to support13 the driver in avoiding collision or forgetting to check on the statusof their vehicle Poor eyesight13 could be enhanced by camera technologies rather thanforcing people off the road if they are unable to read a licence plate
The International Longevity Centre has found that13 one in four Britons thought13 driversshould be made to switch off the ignition for good somewhere between the ages of 70 and75 The numbers may decrease as the population ages and as cars become safer Forcing
40
older people off the road may be a natural consequence of providing free bus passes andsubsidised rail fares but13 the growth in the pavement13 scooter industry demonstrates that13 older people value their independence and will do almost13 anything to get13 out13 and aboutPerhaps legislation will result13 in more regulation of electric vehicles and where they cantravel
There can be no doubt13 that13 getting out13 will be associated with better quality of life andwell-shy‐being and this is likely to be supported in the future as evidence of improvedoutcomes emerges It is to be hoped that13 positive stories will be publicised so that13 publicattitudes arenrsquot13 hardened This may be supported by more in-shy‐car monitoring of drivers andthe linking of performance with on-shy‐line driving records and licences These could throughremotely monitored ignition systems prevent13 the use of motor vehicles by people without13 a licence or without13 insurance
313 Climate change
There is a general view that13 the emissions of carbon gases are contributing to globalwarming in a manner that13 will change the UK climate in such a way that13 the climate maybecome more Mediterranean However some scientists believe that13 manrsquos impact13 on theenvironment13 may be small compared with natural variations caused for example bycyclical changes in the sunrsquos energy output13 or by the effects of volcanoes and earthquakesRecent13 evidence has suggested that13 we are going through a phase of changing extremesand that13 this is more likely to cause storms periods of excessive rainfall and unusualseasonal trends with snow and frost13 in the spring and warmer winters Considerableuncertainty remains and it13 might13 be necessary to plan for a number of different13 scenariosand for the impact13 on vulnerable people
I Colder winters UK properties are poorly insulated resulting in excess mortalitiesduring cold spells due to an increased number of people suffering from stroke aswell as bronchitis and other pulmonary diseases The cost13 of heating continues toincrease putting more households into a state of fuel poverty Any further coolingduring the winter months will result13 in more people living in unhealthy coldconditions Winter fuel payments are likely to be restricted to the poorest13 peoplebut13 this might13 exclude people who live in larger properties that13 are more difficult13 toheat
II More storms excessive winds and rain can cause flooding at any time of the yearMany UK communities are built13 close to rivers and these can surge during heavyrainfall causing houses to be filled with water and furniture and carpets lostInsurance can be problematic for properties built13 on flood plains which can blight13 properties and prevent13 owners from being able to sell and move on High winds canrip off roofs causing injury and also causing families to be left13 homeless anddependent13 on social services
III Hot13 summers Europe suffered high temperatures during the summers of 2003 and2004 leading to heat13 stroke and hypothermia The UK has not13 previously sufferedfrom such problems but13 might13 be expected to experience days of extreme
41
temperature and humidity at times Older people may not13 be prepared for suchweather Street13 dwellers may be unable to find shade and supplies of drinkingwater
Irrespective of what13 combination of weather scenarios arise it13 must13 be concluded that13 any extremes will have a major negative impact13 on vulnerable people especially if theyare not13 prepared because they havenrsquot13 received the weather warnings and advice that13 can be broadcast13 using the TV radio and online services Once again the digitallyexcluded will suffer and will pay a high cost Society will continue to pick up the bill interms of demands on social care services unless preventive actions are taken in theform of connecting these people to each other and to formal services
42
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
s13 13
13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
n13 13
13 s13
r13 n13
e13 at13
e13 y13 e13 ld13
ly13
13 e13 t13 e13
s13 er13 e13
f13
rt13 13
13 13
13
r13 13
s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
e13 g13 13
e13
13 13 ial13
13
d13
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d13 13
s13 y13
e13
13
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proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
more than the combined budgets of the NHS and social care Maintaining or extending thisprovision will help to support13 services in the future and may be supported by technology
Whilst13 there is ample evidence to suggest13 that13 telecare services support13 informal carers asmuch as (if not13 more than) the people that13 they are caring for it13 is the potential for utilisingthe internet13 and apps to make their role easier to coordinate and hence more effectivethat13 is likely to be most13 successful moving forward
Many of these focus on particular tasks that13 informal carers can help offer to older peoplesuch as organising their medication A pillbox program is just13 one feature of an app calledBalance It also includes sections for caregiving tips notes for the doctor and the patientsappointments plus a lsquolearning sectionrsquo with articles on aspects of Alzheimers and an RSSfeed for news about13 the disease Tyze is another multi-shy‐functional app it13 allows carers to
bull Organise appointmentsbull Plan outingsbull Share storiesbull Send updates to other family members
Another application is Rally Round which helps carers to organise someone to perform littlejobs often on a temporary basis when someone has dementia physical frailty or isrecovering from accident13 or illness Similar applications are MeMaxi and Finerday
35 The High13 Street
The shape and appearance of UK shopping centres have been changing for half a centuryPeople complain that13 centres are losing their identity with one town looking like everyother both in terms of the stores and in terms of the layout But13 there are three trendswhich are having a profound impact13 on many of the most13 vulnerable people in society
bull Centres lock their doors at 6pm or in some cases 10pm -shy‐ thus denying people whosuffer from claustrophobia13 from window shopping at times when other shoppershave left
bull Out13 of town shopping malls -shy‐ these US style centres are ideal for people in carsbecause they offer free parking which is essential for people who want13 to buy largeritems but13 difficult13 for people who have no transport13 and who must13 rely on publictransport13 that13 is often deficient
bull The rise of online shopping -shy‐ which means that13 many potential shoppers only visit13 High Street13 stores to check the prices before returning home to make a purchaseonline
It is the third of these effects that13 has the greatest13 potential for changing the High Street13 forever and it13 is making life for traditional retailers increasingly difficult13 at a time when highrents are crippling stores large and small It is difficult13 to see how this trend is likely tochange because consolidation in banking and estate agencies is already forcing the closure
31
of other High Street13 players while additional pressures on pubs has led to the closure ofthousands of pubs every year
Those figures however demonstrate that13 consumers still value what13 the high street13 canoffer -shy‐ the chance to inspect13 what13 theyrsquore thinking of buying -shy‐ as well as the new opennessof the internet Customer service makes a difference to people especially if there is aproblem and goods need to be returned One of the most13 common reasons for furniture tobe returned for example is that13 when a sofa13 or a wardrobe was delivered it13 couldnrsquot13 fit13 through the front13 door or up the stairs In the future people will be able to benefit from13 visualisation technology they will upload the floor plans of their homes enabling theretailer to inform them of the problem before they try to delivery Augmented reality viewwill similarly allow customers to see what13 a new item of furniture will look like in itsintended place so that13 they can be more informed about13 the effect13 of size and colour
In terms of improving the viability of the High Street stores will have to focus on theimportance of brand which could mean that13 individual independent13 retailers will have topartner with national suppliers to support13 a local tailored offering based on products that13 are designed for a more global market This is a lsquoconnected High Streetrsquo approach whichcould be enabled by the developments in internet13 availability and smart13 phone accessdescribed in the previous section
The overall effect13 of all these changes could mean that13 town centres become smaller but13 more vibrant13 areas They could thrive if people are attracted there in large numbers whichmeans that13 retail must13 be developed alongside restaurants pubs galleries and other leisureopportunities This is possible in new shopping centres which are already being integratedwith transport13 hubs including railway and bus stations but13 may be more of a design13 challenge for older towns and cities with large Victorian buildings To ensure that13 morepeople are welcomed into the new centres they should include attention to green spacesand areas where people can relax without13 feeling that13 they are second class citizensbecause they donrsquot13 have the same buying power
3513 Privacy
To some people privacy is their right13 to live their lives without13 interference they may seethe State as a potential lsquoBig Brotherrsquo spying on their every move and judging their actions13 and activities Other people have fewer concerns about13 the role of the State but13 great13 fearof individuals interfering with and invading their privacy Some embrace the concept13 of lsquomyspacersquo an area13 of a square metre or so into which nobody can enter without13 permissionThis allows them to avoid physical contact13 and to feel safe from any form of threateningbehaviour
Yet13 this idea13 of private space and its potential violation is merely the tip of the iceberg asfar as privacy is concerned more significant13 is the idea13 of personal (and private)information being shared with anyone and everyone This could be related to identityopinion or image for an individual who wants to remain anonymous or even secretive thisis going to become an increasing problem as technology provides the means of taking
32
photographs recording conversations and capturing environment13 with something as smalland ubiquitous as a mobile phone The fact13 that13 this information can then be shared withthe rest13 of the world using e-shy‐mail Twitter and Facebook makes the problem all the moredifficult So the threat13 is no longer solely from the long lenses of the Paparazzi but13 fromanyone (and that13 means everyone) who has even the most13 basic of mobile phones
This relates to the changing views of society on what13 information should remain privateand what13 should be shared with others The success of social media13 has been based on anattitude of lsquosharing everythingrsquo with either your friends or the world This has introduced anaiumlve idea13 in the minds of some younger people (especially those known as Millennials ieaged 18-shy‐30) that13 everyone can be their friends whilst13 perhaps failing to reinforce the bondsof genuine friendship with any form of test13 or restriction Technology could play a role indefining these friendships and allowing individuals to understand what13 makes a goodfriend but13 this approach has yet13 to be developed and may be slow to overcome the needfor some people to measure their own popularity simply as the number of people that13 theycan list13 as friends on their Facebook page
It follows that13 there may be a need for a new definition of privacy that13 is in keeping withthe web and its ability to display images and opinion in an unregulated manner This needsto embrace past13 concerns about13 the ability of an individual to live without13 the threat13 ofothers being able to watch them whilst13 offering some protection from random postingsabout13 them online Perhaps this could include a right13 to be able to edit13 or remove anythingrelating to themselves on the Web including images that13 are not13 news-shy‐worthy Theownership of image rights may be an associated issue that13 needs to be addressedespecially as modern technology can remove an individual from a group (or a background)13 view provide digital touch-shy‐up or air-shy‐brushing and then republish it13 in a different13 contextHowever there is general agreement13 that13 personal information (such as contact13 details andbank codes) should not13 have a place on the web Surprisingly few people take proactivemeasures to prevent13 tracking functions being activated
It follows that13 too much privacy could lead to younger people fearing that13 they maybecome lost13 in a digital world It is not13 surprising then that13 they are prepared to make lots13 of personal information available often with no fear of how it13 might13 be used by othersWhen Google glasses and similar technologies become available during the next13 few yearsthey will have the potential to identify a stranger walking down the street and to find manyof their secrets to present13 to the wearer in a fraction of a second They could know moreabout13 them than their genuine friends know -shy‐ so who will be their friends in the future
36 Data sharing and13 protection
By lsquodata13 sharingrsquo we mean the disclosure of data13 held by one organisation on an individualto a third party organisation(s) or the sharing of data13 between different13 parts of anorganisation Some data13 sharing doesnrsquot13 involve personal data13 because it13 has beenanonymised in such a way that13 the statistics can be used for the collective good without13 theidentification of the individual The Data13 Protection Act13 (DPA) is in place to provide a legal
33
framework that13 ensures that13 organisations that13 hold personal data13 must13 act13 responsibly atall times These principles adequately describe the position of public and government13 bodies especially social services departments who are responsible for the informationconcerning the health and well-shy‐being of individuals -shy‐ and hence by implication thesensitive data13 relating to their vulnerability
The legal framework that13 applies to private and third sector organisations differs from that13 which applies to public sector organisations which may only act13 within the defined limits oftheir statutory powers However all bodies must13 comply fully with the data13 protectionprinciples and this situation is unlikely to change within the next13 10 to 15 years In someprivate sector contexts there are legal constraints on the disclosure of personal dataHowever most13 private and third sector organisations have a general ability to shareinformation provided this does not13 breach the DPA or any other law It is advisable for acompany to check its constitutional documents such as its memorandum and articles13 ofassociation to make sure there are no restrictions that13 would prevent13 it13 from sharingpersonal data13 in a particular context The type of data13 held is therefore a subject13 ofconcern as it13 may be difficult13 for legislation to keep up with the additional layers of data13 created on-shy‐line and through the Internet13 of Things
Private and third sector organisations should have regard to any industry-shy‐specific regulationor guidance about13 handling individualsrsquo information as this may affect13 the organisationrsquosability to share information They should also be aware of the legal issues that13 can arisewhen sharing personal data13 with public sector bodies This becomes more of an issue asprivate and third sector bodies are carrying out13 a wider range of traditionally public sectorfunctions Opportunities for inappropriate sharing of sensitive data13 will therefore inevitablyincrease
Public authorities must13 comply with the Human Rights Act13 (HRA) legislation in theperformance of their functions The HRA also applies to organisations in the private sectorinsofar as they carry out13 functions of a public nature which could include delivering a socialcare activity Where the HRA applies organisations must13 not13 act13 in a way that13 would beincompatible with rights under the European Convention on Human Rights Article 8 of theConvention giving everyone the right13 to respect13 for their private and family life their homeand their correspondence is especially relevant13 to sharing personal data If personal data13 isdisclosed or shared in ways that13 comply with the DPA the sharing or disclosure of that13 information is also likely to comply with the HRA The problem may still be in policing theActs and the rights of an individual if they believe that13 their personal data13 has been sharedor accessed by an inappropriate organisation or individual
A legal industry may be born to deal with such matters but13 this is unlikely to benefit13 peoplewho cannot13 afford the fees involved They would require either legal aid or to employ13 more13 lsquono win no feersquo companies Public attitudes to such costs might13 become negative unlessthey prove successful in preventing breaches of data13 security There may need to belegislation to provide a stronger basis for forcing compliance with privacy laws
34
37 Connecting with13 people
We are social creatures most13 of us rely on our friendships and interactions with friendsand families to share our happiest13 moments and experiences Research suggests that13 thishappiness is infectious at all levels and leads to a 15 increase in the happiness of a closecontact 10 for a second degree contact13 such as the friendrsquos spouse and a 6 increase fora friend of a friend It is hardly surprising that13 the success of social media13 such as Facebookis intimately related to the ability of people to quickly share their happiest13 moments with asmany of their friends and connections as possible
All this has happened during the rise of the Internet13 and the corresponding increase inopportunities for connecting online ie this is a 21st Century phenomenon which has beenfacilitated by Information and Communications Technology But13 the Internet13 remains in itsinfancy and we are only beginning to understand and exploit13 its potential In terms ofaccessing the Internet there are now perhaps two billion people who have access with99 of them having gained this during the past13 decade This number will have doubled bythe period 2020 to 2025 It is likely that13 everyone who wants to be connected in the UK willby then be connected Turning this on its head only those who donrsquot13 want13 to be online willnot13 be on the Internet13 within a decade Connecting with the unconnected will therefore bea case of identifying those people who donrsquot13 want13 to be found unfortunately these mayinclude many people who need the support13 of social care organisations It means that13 theywill be looking for support13 only when they are in crisis unless other ways of finding andormonitoring them are found
While the number of people connected via the Internet13 has exploded this might13 bedwarfed by the number of connected lsquothingsrsquo During 2009 the number of thingsconnected to the Internet13 surpassed the number of connected people at which point13 webegan to experience what13 this report13 has described as the lsquoInternet13 of Thingsrsquo Yet 99 ofall physical objects that13 could join this network are not13 yet13 connected but13 the number couldgrow by 25 every year for the next13 decade so that13 there could be 100 billion connectedobjects by 2025 some of which will be owned or used by everyone in the UK includingthose people who donrsquot13 want13 to be connected themselves We will then have an Internet13 of Everything which will be the smart13 connection of people data events and actions
With each new person object or data13 that13 comes online the connection possibilitiesbetween all these elements grows exponentially The rise of big data mobile networkingcloud storage and data13 mining technologies will all play a critical role in the Internet13 ofEverything The result13 will be new capabilities richer experiences and unprecedentedvalue for individuals businesses communities and countries everywhere The lsquonetworkeffectrsquo of the Internet13 of Everything will be a very powerful thing the true impact13 of whichwe wonrsquot13 fully understand for several years As it13 develops however those who are not13 connected will feel even more digitally and socially excluded There will be a need to reachout13 to vulnerable people unless the process of claiming requires proof of online identityand the payments to be received can only be redeemed using a chipped card or adownloaded app onto a smartphone This is of course the way that13 welfare arrangementsare already developing thus it13 might13 prove impossible to make a successful claim without13
35
already being connected to lsquothe systemrsquo either through an online presence or through theInternet13 of Things
38 Downloading everything
Sixty years ago information was discovered by reading books often in a library wherenotes had to be made because the books or journals couldnrsquot13 be removed Then in theearly 1960s the first13 office photocopying machines were introduced into the UK theyimmediately meant13 that13 pages or articles from books could be copied and taken away to beread and summarised later Within a few years photocopying became a replacement13 forreading as researchers became less adept13 at selecting a few sentences and every deskbecame a depository for reams of printed paper Paper became the means of recordingeverything from bank statements through to music
We now appreciate that13 printing everything is a waste of both the ink (or toner) used tocreate the black print13 and of paper which requires trees to be chopped down and pulpedbefore it13 can be pressed into thin sheets Saving paper is therefore seen as green and goodfor the planet Fortunately we no longer need to print13 everything because computermemory is unlimited thanks to the cloud and we can then view pages and articles onportable or fixed screens
The internet13 has everything and it13 is all available instantly for downloading providing thereis a device available to accept13 it and there is sufficient13 communication bandwidth toperform the transfer of data13 sufficiently quickly Thus we can record all text13 articles that13 are relevant13 to us including digital records of birth certificates qualifications and passportsand the need for original printed versions will decline But13 we can also do this forphotographs Most13 handheld computing devices include at least13 one camera so they cangenerate enormous number of pictures which can be kept13 for posterity without13 having toconsume inks and special papers to print13 them
But13 the materials that13 can be downloaded donrsquot13 stop at pictures software is available that13 can grab TV shows after they air and movies as soon as theyre released In the same wayit13 is possible to schedule music comic books video games and practically anything else asa download with minimal effort People will need enormous hard drives if they want13 theirown digital copies of these files so will more than likely make use of cloud storage that13 willbe available from many organisations The location of the servers may become sensitivedue to border restrictions as will the security of the data13 and the way that13 it13 is backed up sothat13 it13 is resilient13 to failures
It may be evident13 that13 application forms for all types of welfare payment13 will be availableonly for downloading so that once digitised they can be processed by computer andrecords sent13 to various servers for subsequent13 storage and processing Some people maywant13 to keep their data13 on them once it13 has been downloaded Pen drives can already holdseveral GB of data so it13 is likely that13 people will be able to carry their downloaded data13 withthem at all times irrespective of the size and complexities of the information
36
39 Health13 and13 well-shy‐being
The general health of the population is unlikely to deteriorate noticeably within 10 to 20years Indeed expectations of the population are that13 things must13 improve as surgicaltechniques mature and as pharmaceutical interventions become more personalised andpowerful However the rising demand for health services due to an ageing population andthe increasing cost13 of providing sophisticated therapies will make delivering a free anduniversal health service difficult13 without13 substantial increases in taxation This is unlikely tohappen in the UK even though spending on health services will be protected against13 thecuts facing other services
There will have to be changes in how the NHS works For twenty years hospitals have beenclosed and replaced by fewer new facilities so that13 the bed count13 is reduced This has led toa significant13 shift13 in resources to primary care and community care supporting shorter staysin hospital and speedier transfer back home for people after surgery or illness This hasbeen13 successful but13 there remain problems with demand for GP services especially out-shy‐of-shy‐hours and at weekends Indeed despite the introduction of NHS24 and similar help-shy‐linesthe demand for GP appointments continues to increase Delays are inevitable and this willincrease system failures with more unnecessary deaths and a failure for people to access adiagnosis that13 might13 lead to early interventions and ultimately lower delivery costs Over250 more patients are added to waiting lists every day
This will lead to a new model of primary care consistent13 with existing changes which haveseen surgeries move from High Street13 locations to medical centres close to bus routes andwith more parking for patients The process of making an appointment13 is changing from atelephone-shy‐based interview process dominated by a medically-shy‐unqualified receptionist13 to achoose and book approach using an online process linked to electronic patient13 records Thiswill give patients more convenience but13 will allow priority for those who have Internet13 access at the expensive of those who are digitally excluded Making the process of bookingan appointment13 quick and easy may also increase demand from people who do not13 need tobe seen as it13 will fail to identify those in greatest13 need
A greater use of telehealth and telecare technologies will be inevitable beginning with thefirst13 contact13 as an encounter using the telephone e-shy‐mail or video conferencing -shy‐ a visit13 tothe GP surgery should be a last13 resort and should involve a nurse consultation in the first13 instance This would be consistent13 with three quarters of appointments currently involvinga chronic disease or long term condition which relates to improved self-shy‐care The support13 ofthese patients at home should be prioritised through tele-shy‐ and web-shy‐based technologies andshould involve training and coaching through a network of nurse practitioners Home visitsshould generally be unnecessary through the use of these technologies but13 could besupplemented by satellite surgeries manned by nursing in community premises or inpharmacies nurseries and Internet13 cafes
The homes13 of people who13 need13 closer monitoring can then become part13 of virtual wardswith real or electronic visits by health professionals University Hospital Southampton NHSFoundation Trust13 already looks after patients who have undergone surgery such as a hip orknee13 replacements in virtual wards with high levels of satisfaction The Royal Free London
37
NHS Foundation Trust13 offers a similar service but13 plans to add the possibility of videoconsultations between patient13 and consultant
310 Attitudes to public health issues ndash obesity smoking alcohol abuse drugs
As self-shy‐care becomes the focus of the NHS the public will increasingly understand that13 thecosts and availability of services are being harmed by the poor health behaviour ofrelatively small numbers of people The link between public health initiatives today andhealthcare needs and costs in the future will become increasingly evident13 as a result13 of theway that13 information is presented Thus the overweight13 smoker who currently attractsconcern and pity when they are diagnosed with diabetes and COPD is increasingly beingseen as the victim of their own stupidity or lack of self-shy‐discipline If they continue to neglect13 medical advice and continue with an unhealthy lifestyle then the way that13 they receivetreatment13 and consume resources will become a matter for the entire population
Obesity is seen as due to a combination of poor diet13 and a sedentary lifestyle No longer isthe idea13 that13 people are lsquobig bonedrsquo acceptable Governments will respond initially byrequiring manufacturers and food processors to provide nutritional information onpackaging and on menus in restaurants But13 people can choose not13 to read the data13 and toneglect13 both the importance of food quality content13 and quantity This will increasepressure to introduce fat13 or sugar taxes and these are likely to be in force within a decade
Although the high taxes on tobacco products has forced some smokers to reduce theirconsumption or to give up altogether the impact13 has been reduced by the smuggling ofproducts from overseas and by the availability of duty-shy‐free cigarettes for people returningfrom foreign holidays and business meetings Further measures are planned to changepackaging and to include even more graphic images and warnings on cigarette packages tomake smokers aware of the effects of smoking on their health and well-shy‐being There is asyet little evidence of how successful this might13 be More effective has been the banning ofsmoking in public places including trains and aircraft Expensive medical interventions suchas heart13 transplants will be denied to individuals until they change their lifestyle behaviourSmokers might13 therefore be increasingly ostracised leading to a loss of esteem This mayhave a particular impact13 on people who already suffer from mental health problems whoare more likely to smoke
The overuse of alcohol is being recognised as a major factor in hospital admissions withNHS figures showing an increase of over 40 in such admissions over the past13 decadeLinked to this has been a 75 increase in prescriptions to treat13 alcohol dependency Fewpeople have sympathy for those who waste their limited income on booze If they havechildren or other dependents they will be the ones who suffer and who may need thesupport13 of social care
Drug users are already significant13 users of social services as their habit13 is likely to makethem unemployable They receive little sympathy from the general public because they areseen as criminals and people who waste public resources Levels of drug abuse have been
38
slowly increasing over the years but13 this trend is slowly being reversed Indeed the numberof people using drugs during the past13 year has fallen to its lowest13 level for nearly 20 years(below 9) with cannabis being most13 likely often following excessive drinking Aselectronic noses and other technologies can detect13 traces of drugs it13 seems likely that13 success in overcoming addiction can be measured objectively This may become a two-shy‐edged sword rewarding those who can turn around their lives but13 further marginalisingthose who canrsquot13 or wont13 accept13 the lsquocold turkeyrsquo
311 Attitudes to surveillance
Issues associated with privacy confidentiality and data13 security have been discussedpreviously in the context13 of information technology the World Wide Web and the ease ofcollecting recording recalling analysing and displaying data The monitoring of individualsand their methods of using this information can be regarded as surveillance As thequantities of data13 increase along with the number of devices that13 can be used to access itthe surveillance tools will also increase in their sophistication Indeed the Big Data13 approaches described in the previous section will enable the combination of structureddata13 (such as the information held in databases) to be married with unstructured data13 fromimages in such a way that13 it13 can be mined
Whilst13 the lsquodigital surveillancersquo methods described above may cause most13 concern topeople because of its impact13 on anonymity it13 is the collection and analysis of images that13 are the major concern to people as they contemplate the ways that13 lsquoBig Brotherrsquo maydevelop to restrict13 freedom Every major UK city and town centre has an array of CCTVcameras that13 continually record activities from every angle If it13 used to be true that13 nobody in London was more than 10 yards from a rat it13 is certainly the case today that13 nobody can be more than this distance from being in view of a surveillance camera Yetthey receive so much positive publicity from TV programmes where their footage is used todetect13 vehicles close to a crime scene or to monitor the movements of suspects that13 theyare now accepted by the public as a deterrent13 in the same way as lsquobobbies on the beatrsquowere seen 25 years ago There is therefore little public reaction to the expansion in the useof video surveillance except13 for the practical observation of how so many views can beinspected and recorded
Looking to the future the tumbling cost13 of video technology will surely lead to anotherincrease in the number of devices The aerial views taken from towers will besupplemented by more local views taken by devices that13 are embedded in the fabric ofbuildings or carried by individuals either on their person (for example on clothing orspectacles) or in the bags that13 they carry The time and date-shy‐stamped images as Big Datawill be recorded to lsquothe Cloudrsquo where it13 can be added to other data It can then be usedwhen an incident13 has occurred or to provide further detail of night-shy‐time activities
It follows that13 there will be no hiding place for people who simply want13 to disappear Theymay respond by wearing clothing (such as hoodies) that13 hide their faces or which make it13 difficult13 to distinguish gait13 or mannerisms from which they might13 be identified New forms
39
of clothing may be designed to make shapes more difficult13 to analyse and these might13 become the uniforms of a class of person who wants to live in a way that13 they donrsquot13 interact13 with officials from any ministry or local government13 department If they also obstruct13 services then they will be considered to be anarchists of some form sparking protests fromother sectors of society
31213 Attitudes to driving
Motor cars have been a feature of UK roads for over a century but13 it13 is only during the past13 50 years that13 they have become a resource that13 most13 families have had access to enablingthem to travel without13 the restrictions imposed by a limited railway network and non-shy‐integrated bus transport People who have had a car throughout13 their lives often see theircars as an important13 factor in enabling them to remain independent13 and to exercise choicesrelating to where they shop and where they spend their leisure time This extends to theirspouse and to friends and neighbours that13 they might13 take with them on their variousexpeditions
Unfortunately there are incidents involving older drivers who perhaps go down amotorway in the wrong direction who are taken ill at the wheel or who are involved in anaccident13 involving no other vehicles These are small in number but13 often lead to a reactionthat13 they shouldnrsquot13 be allowed to drive lsquoat13 their agersquo Age itself is not13 an indicator ofdriving quality but13 because old age also brings more chance of having limited long termconditions and other illnesses it13 is easy to make a link between driving ability and age Thelicensing system does require continued driving to be linked with medical advice andforbids people with poor eyesight epilepsy and other conditions to hold a licence in oldage
Yet13 statistically older drivers cause far fewer accidents than younger drivers The reasonsfor this may be complex and are likely to include the fact13 that13 they drive less often covershorter distances and donrsquot13 go out13 in the dark or in poor weather However it13 does not13 wholly explain why the UKrsquos drivers aged over 70 and who represent13 some 8 of all driversare involved in only 4 of accidents that13 cause injury This compares favourably with the15 of13 drivers aged between 17 and 29 who are involved in over a third of crashes that13 result13 in injury
By 2020 the number of drivers aged over 70 on UK roads is likely to increase to over 7million This will require a new national strategy perhaps involving support13 for olderdrivers further training raising awareness of issues and making more use of adaptivetechnologies to support13 the driver in avoiding collision or forgetting to check on the statusof their vehicle Poor eyesight13 could be enhanced by camera technologies rather thanforcing people off the road if they are unable to read a licence plate
The International Longevity Centre has found that13 one in four Britons thought13 driversshould be made to switch off the ignition for good somewhere between the ages of 70 and75 The numbers may decrease as the population ages and as cars become safer Forcing
40
older people off the road may be a natural consequence of providing free bus passes andsubsidised rail fares but13 the growth in the pavement13 scooter industry demonstrates that13 older people value their independence and will do almost13 anything to get13 out13 and aboutPerhaps legislation will result13 in more regulation of electric vehicles and where they cantravel
There can be no doubt13 that13 getting out13 will be associated with better quality of life andwell-shy‐being and this is likely to be supported in the future as evidence of improvedoutcomes emerges It is to be hoped that13 positive stories will be publicised so that13 publicattitudes arenrsquot13 hardened This may be supported by more in-shy‐car monitoring of drivers andthe linking of performance with on-shy‐line driving records and licences These could throughremotely monitored ignition systems prevent13 the use of motor vehicles by people without13 a licence or without13 insurance
313 Climate change
There is a general view that13 the emissions of carbon gases are contributing to globalwarming in a manner that13 will change the UK climate in such a way that13 the climate maybecome more Mediterranean However some scientists believe that13 manrsquos impact13 on theenvironment13 may be small compared with natural variations caused for example bycyclical changes in the sunrsquos energy output13 or by the effects of volcanoes and earthquakesRecent13 evidence has suggested that13 we are going through a phase of changing extremesand that13 this is more likely to cause storms periods of excessive rainfall and unusualseasonal trends with snow and frost13 in the spring and warmer winters Considerableuncertainty remains and it13 might13 be necessary to plan for a number of different13 scenariosand for the impact13 on vulnerable people
I Colder winters UK properties are poorly insulated resulting in excess mortalitiesduring cold spells due to an increased number of people suffering from stroke aswell as bronchitis and other pulmonary diseases The cost13 of heating continues toincrease putting more households into a state of fuel poverty Any further coolingduring the winter months will result13 in more people living in unhealthy coldconditions Winter fuel payments are likely to be restricted to the poorest13 peoplebut13 this might13 exclude people who live in larger properties that13 are more difficult13 toheat
II More storms excessive winds and rain can cause flooding at any time of the yearMany UK communities are built13 close to rivers and these can surge during heavyrainfall causing houses to be filled with water and furniture and carpets lostInsurance can be problematic for properties built13 on flood plains which can blight13 properties and prevent13 owners from being able to sell and move on High winds canrip off roofs causing injury and also causing families to be left13 homeless anddependent13 on social services
III Hot13 summers Europe suffered high temperatures during the summers of 2003 and2004 leading to heat13 stroke and hypothermia The UK has not13 previously sufferedfrom such problems but13 might13 be expected to experience days of extreme
41
temperature and humidity at times Older people may not13 be prepared for suchweather Street13 dwellers may be unable to find shade and supplies of drinkingwater
Irrespective of what13 combination of weather scenarios arise it13 must13 be concluded that13 any extremes will have a major negative impact13 on vulnerable people especially if theyare not13 prepared because they havenrsquot13 received the weather warnings and advice that13 can be broadcast13 using the TV radio and online services Once again the digitallyexcluded will suffer and will pay a high cost Society will continue to pick up the bill interms of demands on social care services unless preventive actions are taken in theform of connecting these people to each other and to formal services
42
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
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13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
n13 13
13 s13
r13 n13
e13 at13
e13 y13 e13 ld13
ly13
13 e13 t13 e13
s13 er13 e13
f13
rt13 13
13 13
13
r13 13
s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
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e13
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proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
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13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
of other High Street13 players while additional pressures on pubs has led to the closure ofthousands of pubs every year
Those figures however demonstrate that13 consumers still value what13 the high street13 canoffer -shy‐ the chance to inspect13 what13 theyrsquore thinking of buying -shy‐ as well as the new opennessof the internet Customer service makes a difference to people especially if there is aproblem and goods need to be returned One of the most13 common reasons for furniture tobe returned for example is that13 when a sofa13 or a wardrobe was delivered it13 couldnrsquot13 fit13 through the front13 door or up the stairs In the future people will be able to benefit from13 visualisation technology they will upload the floor plans of their homes enabling theretailer to inform them of the problem before they try to delivery Augmented reality viewwill similarly allow customers to see what13 a new item of furniture will look like in itsintended place so that13 they can be more informed about13 the effect13 of size and colour
In terms of improving the viability of the High Street stores will have to focus on theimportance of brand which could mean that13 individual independent13 retailers will have topartner with national suppliers to support13 a local tailored offering based on products that13 are designed for a more global market This is a lsquoconnected High Streetrsquo approach whichcould be enabled by the developments in internet13 availability and smart13 phone accessdescribed in the previous section
The overall effect13 of all these changes could mean that13 town centres become smaller but13 more vibrant13 areas They could thrive if people are attracted there in large numbers whichmeans that13 retail must13 be developed alongside restaurants pubs galleries and other leisureopportunities This is possible in new shopping centres which are already being integratedwith transport13 hubs including railway and bus stations but13 may be more of a design13 challenge for older towns and cities with large Victorian buildings To ensure that13 morepeople are welcomed into the new centres they should include attention to green spacesand areas where people can relax without13 feeling that13 they are second class citizensbecause they donrsquot13 have the same buying power
3513 Privacy
To some people privacy is their right13 to live their lives without13 interference they may seethe State as a potential lsquoBig Brotherrsquo spying on their every move and judging their actions13 and activities Other people have fewer concerns about13 the role of the State but13 great13 fearof individuals interfering with and invading their privacy Some embrace the concept13 of lsquomyspacersquo an area13 of a square metre or so into which nobody can enter without13 permissionThis allows them to avoid physical contact13 and to feel safe from any form of threateningbehaviour
Yet13 this idea13 of private space and its potential violation is merely the tip of the iceberg asfar as privacy is concerned more significant13 is the idea13 of personal (and private)information being shared with anyone and everyone This could be related to identityopinion or image for an individual who wants to remain anonymous or even secretive thisis going to become an increasing problem as technology provides the means of taking
32
photographs recording conversations and capturing environment13 with something as smalland ubiquitous as a mobile phone The fact13 that13 this information can then be shared withthe rest13 of the world using e-shy‐mail Twitter and Facebook makes the problem all the moredifficult So the threat13 is no longer solely from the long lenses of the Paparazzi but13 fromanyone (and that13 means everyone) who has even the most13 basic of mobile phones
This relates to the changing views of society on what13 information should remain privateand what13 should be shared with others The success of social media13 has been based on anattitude of lsquosharing everythingrsquo with either your friends or the world This has introduced anaiumlve idea13 in the minds of some younger people (especially those known as Millennials ieaged 18-shy‐30) that13 everyone can be their friends whilst13 perhaps failing to reinforce the bondsof genuine friendship with any form of test13 or restriction Technology could play a role indefining these friendships and allowing individuals to understand what13 makes a goodfriend but13 this approach has yet13 to be developed and may be slow to overcome the needfor some people to measure their own popularity simply as the number of people that13 theycan list13 as friends on their Facebook page
It follows that13 there may be a need for a new definition of privacy that13 is in keeping withthe web and its ability to display images and opinion in an unregulated manner This needsto embrace past13 concerns about13 the ability of an individual to live without13 the threat13 ofothers being able to watch them whilst13 offering some protection from random postingsabout13 them online Perhaps this could include a right13 to be able to edit13 or remove anythingrelating to themselves on the Web including images that13 are not13 news-shy‐worthy Theownership of image rights may be an associated issue that13 needs to be addressedespecially as modern technology can remove an individual from a group (or a background)13 view provide digital touch-shy‐up or air-shy‐brushing and then republish it13 in a different13 contextHowever there is general agreement13 that13 personal information (such as contact13 details andbank codes) should not13 have a place on the web Surprisingly few people take proactivemeasures to prevent13 tracking functions being activated
It follows that13 too much privacy could lead to younger people fearing that13 they maybecome lost13 in a digital world It is not13 surprising then that13 they are prepared to make lots13 of personal information available often with no fear of how it13 might13 be used by othersWhen Google glasses and similar technologies become available during the next13 few yearsthey will have the potential to identify a stranger walking down the street and to find manyof their secrets to present13 to the wearer in a fraction of a second They could know moreabout13 them than their genuine friends know -shy‐ so who will be their friends in the future
36 Data sharing and13 protection
By lsquodata13 sharingrsquo we mean the disclosure of data13 held by one organisation on an individualto a third party organisation(s) or the sharing of data13 between different13 parts of anorganisation Some data13 sharing doesnrsquot13 involve personal data13 because it13 has beenanonymised in such a way that13 the statistics can be used for the collective good without13 theidentification of the individual The Data13 Protection Act13 (DPA) is in place to provide a legal
33
framework that13 ensures that13 organisations that13 hold personal data13 must13 act13 responsibly atall times These principles adequately describe the position of public and government13 bodies especially social services departments who are responsible for the informationconcerning the health and well-shy‐being of individuals -shy‐ and hence by implication thesensitive data13 relating to their vulnerability
The legal framework that13 applies to private and third sector organisations differs from that13 which applies to public sector organisations which may only act13 within the defined limits oftheir statutory powers However all bodies must13 comply fully with the data13 protectionprinciples and this situation is unlikely to change within the next13 10 to 15 years In someprivate sector contexts there are legal constraints on the disclosure of personal dataHowever most13 private and third sector organisations have a general ability to shareinformation provided this does not13 breach the DPA or any other law It is advisable for acompany to check its constitutional documents such as its memorandum and articles13 ofassociation to make sure there are no restrictions that13 would prevent13 it13 from sharingpersonal data13 in a particular context The type of data13 held is therefore a subject13 ofconcern as it13 may be difficult13 for legislation to keep up with the additional layers of data13 created on-shy‐line and through the Internet13 of Things
Private and third sector organisations should have regard to any industry-shy‐specific regulationor guidance about13 handling individualsrsquo information as this may affect13 the organisationrsquosability to share information They should also be aware of the legal issues that13 can arisewhen sharing personal data13 with public sector bodies This becomes more of an issue asprivate and third sector bodies are carrying out13 a wider range of traditionally public sectorfunctions Opportunities for inappropriate sharing of sensitive data13 will therefore inevitablyincrease
Public authorities must13 comply with the Human Rights Act13 (HRA) legislation in theperformance of their functions The HRA also applies to organisations in the private sectorinsofar as they carry out13 functions of a public nature which could include delivering a socialcare activity Where the HRA applies organisations must13 not13 act13 in a way that13 would beincompatible with rights under the European Convention on Human Rights Article 8 of theConvention giving everyone the right13 to respect13 for their private and family life their homeand their correspondence is especially relevant13 to sharing personal data If personal data13 isdisclosed or shared in ways that13 comply with the DPA the sharing or disclosure of that13 information is also likely to comply with the HRA The problem may still be in policing theActs and the rights of an individual if they believe that13 their personal data13 has been sharedor accessed by an inappropriate organisation or individual
A legal industry may be born to deal with such matters but13 this is unlikely to benefit13 peoplewho cannot13 afford the fees involved They would require either legal aid or to employ13 more13 lsquono win no feersquo companies Public attitudes to such costs might13 become negative unlessthey prove successful in preventing breaches of data13 security There may need to belegislation to provide a stronger basis for forcing compliance with privacy laws
34
37 Connecting with13 people
We are social creatures most13 of us rely on our friendships and interactions with friendsand families to share our happiest13 moments and experiences Research suggests that13 thishappiness is infectious at all levels and leads to a 15 increase in the happiness of a closecontact 10 for a second degree contact13 such as the friendrsquos spouse and a 6 increase fora friend of a friend It is hardly surprising that13 the success of social media13 such as Facebookis intimately related to the ability of people to quickly share their happiest13 moments with asmany of their friends and connections as possible
All this has happened during the rise of the Internet13 and the corresponding increase inopportunities for connecting online ie this is a 21st Century phenomenon which has beenfacilitated by Information and Communications Technology But13 the Internet13 remains in itsinfancy and we are only beginning to understand and exploit13 its potential In terms ofaccessing the Internet there are now perhaps two billion people who have access with99 of them having gained this during the past13 decade This number will have doubled bythe period 2020 to 2025 It is likely that13 everyone who wants to be connected in the UK willby then be connected Turning this on its head only those who donrsquot13 want13 to be online willnot13 be on the Internet13 within a decade Connecting with the unconnected will therefore bea case of identifying those people who donrsquot13 want13 to be found unfortunately these mayinclude many people who need the support13 of social care organisations It means that13 theywill be looking for support13 only when they are in crisis unless other ways of finding andormonitoring them are found
While the number of people connected via the Internet13 has exploded this might13 bedwarfed by the number of connected lsquothingsrsquo During 2009 the number of thingsconnected to the Internet13 surpassed the number of connected people at which point13 webegan to experience what13 this report13 has described as the lsquoInternet13 of Thingsrsquo Yet 99 ofall physical objects that13 could join this network are not13 yet13 connected but13 the number couldgrow by 25 every year for the next13 decade so that13 there could be 100 billion connectedobjects by 2025 some of which will be owned or used by everyone in the UK includingthose people who donrsquot13 want13 to be connected themselves We will then have an Internet13 of Everything which will be the smart13 connection of people data events and actions
With each new person object or data13 that13 comes online the connection possibilitiesbetween all these elements grows exponentially The rise of big data mobile networkingcloud storage and data13 mining technologies will all play a critical role in the Internet13 ofEverything The result13 will be new capabilities richer experiences and unprecedentedvalue for individuals businesses communities and countries everywhere The lsquonetworkeffectrsquo of the Internet13 of Everything will be a very powerful thing the true impact13 of whichwe wonrsquot13 fully understand for several years As it13 develops however those who are not13 connected will feel even more digitally and socially excluded There will be a need to reachout13 to vulnerable people unless the process of claiming requires proof of online identityand the payments to be received can only be redeemed using a chipped card or adownloaded app onto a smartphone This is of course the way that13 welfare arrangementsare already developing thus it13 might13 prove impossible to make a successful claim without13
35
already being connected to lsquothe systemrsquo either through an online presence or through theInternet13 of Things
38 Downloading everything
Sixty years ago information was discovered by reading books often in a library wherenotes had to be made because the books or journals couldnrsquot13 be removed Then in theearly 1960s the first13 office photocopying machines were introduced into the UK theyimmediately meant13 that13 pages or articles from books could be copied and taken away to beread and summarised later Within a few years photocopying became a replacement13 forreading as researchers became less adept13 at selecting a few sentences and every deskbecame a depository for reams of printed paper Paper became the means of recordingeverything from bank statements through to music
We now appreciate that13 printing everything is a waste of both the ink (or toner) used tocreate the black print13 and of paper which requires trees to be chopped down and pulpedbefore it13 can be pressed into thin sheets Saving paper is therefore seen as green and goodfor the planet Fortunately we no longer need to print13 everything because computermemory is unlimited thanks to the cloud and we can then view pages and articles onportable or fixed screens
The internet13 has everything and it13 is all available instantly for downloading providing thereis a device available to accept13 it and there is sufficient13 communication bandwidth toperform the transfer of data13 sufficiently quickly Thus we can record all text13 articles that13 are relevant13 to us including digital records of birth certificates qualifications and passportsand the need for original printed versions will decline But13 we can also do this forphotographs Most13 handheld computing devices include at least13 one camera so they cangenerate enormous number of pictures which can be kept13 for posterity without13 having toconsume inks and special papers to print13 them
But13 the materials that13 can be downloaded donrsquot13 stop at pictures software is available that13 can grab TV shows after they air and movies as soon as theyre released In the same wayit13 is possible to schedule music comic books video games and practically anything else asa download with minimal effort People will need enormous hard drives if they want13 theirown digital copies of these files so will more than likely make use of cloud storage that13 willbe available from many organisations The location of the servers may become sensitivedue to border restrictions as will the security of the data13 and the way that13 it13 is backed up sothat13 it13 is resilient13 to failures
It may be evident13 that13 application forms for all types of welfare payment13 will be availableonly for downloading so that once digitised they can be processed by computer andrecords sent13 to various servers for subsequent13 storage and processing Some people maywant13 to keep their data13 on them once it13 has been downloaded Pen drives can already holdseveral GB of data so it13 is likely that13 people will be able to carry their downloaded data13 withthem at all times irrespective of the size and complexities of the information
36
39 Health13 and13 well-shy‐being
The general health of the population is unlikely to deteriorate noticeably within 10 to 20years Indeed expectations of the population are that13 things must13 improve as surgicaltechniques mature and as pharmaceutical interventions become more personalised andpowerful However the rising demand for health services due to an ageing population andthe increasing cost13 of providing sophisticated therapies will make delivering a free anduniversal health service difficult13 without13 substantial increases in taxation This is unlikely tohappen in the UK even though spending on health services will be protected against13 thecuts facing other services
There will have to be changes in how the NHS works For twenty years hospitals have beenclosed and replaced by fewer new facilities so that13 the bed count13 is reduced This has led toa significant13 shift13 in resources to primary care and community care supporting shorter staysin hospital and speedier transfer back home for people after surgery or illness This hasbeen13 successful but13 there remain problems with demand for GP services especially out-shy‐of-shy‐hours and at weekends Indeed despite the introduction of NHS24 and similar help-shy‐linesthe demand for GP appointments continues to increase Delays are inevitable and this willincrease system failures with more unnecessary deaths and a failure for people to access adiagnosis that13 might13 lead to early interventions and ultimately lower delivery costs Over250 more patients are added to waiting lists every day
This will lead to a new model of primary care consistent13 with existing changes which haveseen surgeries move from High Street13 locations to medical centres close to bus routes andwith more parking for patients The process of making an appointment13 is changing from atelephone-shy‐based interview process dominated by a medically-shy‐unqualified receptionist13 to achoose and book approach using an online process linked to electronic patient13 records Thiswill give patients more convenience but13 will allow priority for those who have Internet13 access at the expensive of those who are digitally excluded Making the process of bookingan appointment13 quick and easy may also increase demand from people who do not13 need tobe seen as it13 will fail to identify those in greatest13 need
A greater use of telehealth and telecare technologies will be inevitable beginning with thefirst13 contact13 as an encounter using the telephone e-shy‐mail or video conferencing -shy‐ a visit13 tothe GP surgery should be a last13 resort and should involve a nurse consultation in the first13 instance This would be consistent13 with three quarters of appointments currently involvinga chronic disease or long term condition which relates to improved self-shy‐care The support13 ofthese patients at home should be prioritised through tele-shy‐ and web-shy‐based technologies andshould involve training and coaching through a network of nurse practitioners Home visitsshould generally be unnecessary through the use of these technologies but13 could besupplemented by satellite surgeries manned by nursing in community premises or inpharmacies nurseries and Internet13 cafes
The homes13 of people who13 need13 closer monitoring can then become part13 of virtual wardswith real or electronic visits by health professionals University Hospital Southampton NHSFoundation Trust13 already looks after patients who have undergone surgery such as a hip orknee13 replacements in virtual wards with high levels of satisfaction The Royal Free London
37
NHS Foundation Trust13 offers a similar service but13 plans to add the possibility of videoconsultations between patient13 and consultant
310 Attitudes to public health issues ndash obesity smoking alcohol abuse drugs
As self-shy‐care becomes the focus of the NHS the public will increasingly understand that13 thecosts and availability of services are being harmed by the poor health behaviour ofrelatively small numbers of people The link between public health initiatives today andhealthcare needs and costs in the future will become increasingly evident13 as a result13 of theway that13 information is presented Thus the overweight13 smoker who currently attractsconcern and pity when they are diagnosed with diabetes and COPD is increasingly beingseen as the victim of their own stupidity or lack of self-shy‐discipline If they continue to neglect13 medical advice and continue with an unhealthy lifestyle then the way that13 they receivetreatment13 and consume resources will become a matter for the entire population
Obesity is seen as due to a combination of poor diet13 and a sedentary lifestyle No longer isthe idea13 that13 people are lsquobig bonedrsquo acceptable Governments will respond initially byrequiring manufacturers and food processors to provide nutritional information onpackaging and on menus in restaurants But13 people can choose not13 to read the data13 and toneglect13 both the importance of food quality content13 and quantity This will increasepressure to introduce fat13 or sugar taxes and these are likely to be in force within a decade
Although the high taxes on tobacco products has forced some smokers to reduce theirconsumption or to give up altogether the impact13 has been reduced by the smuggling ofproducts from overseas and by the availability of duty-shy‐free cigarettes for people returningfrom foreign holidays and business meetings Further measures are planned to changepackaging and to include even more graphic images and warnings on cigarette packages tomake smokers aware of the effects of smoking on their health and well-shy‐being There is asyet little evidence of how successful this might13 be More effective has been the banning ofsmoking in public places including trains and aircraft Expensive medical interventions suchas heart13 transplants will be denied to individuals until they change their lifestyle behaviourSmokers might13 therefore be increasingly ostracised leading to a loss of esteem This mayhave a particular impact13 on people who already suffer from mental health problems whoare more likely to smoke
The overuse of alcohol is being recognised as a major factor in hospital admissions withNHS figures showing an increase of over 40 in such admissions over the past13 decadeLinked to this has been a 75 increase in prescriptions to treat13 alcohol dependency Fewpeople have sympathy for those who waste their limited income on booze If they havechildren or other dependents they will be the ones who suffer and who may need thesupport13 of social care
Drug users are already significant13 users of social services as their habit13 is likely to makethem unemployable They receive little sympathy from the general public because they areseen as criminals and people who waste public resources Levels of drug abuse have been
38
slowly increasing over the years but13 this trend is slowly being reversed Indeed the numberof people using drugs during the past13 year has fallen to its lowest13 level for nearly 20 years(below 9) with cannabis being most13 likely often following excessive drinking Aselectronic noses and other technologies can detect13 traces of drugs it13 seems likely that13 success in overcoming addiction can be measured objectively This may become a two-shy‐edged sword rewarding those who can turn around their lives but13 further marginalisingthose who canrsquot13 or wont13 accept13 the lsquocold turkeyrsquo
311 Attitudes to surveillance
Issues associated with privacy confidentiality and data13 security have been discussedpreviously in the context13 of information technology the World Wide Web and the ease ofcollecting recording recalling analysing and displaying data The monitoring of individualsand their methods of using this information can be regarded as surveillance As thequantities of data13 increase along with the number of devices that13 can be used to access itthe surveillance tools will also increase in their sophistication Indeed the Big Data13 approaches described in the previous section will enable the combination of structureddata13 (such as the information held in databases) to be married with unstructured data13 fromimages in such a way that13 it13 can be mined
Whilst13 the lsquodigital surveillancersquo methods described above may cause most13 concern topeople because of its impact13 on anonymity it13 is the collection and analysis of images that13 are the major concern to people as they contemplate the ways that13 lsquoBig Brotherrsquo maydevelop to restrict13 freedom Every major UK city and town centre has an array of CCTVcameras that13 continually record activities from every angle If it13 used to be true that13 nobody in London was more than 10 yards from a rat it13 is certainly the case today that13 nobody can be more than this distance from being in view of a surveillance camera Yetthey receive so much positive publicity from TV programmes where their footage is used todetect13 vehicles close to a crime scene or to monitor the movements of suspects that13 theyare now accepted by the public as a deterrent13 in the same way as lsquobobbies on the beatrsquowere seen 25 years ago There is therefore little public reaction to the expansion in the useof video surveillance except13 for the practical observation of how so many views can beinspected and recorded
Looking to the future the tumbling cost13 of video technology will surely lead to anotherincrease in the number of devices The aerial views taken from towers will besupplemented by more local views taken by devices that13 are embedded in the fabric ofbuildings or carried by individuals either on their person (for example on clothing orspectacles) or in the bags that13 they carry The time and date-shy‐stamped images as Big Datawill be recorded to lsquothe Cloudrsquo where it13 can be added to other data It can then be usedwhen an incident13 has occurred or to provide further detail of night-shy‐time activities
It follows that13 there will be no hiding place for people who simply want13 to disappear Theymay respond by wearing clothing (such as hoodies) that13 hide their faces or which make it13 difficult13 to distinguish gait13 or mannerisms from which they might13 be identified New forms
39
of clothing may be designed to make shapes more difficult13 to analyse and these might13 become the uniforms of a class of person who wants to live in a way that13 they donrsquot13 interact13 with officials from any ministry or local government13 department If they also obstruct13 services then they will be considered to be anarchists of some form sparking protests fromother sectors of society
31213 Attitudes to driving
Motor cars have been a feature of UK roads for over a century but13 it13 is only during the past13 50 years that13 they have become a resource that13 most13 families have had access to enablingthem to travel without13 the restrictions imposed by a limited railway network and non-shy‐integrated bus transport People who have had a car throughout13 their lives often see theircars as an important13 factor in enabling them to remain independent13 and to exercise choicesrelating to where they shop and where they spend their leisure time This extends to theirspouse and to friends and neighbours that13 they might13 take with them on their variousexpeditions
Unfortunately there are incidents involving older drivers who perhaps go down amotorway in the wrong direction who are taken ill at the wheel or who are involved in anaccident13 involving no other vehicles These are small in number but13 often lead to a reactionthat13 they shouldnrsquot13 be allowed to drive lsquoat13 their agersquo Age itself is not13 an indicator ofdriving quality but13 because old age also brings more chance of having limited long termconditions and other illnesses it13 is easy to make a link between driving ability and age Thelicensing system does require continued driving to be linked with medical advice andforbids people with poor eyesight epilepsy and other conditions to hold a licence in oldage
Yet13 statistically older drivers cause far fewer accidents than younger drivers The reasonsfor this may be complex and are likely to include the fact13 that13 they drive less often covershorter distances and donrsquot13 go out13 in the dark or in poor weather However it13 does not13 wholly explain why the UKrsquos drivers aged over 70 and who represent13 some 8 of all driversare involved in only 4 of accidents that13 cause injury This compares favourably with the15 of13 drivers aged between 17 and 29 who are involved in over a third of crashes that13 result13 in injury
By 2020 the number of drivers aged over 70 on UK roads is likely to increase to over 7million This will require a new national strategy perhaps involving support13 for olderdrivers further training raising awareness of issues and making more use of adaptivetechnologies to support13 the driver in avoiding collision or forgetting to check on the statusof their vehicle Poor eyesight13 could be enhanced by camera technologies rather thanforcing people off the road if they are unable to read a licence plate
The International Longevity Centre has found that13 one in four Britons thought13 driversshould be made to switch off the ignition for good somewhere between the ages of 70 and75 The numbers may decrease as the population ages and as cars become safer Forcing
40
older people off the road may be a natural consequence of providing free bus passes andsubsidised rail fares but13 the growth in the pavement13 scooter industry demonstrates that13 older people value their independence and will do almost13 anything to get13 out13 and aboutPerhaps legislation will result13 in more regulation of electric vehicles and where they cantravel
There can be no doubt13 that13 getting out13 will be associated with better quality of life andwell-shy‐being and this is likely to be supported in the future as evidence of improvedoutcomes emerges It is to be hoped that13 positive stories will be publicised so that13 publicattitudes arenrsquot13 hardened This may be supported by more in-shy‐car monitoring of drivers andthe linking of performance with on-shy‐line driving records and licences These could throughremotely monitored ignition systems prevent13 the use of motor vehicles by people without13 a licence or without13 insurance
313 Climate change
There is a general view that13 the emissions of carbon gases are contributing to globalwarming in a manner that13 will change the UK climate in such a way that13 the climate maybecome more Mediterranean However some scientists believe that13 manrsquos impact13 on theenvironment13 may be small compared with natural variations caused for example bycyclical changes in the sunrsquos energy output13 or by the effects of volcanoes and earthquakesRecent13 evidence has suggested that13 we are going through a phase of changing extremesand that13 this is more likely to cause storms periods of excessive rainfall and unusualseasonal trends with snow and frost13 in the spring and warmer winters Considerableuncertainty remains and it13 might13 be necessary to plan for a number of different13 scenariosand for the impact13 on vulnerable people
I Colder winters UK properties are poorly insulated resulting in excess mortalitiesduring cold spells due to an increased number of people suffering from stroke aswell as bronchitis and other pulmonary diseases The cost13 of heating continues toincrease putting more households into a state of fuel poverty Any further coolingduring the winter months will result13 in more people living in unhealthy coldconditions Winter fuel payments are likely to be restricted to the poorest13 peoplebut13 this might13 exclude people who live in larger properties that13 are more difficult13 toheat
II More storms excessive winds and rain can cause flooding at any time of the yearMany UK communities are built13 close to rivers and these can surge during heavyrainfall causing houses to be filled with water and furniture and carpets lostInsurance can be problematic for properties built13 on flood plains which can blight13 properties and prevent13 owners from being able to sell and move on High winds canrip off roofs causing injury and also causing families to be left13 homeless anddependent13 on social services
III Hot13 summers Europe suffered high temperatures during the summers of 2003 and2004 leading to heat13 stroke and hypothermia The UK has not13 previously sufferedfrom such problems but13 might13 be expected to experience days of extreme
41
temperature and humidity at times Older people may not13 be prepared for suchweather Street13 dwellers may be unable to find shade and supplies of drinkingwater
Irrespective of what13 combination of weather scenarios arise it13 must13 be concluded that13 any extremes will have a major negative impact13 on vulnerable people especially if theyare not13 prepared because they havenrsquot13 received the weather warnings and advice that13 can be broadcast13 using the TV radio and online services Once again the digitallyexcluded will suffer and will pay a high cost Society will continue to pick up the bill interms of demands on social care services unless preventive actions are taken in theform of connecting these people to each other and to formal services
42
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
s13 13
13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
n13 13
13 s13
r13 n13
e13 at13
e13 y13 e13 ld13
ly13
13 e13 t13 e13
s13 er13 e13
f13
rt13 13
13 13
13
r13 13
s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
e13 g13 13
e13
13 13 ial13
13
d13
13 d13 h13 r13
d13 13
s13 y13
e13
13
rd13 r13 e13
13
13
13
e13
e13
d13 13
13
13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
photographs recording conversations and capturing environment13 with something as smalland ubiquitous as a mobile phone The fact13 that13 this information can then be shared withthe rest13 of the world using e-shy‐mail Twitter and Facebook makes the problem all the moredifficult So the threat13 is no longer solely from the long lenses of the Paparazzi but13 fromanyone (and that13 means everyone) who has even the most13 basic of mobile phones
This relates to the changing views of society on what13 information should remain privateand what13 should be shared with others The success of social media13 has been based on anattitude of lsquosharing everythingrsquo with either your friends or the world This has introduced anaiumlve idea13 in the minds of some younger people (especially those known as Millennials ieaged 18-shy‐30) that13 everyone can be their friends whilst13 perhaps failing to reinforce the bondsof genuine friendship with any form of test13 or restriction Technology could play a role indefining these friendships and allowing individuals to understand what13 makes a goodfriend but13 this approach has yet13 to be developed and may be slow to overcome the needfor some people to measure their own popularity simply as the number of people that13 theycan list13 as friends on their Facebook page
It follows that13 there may be a need for a new definition of privacy that13 is in keeping withthe web and its ability to display images and opinion in an unregulated manner This needsto embrace past13 concerns about13 the ability of an individual to live without13 the threat13 ofothers being able to watch them whilst13 offering some protection from random postingsabout13 them online Perhaps this could include a right13 to be able to edit13 or remove anythingrelating to themselves on the Web including images that13 are not13 news-shy‐worthy Theownership of image rights may be an associated issue that13 needs to be addressedespecially as modern technology can remove an individual from a group (or a background)13 view provide digital touch-shy‐up or air-shy‐brushing and then republish it13 in a different13 contextHowever there is general agreement13 that13 personal information (such as contact13 details andbank codes) should not13 have a place on the web Surprisingly few people take proactivemeasures to prevent13 tracking functions being activated
It follows that13 too much privacy could lead to younger people fearing that13 they maybecome lost13 in a digital world It is not13 surprising then that13 they are prepared to make lots13 of personal information available often with no fear of how it13 might13 be used by othersWhen Google glasses and similar technologies become available during the next13 few yearsthey will have the potential to identify a stranger walking down the street and to find manyof their secrets to present13 to the wearer in a fraction of a second They could know moreabout13 them than their genuine friends know -shy‐ so who will be their friends in the future
36 Data sharing and13 protection
By lsquodata13 sharingrsquo we mean the disclosure of data13 held by one organisation on an individualto a third party organisation(s) or the sharing of data13 between different13 parts of anorganisation Some data13 sharing doesnrsquot13 involve personal data13 because it13 has beenanonymised in such a way that13 the statistics can be used for the collective good without13 theidentification of the individual The Data13 Protection Act13 (DPA) is in place to provide a legal
33
framework that13 ensures that13 organisations that13 hold personal data13 must13 act13 responsibly atall times These principles adequately describe the position of public and government13 bodies especially social services departments who are responsible for the informationconcerning the health and well-shy‐being of individuals -shy‐ and hence by implication thesensitive data13 relating to their vulnerability
The legal framework that13 applies to private and third sector organisations differs from that13 which applies to public sector organisations which may only act13 within the defined limits oftheir statutory powers However all bodies must13 comply fully with the data13 protectionprinciples and this situation is unlikely to change within the next13 10 to 15 years In someprivate sector contexts there are legal constraints on the disclosure of personal dataHowever most13 private and third sector organisations have a general ability to shareinformation provided this does not13 breach the DPA or any other law It is advisable for acompany to check its constitutional documents such as its memorandum and articles13 ofassociation to make sure there are no restrictions that13 would prevent13 it13 from sharingpersonal data13 in a particular context The type of data13 held is therefore a subject13 ofconcern as it13 may be difficult13 for legislation to keep up with the additional layers of data13 created on-shy‐line and through the Internet13 of Things
Private and third sector organisations should have regard to any industry-shy‐specific regulationor guidance about13 handling individualsrsquo information as this may affect13 the organisationrsquosability to share information They should also be aware of the legal issues that13 can arisewhen sharing personal data13 with public sector bodies This becomes more of an issue asprivate and third sector bodies are carrying out13 a wider range of traditionally public sectorfunctions Opportunities for inappropriate sharing of sensitive data13 will therefore inevitablyincrease
Public authorities must13 comply with the Human Rights Act13 (HRA) legislation in theperformance of their functions The HRA also applies to organisations in the private sectorinsofar as they carry out13 functions of a public nature which could include delivering a socialcare activity Where the HRA applies organisations must13 not13 act13 in a way that13 would beincompatible with rights under the European Convention on Human Rights Article 8 of theConvention giving everyone the right13 to respect13 for their private and family life their homeand their correspondence is especially relevant13 to sharing personal data If personal data13 isdisclosed or shared in ways that13 comply with the DPA the sharing or disclosure of that13 information is also likely to comply with the HRA The problem may still be in policing theActs and the rights of an individual if they believe that13 their personal data13 has been sharedor accessed by an inappropriate organisation or individual
A legal industry may be born to deal with such matters but13 this is unlikely to benefit13 peoplewho cannot13 afford the fees involved They would require either legal aid or to employ13 more13 lsquono win no feersquo companies Public attitudes to such costs might13 become negative unlessthey prove successful in preventing breaches of data13 security There may need to belegislation to provide a stronger basis for forcing compliance with privacy laws
34
37 Connecting with13 people
We are social creatures most13 of us rely on our friendships and interactions with friendsand families to share our happiest13 moments and experiences Research suggests that13 thishappiness is infectious at all levels and leads to a 15 increase in the happiness of a closecontact 10 for a second degree contact13 such as the friendrsquos spouse and a 6 increase fora friend of a friend It is hardly surprising that13 the success of social media13 such as Facebookis intimately related to the ability of people to quickly share their happiest13 moments with asmany of their friends and connections as possible
All this has happened during the rise of the Internet13 and the corresponding increase inopportunities for connecting online ie this is a 21st Century phenomenon which has beenfacilitated by Information and Communications Technology But13 the Internet13 remains in itsinfancy and we are only beginning to understand and exploit13 its potential In terms ofaccessing the Internet there are now perhaps two billion people who have access with99 of them having gained this during the past13 decade This number will have doubled bythe period 2020 to 2025 It is likely that13 everyone who wants to be connected in the UK willby then be connected Turning this on its head only those who donrsquot13 want13 to be online willnot13 be on the Internet13 within a decade Connecting with the unconnected will therefore bea case of identifying those people who donrsquot13 want13 to be found unfortunately these mayinclude many people who need the support13 of social care organisations It means that13 theywill be looking for support13 only when they are in crisis unless other ways of finding andormonitoring them are found
While the number of people connected via the Internet13 has exploded this might13 bedwarfed by the number of connected lsquothingsrsquo During 2009 the number of thingsconnected to the Internet13 surpassed the number of connected people at which point13 webegan to experience what13 this report13 has described as the lsquoInternet13 of Thingsrsquo Yet 99 ofall physical objects that13 could join this network are not13 yet13 connected but13 the number couldgrow by 25 every year for the next13 decade so that13 there could be 100 billion connectedobjects by 2025 some of which will be owned or used by everyone in the UK includingthose people who donrsquot13 want13 to be connected themselves We will then have an Internet13 of Everything which will be the smart13 connection of people data events and actions
With each new person object or data13 that13 comes online the connection possibilitiesbetween all these elements grows exponentially The rise of big data mobile networkingcloud storage and data13 mining technologies will all play a critical role in the Internet13 ofEverything The result13 will be new capabilities richer experiences and unprecedentedvalue for individuals businesses communities and countries everywhere The lsquonetworkeffectrsquo of the Internet13 of Everything will be a very powerful thing the true impact13 of whichwe wonrsquot13 fully understand for several years As it13 develops however those who are not13 connected will feel even more digitally and socially excluded There will be a need to reachout13 to vulnerable people unless the process of claiming requires proof of online identityand the payments to be received can only be redeemed using a chipped card or adownloaded app onto a smartphone This is of course the way that13 welfare arrangementsare already developing thus it13 might13 prove impossible to make a successful claim without13
35
already being connected to lsquothe systemrsquo either through an online presence or through theInternet13 of Things
38 Downloading everything
Sixty years ago information was discovered by reading books often in a library wherenotes had to be made because the books or journals couldnrsquot13 be removed Then in theearly 1960s the first13 office photocopying machines were introduced into the UK theyimmediately meant13 that13 pages or articles from books could be copied and taken away to beread and summarised later Within a few years photocopying became a replacement13 forreading as researchers became less adept13 at selecting a few sentences and every deskbecame a depository for reams of printed paper Paper became the means of recordingeverything from bank statements through to music
We now appreciate that13 printing everything is a waste of both the ink (or toner) used tocreate the black print13 and of paper which requires trees to be chopped down and pulpedbefore it13 can be pressed into thin sheets Saving paper is therefore seen as green and goodfor the planet Fortunately we no longer need to print13 everything because computermemory is unlimited thanks to the cloud and we can then view pages and articles onportable or fixed screens
The internet13 has everything and it13 is all available instantly for downloading providing thereis a device available to accept13 it and there is sufficient13 communication bandwidth toperform the transfer of data13 sufficiently quickly Thus we can record all text13 articles that13 are relevant13 to us including digital records of birth certificates qualifications and passportsand the need for original printed versions will decline But13 we can also do this forphotographs Most13 handheld computing devices include at least13 one camera so they cangenerate enormous number of pictures which can be kept13 for posterity without13 having toconsume inks and special papers to print13 them
But13 the materials that13 can be downloaded donrsquot13 stop at pictures software is available that13 can grab TV shows after they air and movies as soon as theyre released In the same wayit13 is possible to schedule music comic books video games and practically anything else asa download with minimal effort People will need enormous hard drives if they want13 theirown digital copies of these files so will more than likely make use of cloud storage that13 willbe available from many organisations The location of the servers may become sensitivedue to border restrictions as will the security of the data13 and the way that13 it13 is backed up sothat13 it13 is resilient13 to failures
It may be evident13 that13 application forms for all types of welfare payment13 will be availableonly for downloading so that once digitised they can be processed by computer andrecords sent13 to various servers for subsequent13 storage and processing Some people maywant13 to keep their data13 on them once it13 has been downloaded Pen drives can already holdseveral GB of data so it13 is likely that13 people will be able to carry their downloaded data13 withthem at all times irrespective of the size and complexities of the information
36
39 Health13 and13 well-shy‐being
The general health of the population is unlikely to deteriorate noticeably within 10 to 20years Indeed expectations of the population are that13 things must13 improve as surgicaltechniques mature and as pharmaceutical interventions become more personalised andpowerful However the rising demand for health services due to an ageing population andthe increasing cost13 of providing sophisticated therapies will make delivering a free anduniversal health service difficult13 without13 substantial increases in taxation This is unlikely tohappen in the UK even though spending on health services will be protected against13 thecuts facing other services
There will have to be changes in how the NHS works For twenty years hospitals have beenclosed and replaced by fewer new facilities so that13 the bed count13 is reduced This has led toa significant13 shift13 in resources to primary care and community care supporting shorter staysin hospital and speedier transfer back home for people after surgery or illness This hasbeen13 successful but13 there remain problems with demand for GP services especially out-shy‐of-shy‐hours and at weekends Indeed despite the introduction of NHS24 and similar help-shy‐linesthe demand for GP appointments continues to increase Delays are inevitable and this willincrease system failures with more unnecessary deaths and a failure for people to access adiagnosis that13 might13 lead to early interventions and ultimately lower delivery costs Over250 more patients are added to waiting lists every day
This will lead to a new model of primary care consistent13 with existing changes which haveseen surgeries move from High Street13 locations to medical centres close to bus routes andwith more parking for patients The process of making an appointment13 is changing from atelephone-shy‐based interview process dominated by a medically-shy‐unqualified receptionist13 to achoose and book approach using an online process linked to electronic patient13 records Thiswill give patients more convenience but13 will allow priority for those who have Internet13 access at the expensive of those who are digitally excluded Making the process of bookingan appointment13 quick and easy may also increase demand from people who do not13 need tobe seen as it13 will fail to identify those in greatest13 need
A greater use of telehealth and telecare technologies will be inevitable beginning with thefirst13 contact13 as an encounter using the telephone e-shy‐mail or video conferencing -shy‐ a visit13 tothe GP surgery should be a last13 resort and should involve a nurse consultation in the first13 instance This would be consistent13 with three quarters of appointments currently involvinga chronic disease or long term condition which relates to improved self-shy‐care The support13 ofthese patients at home should be prioritised through tele-shy‐ and web-shy‐based technologies andshould involve training and coaching through a network of nurse practitioners Home visitsshould generally be unnecessary through the use of these technologies but13 could besupplemented by satellite surgeries manned by nursing in community premises or inpharmacies nurseries and Internet13 cafes
The homes13 of people who13 need13 closer monitoring can then become part13 of virtual wardswith real or electronic visits by health professionals University Hospital Southampton NHSFoundation Trust13 already looks after patients who have undergone surgery such as a hip orknee13 replacements in virtual wards with high levels of satisfaction The Royal Free London
37
NHS Foundation Trust13 offers a similar service but13 plans to add the possibility of videoconsultations between patient13 and consultant
310 Attitudes to public health issues ndash obesity smoking alcohol abuse drugs
As self-shy‐care becomes the focus of the NHS the public will increasingly understand that13 thecosts and availability of services are being harmed by the poor health behaviour ofrelatively small numbers of people The link between public health initiatives today andhealthcare needs and costs in the future will become increasingly evident13 as a result13 of theway that13 information is presented Thus the overweight13 smoker who currently attractsconcern and pity when they are diagnosed with diabetes and COPD is increasingly beingseen as the victim of their own stupidity or lack of self-shy‐discipline If they continue to neglect13 medical advice and continue with an unhealthy lifestyle then the way that13 they receivetreatment13 and consume resources will become a matter for the entire population
Obesity is seen as due to a combination of poor diet13 and a sedentary lifestyle No longer isthe idea13 that13 people are lsquobig bonedrsquo acceptable Governments will respond initially byrequiring manufacturers and food processors to provide nutritional information onpackaging and on menus in restaurants But13 people can choose not13 to read the data13 and toneglect13 both the importance of food quality content13 and quantity This will increasepressure to introduce fat13 or sugar taxes and these are likely to be in force within a decade
Although the high taxes on tobacco products has forced some smokers to reduce theirconsumption or to give up altogether the impact13 has been reduced by the smuggling ofproducts from overseas and by the availability of duty-shy‐free cigarettes for people returningfrom foreign holidays and business meetings Further measures are planned to changepackaging and to include even more graphic images and warnings on cigarette packages tomake smokers aware of the effects of smoking on their health and well-shy‐being There is asyet little evidence of how successful this might13 be More effective has been the banning ofsmoking in public places including trains and aircraft Expensive medical interventions suchas heart13 transplants will be denied to individuals until they change their lifestyle behaviourSmokers might13 therefore be increasingly ostracised leading to a loss of esteem This mayhave a particular impact13 on people who already suffer from mental health problems whoare more likely to smoke
The overuse of alcohol is being recognised as a major factor in hospital admissions withNHS figures showing an increase of over 40 in such admissions over the past13 decadeLinked to this has been a 75 increase in prescriptions to treat13 alcohol dependency Fewpeople have sympathy for those who waste their limited income on booze If they havechildren or other dependents they will be the ones who suffer and who may need thesupport13 of social care
Drug users are already significant13 users of social services as their habit13 is likely to makethem unemployable They receive little sympathy from the general public because they areseen as criminals and people who waste public resources Levels of drug abuse have been
38
slowly increasing over the years but13 this trend is slowly being reversed Indeed the numberof people using drugs during the past13 year has fallen to its lowest13 level for nearly 20 years(below 9) with cannabis being most13 likely often following excessive drinking Aselectronic noses and other technologies can detect13 traces of drugs it13 seems likely that13 success in overcoming addiction can be measured objectively This may become a two-shy‐edged sword rewarding those who can turn around their lives but13 further marginalisingthose who canrsquot13 or wont13 accept13 the lsquocold turkeyrsquo
311 Attitudes to surveillance
Issues associated with privacy confidentiality and data13 security have been discussedpreviously in the context13 of information technology the World Wide Web and the ease ofcollecting recording recalling analysing and displaying data The monitoring of individualsand their methods of using this information can be regarded as surveillance As thequantities of data13 increase along with the number of devices that13 can be used to access itthe surveillance tools will also increase in their sophistication Indeed the Big Data13 approaches described in the previous section will enable the combination of structureddata13 (such as the information held in databases) to be married with unstructured data13 fromimages in such a way that13 it13 can be mined
Whilst13 the lsquodigital surveillancersquo methods described above may cause most13 concern topeople because of its impact13 on anonymity it13 is the collection and analysis of images that13 are the major concern to people as they contemplate the ways that13 lsquoBig Brotherrsquo maydevelop to restrict13 freedom Every major UK city and town centre has an array of CCTVcameras that13 continually record activities from every angle If it13 used to be true that13 nobody in London was more than 10 yards from a rat it13 is certainly the case today that13 nobody can be more than this distance from being in view of a surveillance camera Yetthey receive so much positive publicity from TV programmes where their footage is used todetect13 vehicles close to a crime scene or to monitor the movements of suspects that13 theyare now accepted by the public as a deterrent13 in the same way as lsquobobbies on the beatrsquowere seen 25 years ago There is therefore little public reaction to the expansion in the useof video surveillance except13 for the practical observation of how so many views can beinspected and recorded
Looking to the future the tumbling cost13 of video technology will surely lead to anotherincrease in the number of devices The aerial views taken from towers will besupplemented by more local views taken by devices that13 are embedded in the fabric ofbuildings or carried by individuals either on their person (for example on clothing orspectacles) or in the bags that13 they carry The time and date-shy‐stamped images as Big Datawill be recorded to lsquothe Cloudrsquo where it13 can be added to other data It can then be usedwhen an incident13 has occurred or to provide further detail of night-shy‐time activities
It follows that13 there will be no hiding place for people who simply want13 to disappear Theymay respond by wearing clothing (such as hoodies) that13 hide their faces or which make it13 difficult13 to distinguish gait13 or mannerisms from which they might13 be identified New forms
39
of clothing may be designed to make shapes more difficult13 to analyse and these might13 become the uniforms of a class of person who wants to live in a way that13 they donrsquot13 interact13 with officials from any ministry or local government13 department If they also obstruct13 services then they will be considered to be anarchists of some form sparking protests fromother sectors of society
31213 Attitudes to driving
Motor cars have been a feature of UK roads for over a century but13 it13 is only during the past13 50 years that13 they have become a resource that13 most13 families have had access to enablingthem to travel without13 the restrictions imposed by a limited railway network and non-shy‐integrated bus transport People who have had a car throughout13 their lives often see theircars as an important13 factor in enabling them to remain independent13 and to exercise choicesrelating to where they shop and where they spend their leisure time This extends to theirspouse and to friends and neighbours that13 they might13 take with them on their variousexpeditions
Unfortunately there are incidents involving older drivers who perhaps go down amotorway in the wrong direction who are taken ill at the wheel or who are involved in anaccident13 involving no other vehicles These are small in number but13 often lead to a reactionthat13 they shouldnrsquot13 be allowed to drive lsquoat13 their agersquo Age itself is not13 an indicator ofdriving quality but13 because old age also brings more chance of having limited long termconditions and other illnesses it13 is easy to make a link between driving ability and age Thelicensing system does require continued driving to be linked with medical advice andforbids people with poor eyesight epilepsy and other conditions to hold a licence in oldage
Yet13 statistically older drivers cause far fewer accidents than younger drivers The reasonsfor this may be complex and are likely to include the fact13 that13 they drive less often covershorter distances and donrsquot13 go out13 in the dark or in poor weather However it13 does not13 wholly explain why the UKrsquos drivers aged over 70 and who represent13 some 8 of all driversare involved in only 4 of accidents that13 cause injury This compares favourably with the15 of13 drivers aged between 17 and 29 who are involved in over a third of crashes that13 result13 in injury
By 2020 the number of drivers aged over 70 on UK roads is likely to increase to over 7million This will require a new national strategy perhaps involving support13 for olderdrivers further training raising awareness of issues and making more use of adaptivetechnologies to support13 the driver in avoiding collision or forgetting to check on the statusof their vehicle Poor eyesight13 could be enhanced by camera technologies rather thanforcing people off the road if they are unable to read a licence plate
The International Longevity Centre has found that13 one in four Britons thought13 driversshould be made to switch off the ignition for good somewhere between the ages of 70 and75 The numbers may decrease as the population ages and as cars become safer Forcing
40
older people off the road may be a natural consequence of providing free bus passes andsubsidised rail fares but13 the growth in the pavement13 scooter industry demonstrates that13 older people value their independence and will do almost13 anything to get13 out13 and aboutPerhaps legislation will result13 in more regulation of electric vehicles and where they cantravel
There can be no doubt13 that13 getting out13 will be associated with better quality of life andwell-shy‐being and this is likely to be supported in the future as evidence of improvedoutcomes emerges It is to be hoped that13 positive stories will be publicised so that13 publicattitudes arenrsquot13 hardened This may be supported by more in-shy‐car monitoring of drivers andthe linking of performance with on-shy‐line driving records and licences These could throughremotely monitored ignition systems prevent13 the use of motor vehicles by people without13 a licence or without13 insurance
313 Climate change
There is a general view that13 the emissions of carbon gases are contributing to globalwarming in a manner that13 will change the UK climate in such a way that13 the climate maybecome more Mediterranean However some scientists believe that13 manrsquos impact13 on theenvironment13 may be small compared with natural variations caused for example bycyclical changes in the sunrsquos energy output13 or by the effects of volcanoes and earthquakesRecent13 evidence has suggested that13 we are going through a phase of changing extremesand that13 this is more likely to cause storms periods of excessive rainfall and unusualseasonal trends with snow and frost13 in the spring and warmer winters Considerableuncertainty remains and it13 might13 be necessary to plan for a number of different13 scenariosand for the impact13 on vulnerable people
I Colder winters UK properties are poorly insulated resulting in excess mortalitiesduring cold spells due to an increased number of people suffering from stroke aswell as bronchitis and other pulmonary diseases The cost13 of heating continues toincrease putting more households into a state of fuel poverty Any further coolingduring the winter months will result13 in more people living in unhealthy coldconditions Winter fuel payments are likely to be restricted to the poorest13 peoplebut13 this might13 exclude people who live in larger properties that13 are more difficult13 toheat
II More storms excessive winds and rain can cause flooding at any time of the yearMany UK communities are built13 close to rivers and these can surge during heavyrainfall causing houses to be filled with water and furniture and carpets lostInsurance can be problematic for properties built13 on flood plains which can blight13 properties and prevent13 owners from being able to sell and move on High winds canrip off roofs causing injury and also causing families to be left13 homeless anddependent13 on social services
III Hot13 summers Europe suffered high temperatures during the summers of 2003 and2004 leading to heat13 stroke and hypothermia The UK has not13 previously sufferedfrom such problems but13 might13 be expected to experience days of extreme
41
temperature and humidity at times Older people may not13 be prepared for suchweather Street13 dwellers may be unable to find shade and supplies of drinkingwater
Irrespective of what13 combination of weather scenarios arise it13 must13 be concluded that13 any extremes will have a major negative impact13 on vulnerable people especially if theyare not13 prepared because they havenrsquot13 received the weather warnings and advice that13 can be broadcast13 using the TV radio and online services Once again the digitallyexcluded will suffer and will pay a high cost Society will continue to pick up the bill interms of demands on social care services unless preventive actions are taken in theform of connecting these people to each other and to formal services
42
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
s13 13
13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
n13 13
13 s13
r13 n13
e13 at13
e13 y13 e13 ld13
ly13
13 e13 t13 e13
s13 er13 e13
f13
rt13 13
13 13
13
r13 13
s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
e13 g13 13
e13
13 13 ial13
13
d13
13 d13 h13 r13
d13 13
s13 y13
e13
13
rd13 r13 e13
13
13
13
e13
e13
d13 13
13
13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
framework that13 ensures that13 organisations that13 hold personal data13 must13 act13 responsibly atall times These principles adequately describe the position of public and government13 bodies especially social services departments who are responsible for the informationconcerning the health and well-shy‐being of individuals -shy‐ and hence by implication thesensitive data13 relating to their vulnerability
The legal framework that13 applies to private and third sector organisations differs from that13 which applies to public sector organisations which may only act13 within the defined limits oftheir statutory powers However all bodies must13 comply fully with the data13 protectionprinciples and this situation is unlikely to change within the next13 10 to 15 years In someprivate sector contexts there are legal constraints on the disclosure of personal dataHowever most13 private and third sector organisations have a general ability to shareinformation provided this does not13 breach the DPA or any other law It is advisable for acompany to check its constitutional documents such as its memorandum and articles13 ofassociation to make sure there are no restrictions that13 would prevent13 it13 from sharingpersonal data13 in a particular context The type of data13 held is therefore a subject13 ofconcern as it13 may be difficult13 for legislation to keep up with the additional layers of data13 created on-shy‐line and through the Internet13 of Things
Private and third sector organisations should have regard to any industry-shy‐specific regulationor guidance about13 handling individualsrsquo information as this may affect13 the organisationrsquosability to share information They should also be aware of the legal issues that13 can arisewhen sharing personal data13 with public sector bodies This becomes more of an issue asprivate and third sector bodies are carrying out13 a wider range of traditionally public sectorfunctions Opportunities for inappropriate sharing of sensitive data13 will therefore inevitablyincrease
Public authorities must13 comply with the Human Rights Act13 (HRA) legislation in theperformance of their functions The HRA also applies to organisations in the private sectorinsofar as they carry out13 functions of a public nature which could include delivering a socialcare activity Where the HRA applies organisations must13 not13 act13 in a way that13 would beincompatible with rights under the European Convention on Human Rights Article 8 of theConvention giving everyone the right13 to respect13 for their private and family life their homeand their correspondence is especially relevant13 to sharing personal data If personal data13 isdisclosed or shared in ways that13 comply with the DPA the sharing or disclosure of that13 information is also likely to comply with the HRA The problem may still be in policing theActs and the rights of an individual if they believe that13 their personal data13 has been sharedor accessed by an inappropriate organisation or individual
A legal industry may be born to deal with such matters but13 this is unlikely to benefit13 peoplewho cannot13 afford the fees involved They would require either legal aid or to employ13 more13 lsquono win no feersquo companies Public attitudes to such costs might13 become negative unlessthey prove successful in preventing breaches of data13 security There may need to belegislation to provide a stronger basis for forcing compliance with privacy laws
34
37 Connecting with13 people
We are social creatures most13 of us rely on our friendships and interactions with friendsand families to share our happiest13 moments and experiences Research suggests that13 thishappiness is infectious at all levels and leads to a 15 increase in the happiness of a closecontact 10 for a second degree contact13 such as the friendrsquos spouse and a 6 increase fora friend of a friend It is hardly surprising that13 the success of social media13 such as Facebookis intimately related to the ability of people to quickly share their happiest13 moments with asmany of their friends and connections as possible
All this has happened during the rise of the Internet13 and the corresponding increase inopportunities for connecting online ie this is a 21st Century phenomenon which has beenfacilitated by Information and Communications Technology But13 the Internet13 remains in itsinfancy and we are only beginning to understand and exploit13 its potential In terms ofaccessing the Internet there are now perhaps two billion people who have access with99 of them having gained this during the past13 decade This number will have doubled bythe period 2020 to 2025 It is likely that13 everyone who wants to be connected in the UK willby then be connected Turning this on its head only those who donrsquot13 want13 to be online willnot13 be on the Internet13 within a decade Connecting with the unconnected will therefore bea case of identifying those people who donrsquot13 want13 to be found unfortunately these mayinclude many people who need the support13 of social care organisations It means that13 theywill be looking for support13 only when they are in crisis unless other ways of finding andormonitoring them are found
While the number of people connected via the Internet13 has exploded this might13 bedwarfed by the number of connected lsquothingsrsquo During 2009 the number of thingsconnected to the Internet13 surpassed the number of connected people at which point13 webegan to experience what13 this report13 has described as the lsquoInternet13 of Thingsrsquo Yet 99 ofall physical objects that13 could join this network are not13 yet13 connected but13 the number couldgrow by 25 every year for the next13 decade so that13 there could be 100 billion connectedobjects by 2025 some of which will be owned or used by everyone in the UK includingthose people who donrsquot13 want13 to be connected themselves We will then have an Internet13 of Everything which will be the smart13 connection of people data events and actions
With each new person object or data13 that13 comes online the connection possibilitiesbetween all these elements grows exponentially The rise of big data mobile networkingcloud storage and data13 mining technologies will all play a critical role in the Internet13 ofEverything The result13 will be new capabilities richer experiences and unprecedentedvalue for individuals businesses communities and countries everywhere The lsquonetworkeffectrsquo of the Internet13 of Everything will be a very powerful thing the true impact13 of whichwe wonrsquot13 fully understand for several years As it13 develops however those who are not13 connected will feel even more digitally and socially excluded There will be a need to reachout13 to vulnerable people unless the process of claiming requires proof of online identityand the payments to be received can only be redeemed using a chipped card or adownloaded app onto a smartphone This is of course the way that13 welfare arrangementsare already developing thus it13 might13 prove impossible to make a successful claim without13
35
already being connected to lsquothe systemrsquo either through an online presence or through theInternet13 of Things
38 Downloading everything
Sixty years ago information was discovered by reading books often in a library wherenotes had to be made because the books or journals couldnrsquot13 be removed Then in theearly 1960s the first13 office photocopying machines were introduced into the UK theyimmediately meant13 that13 pages or articles from books could be copied and taken away to beread and summarised later Within a few years photocopying became a replacement13 forreading as researchers became less adept13 at selecting a few sentences and every deskbecame a depository for reams of printed paper Paper became the means of recordingeverything from bank statements through to music
We now appreciate that13 printing everything is a waste of both the ink (or toner) used tocreate the black print13 and of paper which requires trees to be chopped down and pulpedbefore it13 can be pressed into thin sheets Saving paper is therefore seen as green and goodfor the planet Fortunately we no longer need to print13 everything because computermemory is unlimited thanks to the cloud and we can then view pages and articles onportable or fixed screens
The internet13 has everything and it13 is all available instantly for downloading providing thereis a device available to accept13 it and there is sufficient13 communication bandwidth toperform the transfer of data13 sufficiently quickly Thus we can record all text13 articles that13 are relevant13 to us including digital records of birth certificates qualifications and passportsand the need for original printed versions will decline But13 we can also do this forphotographs Most13 handheld computing devices include at least13 one camera so they cangenerate enormous number of pictures which can be kept13 for posterity without13 having toconsume inks and special papers to print13 them
But13 the materials that13 can be downloaded donrsquot13 stop at pictures software is available that13 can grab TV shows after they air and movies as soon as theyre released In the same wayit13 is possible to schedule music comic books video games and practically anything else asa download with minimal effort People will need enormous hard drives if they want13 theirown digital copies of these files so will more than likely make use of cloud storage that13 willbe available from many organisations The location of the servers may become sensitivedue to border restrictions as will the security of the data13 and the way that13 it13 is backed up sothat13 it13 is resilient13 to failures
It may be evident13 that13 application forms for all types of welfare payment13 will be availableonly for downloading so that once digitised they can be processed by computer andrecords sent13 to various servers for subsequent13 storage and processing Some people maywant13 to keep their data13 on them once it13 has been downloaded Pen drives can already holdseveral GB of data so it13 is likely that13 people will be able to carry their downloaded data13 withthem at all times irrespective of the size and complexities of the information
36
39 Health13 and13 well-shy‐being
The general health of the population is unlikely to deteriorate noticeably within 10 to 20years Indeed expectations of the population are that13 things must13 improve as surgicaltechniques mature and as pharmaceutical interventions become more personalised andpowerful However the rising demand for health services due to an ageing population andthe increasing cost13 of providing sophisticated therapies will make delivering a free anduniversal health service difficult13 without13 substantial increases in taxation This is unlikely tohappen in the UK even though spending on health services will be protected against13 thecuts facing other services
There will have to be changes in how the NHS works For twenty years hospitals have beenclosed and replaced by fewer new facilities so that13 the bed count13 is reduced This has led toa significant13 shift13 in resources to primary care and community care supporting shorter staysin hospital and speedier transfer back home for people after surgery or illness This hasbeen13 successful but13 there remain problems with demand for GP services especially out-shy‐of-shy‐hours and at weekends Indeed despite the introduction of NHS24 and similar help-shy‐linesthe demand for GP appointments continues to increase Delays are inevitable and this willincrease system failures with more unnecessary deaths and a failure for people to access adiagnosis that13 might13 lead to early interventions and ultimately lower delivery costs Over250 more patients are added to waiting lists every day
This will lead to a new model of primary care consistent13 with existing changes which haveseen surgeries move from High Street13 locations to medical centres close to bus routes andwith more parking for patients The process of making an appointment13 is changing from atelephone-shy‐based interview process dominated by a medically-shy‐unqualified receptionist13 to achoose and book approach using an online process linked to electronic patient13 records Thiswill give patients more convenience but13 will allow priority for those who have Internet13 access at the expensive of those who are digitally excluded Making the process of bookingan appointment13 quick and easy may also increase demand from people who do not13 need tobe seen as it13 will fail to identify those in greatest13 need
A greater use of telehealth and telecare technologies will be inevitable beginning with thefirst13 contact13 as an encounter using the telephone e-shy‐mail or video conferencing -shy‐ a visit13 tothe GP surgery should be a last13 resort and should involve a nurse consultation in the first13 instance This would be consistent13 with three quarters of appointments currently involvinga chronic disease or long term condition which relates to improved self-shy‐care The support13 ofthese patients at home should be prioritised through tele-shy‐ and web-shy‐based technologies andshould involve training and coaching through a network of nurse practitioners Home visitsshould generally be unnecessary through the use of these technologies but13 could besupplemented by satellite surgeries manned by nursing in community premises or inpharmacies nurseries and Internet13 cafes
The homes13 of people who13 need13 closer monitoring can then become part13 of virtual wardswith real or electronic visits by health professionals University Hospital Southampton NHSFoundation Trust13 already looks after patients who have undergone surgery such as a hip orknee13 replacements in virtual wards with high levels of satisfaction The Royal Free London
37
NHS Foundation Trust13 offers a similar service but13 plans to add the possibility of videoconsultations between patient13 and consultant
310 Attitudes to public health issues ndash obesity smoking alcohol abuse drugs
As self-shy‐care becomes the focus of the NHS the public will increasingly understand that13 thecosts and availability of services are being harmed by the poor health behaviour ofrelatively small numbers of people The link between public health initiatives today andhealthcare needs and costs in the future will become increasingly evident13 as a result13 of theway that13 information is presented Thus the overweight13 smoker who currently attractsconcern and pity when they are diagnosed with diabetes and COPD is increasingly beingseen as the victim of their own stupidity or lack of self-shy‐discipline If they continue to neglect13 medical advice and continue with an unhealthy lifestyle then the way that13 they receivetreatment13 and consume resources will become a matter for the entire population
Obesity is seen as due to a combination of poor diet13 and a sedentary lifestyle No longer isthe idea13 that13 people are lsquobig bonedrsquo acceptable Governments will respond initially byrequiring manufacturers and food processors to provide nutritional information onpackaging and on menus in restaurants But13 people can choose not13 to read the data13 and toneglect13 both the importance of food quality content13 and quantity This will increasepressure to introduce fat13 or sugar taxes and these are likely to be in force within a decade
Although the high taxes on tobacco products has forced some smokers to reduce theirconsumption or to give up altogether the impact13 has been reduced by the smuggling ofproducts from overseas and by the availability of duty-shy‐free cigarettes for people returningfrom foreign holidays and business meetings Further measures are planned to changepackaging and to include even more graphic images and warnings on cigarette packages tomake smokers aware of the effects of smoking on their health and well-shy‐being There is asyet little evidence of how successful this might13 be More effective has been the banning ofsmoking in public places including trains and aircraft Expensive medical interventions suchas heart13 transplants will be denied to individuals until they change their lifestyle behaviourSmokers might13 therefore be increasingly ostracised leading to a loss of esteem This mayhave a particular impact13 on people who already suffer from mental health problems whoare more likely to smoke
The overuse of alcohol is being recognised as a major factor in hospital admissions withNHS figures showing an increase of over 40 in such admissions over the past13 decadeLinked to this has been a 75 increase in prescriptions to treat13 alcohol dependency Fewpeople have sympathy for those who waste their limited income on booze If they havechildren or other dependents they will be the ones who suffer and who may need thesupport13 of social care
Drug users are already significant13 users of social services as their habit13 is likely to makethem unemployable They receive little sympathy from the general public because they areseen as criminals and people who waste public resources Levels of drug abuse have been
38
slowly increasing over the years but13 this trend is slowly being reversed Indeed the numberof people using drugs during the past13 year has fallen to its lowest13 level for nearly 20 years(below 9) with cannabis being most13 likely often following excessive drinking Aselectronic noses and other technologies can detect13 traces of drugs it13 seems likely that13 success in overcoming addiction can be measured objectively This may become a two-shy‐edged sword rewarding those who can turn around their lives but13 further marginalisingthose who canrsquot13 or wont13 accept13 the lsquocold turkeyrsquo
311 Attitudes to surveillance
Issues associated with privacy confidentiality and data13 security have been discussedpreviously in the context13 of information technology the World Wide Web and the ease ofcollecting recording recalling analysing and displaying data The monitoring of individualsand their methods of using this information can be regarded as surveillance As thequantities of data13 increase along with the number of devices that13 can be used to access itthe surveillance tools will also increase in their sophistication Indeed the Big Data13 approaches described in the previous section will enable the combination of structureddata13 (such as the information held in databases) to be married with unstructured data13 fromimages in such a way that13 it13 can be mined
Whilst13 the lsquodigital surveillancersquo methods described above may cause most13 concern topeople because of its impact13 on anonymity it13 is the collection and analysis of images that13 are the major concern to people as they contemplate the ways that13 lsquoBig Brotherrsquo maydevelop to restrict13 freedom Every major UK city and town centre has an array of CCTVcameras that13 continually record activities from every angle If it13 used to be true that13 nobody in London was more than 10 yards from a rat it13 is certainly the case today that13 nobody can be more than this distance from being in view of a surveillance camera Yetthey receive so much positive publicity from TV programmes where their footage is used todetect13 vehicles close to a crime scene or to monitor the movements of suspects that13 theyare now accepted by the public as a deterrent13 in the same way as lsquobobbies on the beatrsquowere seen 25 years ago There is therefore little public reaction to the expansion in the useof video surveillance except13 for the practical observation of how so many views can beinspected and recorded
Looking to the future the tumbling cost13 of video technology will surely lead to anotherincrease in the number of devices The aerial views taken from towers will besupplemented by more local views taken by devices that13 are embedded in the fabric ofbuildings or carried by individuals either on their person (for example on clothing orspectacles) or in the bags that13 they carry The time and date-shy‐stamped images as Big Datawill be recorded to lsquothe Cloudrsquo where it13 can be added to other data It can then be usedwhen an incident13 has occurred or to provide further detail of night-shy‐time activities
It follows that13 there will be no hiding place for people who simply want13 to disappear Theymay respond by wearing clothing (such as hoodies) that13 hide their faces or which make it13 difficult13 to distinguish gait13 or mannerisms from which they might13 be identified New forms
39
of clothing may be designed to make shapes more difficult13 to analyse and these might13 become the uniforms of a class of person who wants to live in a way that13 they donrsquot13 interact13 with officials from any ministry or local government13 department If they also obstruct13 services then they will be considered to be anarchists of some form sparking protests fromother sectors of society
31213 Attitudes to driving
Motor cars have been a feature of UK roads for over a century but13 it13 is only during the past13 50 years that13 they have become a resource that13 most13 families have had access to enablingthem to travel without13 the restrictions imposed by a limited railway network and non-shy‐integrated bus transport People who have had a car throughout13 their lives often see theircars as an important13 factor in enabling them to remain independent13 and to exercise choicesrelating to where they shop and where they spend their leisure time This extends to theirspouse and to friends and neighbours that13 they might13 take with them on their variousexpeditions
Unfortunately there are incidents involving older drivers who perhaps go down amotorway in the wrong direction who are taken ill at the wheel or who are involved in anaccident13 involving no other vehicles These are small in number but13 often lead to a reactionthat13 they shouldnrsquot13 be allowed to drive lsquoat13 their agersquo Age itself is not13 an indicator ofdriving quality but13 because old age also brings more chance of having limited long termconditions and other illnesses it13 is easy to make a link between driving ability and age Thelicensing system does require continued driving to be linked with medical advice andforbids people with poor eyesight epilepsy and other conditions to hold a licence in oldage
Yet13 statistically older drivers cause far fewer accidents than younger drivers The reasonsfor this may be complex and are likely to include the fact13 that13 they drive less often covershorter distances and donrsquot13 go out13 in the dark or in poor weather However it13 does not13 wholly explain why the UKrsquos drivers aged over 70 and who represent13 some 8 of all driversare involved in only 4 of accidents that13 cause injury This compares favourably with the15 of13 drivers aged between 17 and 29 who are involved in over a third of crashes that13 result13 in injury
By 2020 the number of drivers aged over 70 on UK roads is likely to increase to over 7million This will require a new national strategy perhaps involving support13 for olderdrivers further training raising awareness of issues and making more use of adaptivetechnologies to support13 the driver in avoiding collision or forgetting to check on the statusof their vehicle Poor eyesight13 could be enhanced by camera technologies rather thanforcing people off the road if they are unable to read a licence plate
The International Longevity Centre has found that13 one in four Britons thought13 driversshould be made to switch off the ignition for good somewhere between the ages of 70 and75 The numbers may decrease as the population ages and as cars become safer Forcing
40
older people off the road may be a natural consequence of providing free bus passes andsubsidised rail fares but13 the growth in the pavement13 scooter industry demonstrates that13 older people value their independence and will do almost13 anything to get13 out13 and aboutPerhaps legislation will result13 in more regulation of electric vehicles and where they cantravel
There can be no doubt13 that13 getting out13 will be associated with better quality of life andwell-shy‐being and this is likely to be supported in the future as evidence of improvedoutcomes emerges It is to be hoped that13 positive stories will be publicised so that13 publicattitudes arenrsquot13 hardened This may be supported by more in-shy‐car monitoring of drivers andthe linking of performance with on-shy‐line driving records and licences These could throughremotely monitored ignition systems prevent13 the use of motor vehicles by people without13 a licence or without13 insurance
313 Climate change
There is a general view that13 the emissions of carbon gases are contributing to globalwarming in a manner that13 will change the UK climate in such a way that13 the climate maybecome more Mediterranean However some scientists believe that13 manrsquos impact13 on theenvironment13 may be small compared with natural variations caused for example bycyclical changes in the sunrsquos energy output13 or by the effects of volcanoes and earthquakesRecent13 evidence has suggested that13 we are going through a phase of changing extremesand that13 this is more likely to cause storms periods of excessive rainfall and unusualseasonal trends with snow and frost13 in the spring and warmer winters Considerableuncertainty remains and it13 might13 be necessary to plan for a number of different13 scenariosand for the impact13 on vulnerable people
I Colder winters UK properties are poorly insulated resulting in excess mortalitiesduring cold spells due to an increased number of people suffering from stroke aswell as bronchitis and other pulmonary diseases The cost13 of heating continues toincrease putting more households into a state of fuel poverty Any further coolingduring the winter months will result13 in more people living in unhealthy coldconditions Winter fuel payments are likely to be restricted to the poorest13 peoplebut13 this might13 exclude people who live in larger properties that13 are more difficult13 toheat
II More storms excessive winds and rain can cause flooding at any time of the yearMany UK communities are built13 close to rivers and these can surge during heavyrainfall causing houses to be filled with water and furniture and carpets lostInsurance can be problematic for properties built13 on flood plains which can blight13 properties and prevent13 owners from being able to sell and move on High winds canrip off roofs causing injury and also causing families to be left13 homeless anddependent13 on social services
III Hot13 summers Europe suffered high temperatures during the summers of 2003 and2004 leading to heat13 stroke and hypothermia The UK has not13 previously sufferedfrom such problems but13 might13 be expected to experience days of extreme
41
temperature and humidity at times Older people may not13 be prepared for suchweather Street13 dwellers may be unable to find shade and supplies of drinkingwater
Irrespective of what13 combination of weather scenarios arise it13 must13 be concluded that13 any extremes will have a major negative impact13 on vulnerable people especially if theyare not13 prepared because they havenrsquot13 received the weather warnings and advice that13 can be broadcast13 using the TV radio and online services Once again the digitallyexcluded will suffer and will pay a high cost Society will continue to pick up the bill interms of demands on social care services unless preventive actions are taken in theform of connecting these people to each other and to formal services
42
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
s13 13
13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
n13 13
13 s13
r13 n13
e13 at13
e13 y13 e13 ld13
ly13
13 e13 t13 e13
s13 er13 e13
f13
rt13 13
13 13
13
r13 13
s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
e13 g13 13
e13
13 13 ial13
13
d13
13 d13 h13 r13
d13 13
s13 y13
e13
13
rd13 r13 e13
13
13
13
e13
e13
d13 13
13
13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
37 Connecting with13 people
We are social creatures most13 of us rely on our friendships and interactions with friendsand families to share our happiest13 moments and experiences Research suggests that13 thishappiness is infectious at all levels and leads to a 15 increase in the happiness of a closecontact 10 for a second degree contact13 such as the friendrsquos spouse and a 6 increase fora friend of a friend It is hardly surprising that13 the success of social media13 such as Facebookis intimately related to the ability of people to quickly share their happiest13 moments with asmany of their friends and connections as possible
All this has happened during the rise of the Internet13 and the corresponding increase inopportunities for connecting online ie this is a 21st Century phenomenon which has beenfacilitated by Information and Communications Technology But13 the Internet13 remains in itsinfancy and we are only beginning to understand and exploit13 its potential In terms ofaccessing the Internet there are now perhaps two billion people who have access with99 of them having gained this during the past13 decade This number will have doubled bythe period 2020 to 2025 It is likely that13 everyone who wants to be connected in the UK willby then be connected Turning this on its head only those who donrsquot13 want13 to be online willnot13 be on the Internet13 within a decade Connecting with the unconnected will therefore bea case of identifying those people who donrsquot13 want13 to be found unfortunately these mayinclude many people who need the support13 of social care organisations It means that13 theywill be looking for support13 only when they are in crisis unless other ways of finding andormonitoring them are found
While the number of people connected via the Internet13 has exploded this might13 bedwarfed by the number of connected lsquothingsrsquo During 2009 the number of thingsconnected to the Internet13 surpassed the number of connected people at which point13 webegan to experience what13 this report13 has described as the lsquoInternet13 of Thingsrsquo Yet 99 ofall physical objects that13 could join this network are not13 yet13 connected but13 the number couldgrow by 25 every year for the next13 decade so that13 there could be 100 billion connectedobjects by 2025 some of which will be owned or used by everyone in the UK includingthose people who donrsquot13 want13 to be connected themselves We will then have an Internet13 of Everything which will be the smart13 connection of people data events and actions
With each new person object or data13 that13 comes online the connection possibilitiesbetween all these elements grows exponentially The rise of big data mobile networkingcloud storage and data13 mining technologies will all play a critical role in the Internet13 ofEverything The result13 will be new capabilities richer experiences and unprecedentedvalue for individuals businesses communities and countries everywhere The lsquonetworkeffectrsquo of the Internet13 of Everything will be a very powerful thing the true impact13 of whichwe wonrsquot13 fully understand for several years As it13 develops however those who are not13 connected will feel even more digitally and socially excluded There will be a need to reachout13 to vulnerable people unless the process of claiming requires proof of online identityand the payments to be received can only be redeemed using a chipped card or adownloaded app onto a smartphone This is of course the way that13 welfare arrangementsare already developing thus it13 might13 prove impossible to make a successful claim without13
35
already being connected to lsquothe systemrsquo either through an online presence or through theInternet13 of Things
38 Downloading everything
Sixty years ago information was discovered by reading books often in a library wherenotes had to be made because the books or journals couldnrsquot13 be removed Then in theearly 1960s the first13 office photocopying machines were introduced into the UK theyimmediately meant13 that13 pages or articles from books could be copied and taken away to beread and summarised later Within a few years photocopying became a replacement13 forreading as researchers became less adept13 at selecting a few sentences and every deskbecame a depository for reams of printed paper Paper became the means of recordingeverything from bank statements through to music
We now appreciate that13 printing everything is a waste of both the ink (or toner) used tocreate the black print13 and of paper which requires trees to be chopped down and pulpedbefore it13 can be pressed into thin sheets Saving paper is therefore seen as green and goodfor the planet Fortunately we no longer need to print13 everything because computermemory is unlimited thanks to the cloud and we can then view pages and articles onportable or fixed screens
The internet13 has everything and it13 is all available instantly for downloading providing thereis a device available to accept13 it and there is sufficient13 communication bandwidth toperform the transfer of data13 sufficiently quickly Thus we can record all text13 articles that13 are relevant13 to us including digital records of birth certificates qualifications and passportsand the need for original printed versions will decline But13 we can also do this forphotographs Most13 handheld computing devices include at least13 one camera so they cangenerate enormous number of pictures which can be kept13 for posterity without13 having toconsume inks and special papers to print13 them
But13 the materials that13 can be downloaded donrsquot13 stop at pictures software is available that13 can grab TV shows after they air and movies as soon as theyre released In the same wayit13 is possible to schedule music comic books video games and practically anything else asa download with minimal effort People will need enormous hard drives if they want13 theirown digital copies of these files so will more than likely make use of cloud storage that13 willbe available from many organisations The location of the servers may become sensitivedue to border restrictions as will the security of the data13 and the way that13 it13 is backed up sothat13 it13 is resilient13 to failures
It may be evident13 that13 application forms for all types of welfare payment13 will be availableonly for downloading so that once digitised they can be processed by computer andrecords sent13 to various servers for subsequent13 storage and processing Some people maywant13 to keep their data13 on them once it13 has been downloaded Pen drives can already holdseveral GB of data so it13 is likely that13 people will be able to carry their downloaded data13 withthem at all times irrespective of the size and complexities of the information
36
39 Health13 and13 well-shy‐being
The general health of the population is unlikely to deteriorate noticeably within 10 to 20years Indeed expectations of the population are that13 things must13 improve as surgicaltechniques mature and as pharmaceutical interventions become more personalised andpowerful However the rising demand for health services due to an ageing population andthe increasing cost13 of providing sophisticated therapies will make delivering a free anduniversal health service difficult13 without13 substantial increases in taxation This is unlikely tohappen in the UK even though spending on health services will be protected against13 thecuts facing other services
There will have to be changes in how the NHS works For twenty years hospitals have beenclosed and replaced by fewer new facilities so that13 the bed count13 is reduced This has led toa significant13 shift13 in resources to primary care and community care supporting shorter staysin hospital and speedier transfer back home for people after surgery or illness This hasbeen13 successful but13 there remain problems with demand for GP services especially out-shy‐of-shy‐hours and at weekends Indeed despite the introduction of NHS24 and similar help-shy‐linesthe demand for GP appointments continues to increase Delays are inevitable and this willincrease system failures with more unnecessary deaths and a failure for people to access adiagnosis that13 might13 lead to early interventions and ultimately lower delivery costs Over250 more patients are added to waiting lists every day
This will lead to a new model of primary care consistent13 with existing changes which haveseen surgeries move from High Street13 locations to medical centres close to bus routes andwith more parking for patients The process of making an appointment13 is changing from atelephone-shy‐based interview process dominated by a medically-shy‐unqualified receptionist13 to achoose and book approach using an online process linked to electronic patient13 records Thiswill give patients more convenience but13 will allow priority for those who have Internet13 access at the expensive of those who are digitally excluded Making the process of bookingan appointment13 quick and easy may also increase demand from people who do not13 need tobe seen as it13 will fail to identify those in greatest13 need
A greater use of telehealth and telecare technologies will be inevitable beginning with thefirst13 contact13 as an encounter using the telephone e-shy‐mail or video conferencing -shy‐ a visit13 tothe GP surgery should be a last13 resort and should involve a nurse consultation in the first13 instance This would be consistent13 with three quarters of appointments currently involvinga chronic disease or long term condition which relates to improved self-shy‐care The support13 ofthese patients at home should be prioritised through tele-shy‐ and web-shy‐based technologies andshould involve training and coaching through a network of nurse practitioners Home visitsshould generally be unnecessary through the use of these technologies but13 could besupplemented by satellite surgeries manned by nursing in community premises or inpharmacies nurseries and Internet13 cafes
The homes13 of people who13 need13 closer monitoring can then become part13 of virtual wardswith real or electronic visits by health professionals University Hospital Southampton NHSFoundation Trust13 already looks after patients who have undergone surgery such as a hip orknee13 replacements in virtual wards with high levels of satisfaction The Royal Free London
37
NHS Foundation Trust13 offers a similar service but13 plans to add the possibility of videoconsultations between patient13 and consultant
310 Attitudes to public health issues ndash obesity smoking alcohol abuse drugs
As self-shy‐care becomes the focus of the NHS the public will increasingly understand that13 thecosts and availability of services are being harmed by the poor health behaviour ofrelatively small numbers of people The link between public health initiatives today andhealthcare needs and costs in the future will become increasingly evident13 as a result13 of theway that13 information is presented Thus the overweight13 smoker who currently attractsconcern and pity when they are diagnosed with diabetes and COPD is increasingly beingseen as the victim of their own stupidity or lack of self-shy‐discipline If they continue to neglect13 medical advice and continue with an unhealthy lifestyle then the way that13 they receivetreatment13 and consume resources will become a matter for the entire population
Obesity is seen as due to a combination of poor diet13 and a sedentary lifestyle No longer isthe idea13 that13 people are lsquobig bonedrsquo acceptable Governments will respond initially byrequiring manufacturers and food processors to provide nutritional information onpackaging and on menus in restaurants But13 people can choose not13 to read the data13 and toneglect13 both the importance of food quality content13 and quantity This will increasepressure to introduce fat13 or sugar taxes and these are likely to be in force within a decade
Although the high taxes on tobacco products has forced some smokers to reduce theirconsumption or to give up altogether the impact13 has been reduced by the smuggling ofproducts from overseas and by the availability of duty-shy‐free cigarettes for people returningfrom foreign holidays and business meetings Further measures are planned to changepackaging and to include even more graphic images and warnings on cigarette packages tomake smokers aware of the effects of smoking on their health and well-shy‐being There is asyet little evidence of how successful this might13 be More effective has been the banning ofsmoking in public places including trains and aircraft Expensive medical interventions suchas heart13 transplants will be denied to individuals until they change their lifestyle behaviourSmokers might13 therefore be increasingly ostracised leading to a loss of esteem This mayhave a particular impact13 on people who already suffer from mental health problems whoare more likely to smoke
The overuse of alcohol is being recognised as a major factor in hospital admissions withNHS figures showing an increase of over 40 in such admissions over the past13 decadeLinked to this has been a 75 increase in prescriptions to treat13 alcohol dependency Fewpeople have sympathy for those who waste their limited income on booze If they havechildren or other dependents they will be the ones who suffer and who may need thesupport13 of social care
Drug users are already significant13 users of social services as their habit13 is likely to makethem unemployable They receive little sympathy from the general public because they areseen as criminals and people who waste public resources Levels of drug abuse have been
38
slowly increasing over the years but13 this trend is slowly being reversed Indeed the numberof people using drugs during the past13 year has fallen to its lowest13 level for nearly 20 years(below 9) with cannabis being most13 likely often following excessive drinking Aselectronic noses and other technologies can detect13 traces of drugs it13 seems likely that13 success in overcoming addiction can be measured objectively This may become a two-shy‐edged sword rewarding those who can turn around their lives but13 further marginalisingthose who canrsquot13 or wont13 accept13 the lsquocold turkeyrsquo
311 Attitudes to surveillance
Issues associated with privacy confidentiality and data13 security have been discussedpreviously in the context13 of information technology the World Wide Web and the ease ofcollecting recording recalling analysing and displaying data The monitoring of individualsand their methods of using this information can be regarded as surveillance As thequantities of data13 increase along with the number of devices that13 can be used to access itthe surveillance tools will also increase in their sophistication Indeed the Big Data13 approaches described in the previous section will enable the combination of structureddata13 (such as the information held in databases) to be married with unstructured data13 fromimages in such a way that13 it13 can be mined
Whilst13 the lsquodigital surveillancersquo methods described above may cause most13 concern topeople because of its impact13 on anonymity it13 is the collection and analysis of images that13 are the major concern to people as they contemplate the ways that13 lsquoBig Brotherrsquo maydevelop to restrict13 freedom Every major UK city and town centre has an array of CCTVcameras that13 continually record activities from every angle If it13 used to be true that13 nobody in London was more than 10 yards from a rat it13 is certainly the case today that13 nobody can be more than this distance from being in view of a surveillance camera Yetthey receive so much positive publicity from TV programmes where their footage is used todetect13 vehicles close to a crime scene or to monitor the movements of suspects that13 theyare now accepted by the public as a deterrent13 in the same way as lsquobobbies on the beatrsquowere seen 25 years ago There is therefore little public reaction to the expansion in the useof video surveillance except13 for the practical observation of how so many views can beinspected and recorded
Looking to the future the tumbling cost13 of video technology will surely lead to anotherincrease in the number of devices The aerial views taken from towers will besupplemented by more local views taken by devices that13 are embedded in the fabric ofbuildings or carried by individuals either on their person (for example on clothing orspectacles) or in the bags that13 they carry The time and date-shy‐stamped images as Big Datawill be recorded to lsquothe Cloudrsquo where it13 can be added to other data It can then be usedwhen an incident13 has occurred or to provide further detail of night-shy‐time activities
It follows that13 there will be no hiding place for people who simply want13 to disappear Theymay respond by wearing clothing (such as hoodies) that13 hide their faces or which make it13 difficult13 to distinguish gait13 or mannerisms from which they might13 be identified New forms
39
of clothing may be designed to make shapes more difficult13 to analyse and these might13 become the uniforms of a class of person who wants to live in a way that13 they donrsquot13 interact13 with officials from any ministry or local government13 department If they also obstruct13 services then they will be considered to be anarchists of some form sparking protests fromother sectors of society
31213 Attitudes to driving
Motor cars have been a feature of UK roads for over a century but13 it13 is only during the past13 50 years that13 they have become a resource that13 most13 families have had access to enablingthem to travel without13 the restrictions imposed by a limited railway network and non-shy‐integrated bus transport People who have had a car throughout13 their lives often see theircars as an important13 factor in enabling them to remain independent13 and to exercise choicesrelating to where they shop and where they spend their leisure time This extends to theirspouse and to friends and neighbours that13 they might13 take with them on their variousexpeditions
Unfortunately there are incidents involving older drivers who perhaps go down amotorway in the wrong direction who are taken ill at the wheel or who are involved in anaccident13 involving no other vehicles These are small in number but13 often lead to a reactionthat13 they shouldnrsquot13 be allowed to drive lsquoat13 their agersquo Age itself is not13 an indicator ofdriving quality but13 because old age also brings more chance of having limited long termconditions and other illnesses it13 is easy to make a link between driving ability and age Thelicensing system does require continued driving to be linked with medical advice andforbids people with poor eyesight epilepsy and other conditions to hold a licence in oldage
Yet13 statistically older drivers cause far fewer accidents than younger drivers The reasonsfor this may be complex and are likely to include the fact13 that13 they drive less often covershorter distances and donrsquot13 go out13 in the dark or in poor weather However it13 does not13 wholly explain why the UKrsquos drivers aged over 70 and who represent13 some 8 of all driversare involved in only 4 of accidents that13 cause injury This compares favourably with the15 of13 drivers aged between 17 and 29 who are involved in over a third of crashes that13 result13 in injury
By 2020 the number of drivers aged over 70 on UK roads is likely to increase to over 7million This will require a new national strategy perhaps involving support13 for olderdrivers further training raising awareness of issues and making more use of adaptivetechnologies to support13 the driver in avoiding collision or forgetting to check on the statusof their vehicle Poor eyesight13 could be enhanced by camera technologies rather thanforcing people off the road if they are unable to read a licence plate
The International Longevity Centre has found that13 one in four Britons thought13 driversshould be made to switch off the ignition for good somewhere between the ages of 70 and75 The numbers may decrease as the population ages and as cars become safer Forcing
40
older people off the road may be a natural consequence of providing free bus passes andsubsidised rail fares but13 the growth in the pavement13 scooter industry demonstrates that13 older people value their independence and will do almost13 anything to get13 out13 and aboutPerhaps legislation will result13 in more regulation of electric vehicles and where they cantravel
There can be no doubt13 that13 getting out13 will be associated with better quality of life andwell-shy‐being and this is likely to be supported in the future as evidence of improvedoutcomes emerges It is to be hoped that13 positive stories will be publicised so that13 publicattitudes arenrsquot13 hardened This may be supported by more in-shy‐car monitoring of drivers andthe linking of performance with on-shy‐line driving records and licences These could throughremotely monitored ignition systems prevent13 the use of motor vehicles by people without13 a licence or without13 insurance
313 Climate change
There is a general view that13 the emissions of carbon gases are contributing to globalwarming in a manner that13 will change the UK climate in such a way that13 the climate maybecome more Mediterranean However some scientists believe that13 manrsquos impact13 on theenvironment13 may be small compared with natural variations caused for example bycyclical changes in the sunrsquos energy output13 or by the effects of volcanoes and earthquakesRecent13 evidence has suggested that13 we are going through a phase of changing extremesand that13 this is more likely to cause storms periods of excessive rainfall and unusualseasonal trends with snow and frost13 in the spring and warmer winters Considerableuncertainty remains and it13 might13 be necessary to plan for a number of different13 scenariosand for the impact13 on vulnerable people
I Colder winters UK properties are poorly insulated resulting in excess mortalitiesduring cold spells due to an increased number of people suffering from stroke aswell as bronchitis and other pulmonary diseases The cost13 of heating continues toincrease putting more households into a state of fuel poverty Any further coolingduring the winter months will result13 in more people living in unhealthy coldconditions Winter fuel payments are likely to be restricted to the poorest13 peoplebut13 this might13 exclude people who live in larger properties that13 are more difficult13 toheat
II More storms excessive winds and rain can cause flooding at any time of the yearMany UK communities are built13 close to rivers and these can surge during heavyrainfall causing houses to be filled with water and furniture and carpets lostInsurance can be problematic for properties built13 on flood plains which can blight13 properties and prevent13 owners from being able to sell and move on High winds canrip off roofs causing injury and also causing families to be left13 homeless anddependent13 on social services
III Hot13 summers Europe suffered high temperatures during the summers of 2003 and2004 leading to heat13 stroke and hypothermia The UK has not13 previously sufferedfrom such problems but13 might13 be expected to experience days of extreme
41
temperature and humidity at times Older people may not13 be prepared for suchweather Street13 dwellers may be unable to find shade and supplies of drinkingwater
Irrespective of what13 combination of weather scenarios arise it13 must13 be concluded that13 any extremes will have a major negative impact13 on vulnerable people especially if theyare not13 prepared because they havenrsquot13 received the weather warnings and advice that13 can be broadcast13 using the TV radio and online services Once again the digitallyexcluded will suffer and will pay a high cost Society will continue to pick up the bill interms of demands on social care services unless preventive actions are taken in theform of connecting these people to each other and to formal services
42
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
s13 13
13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
n13 13
13 s13
r13 n13
e13 at13
e13 y13 e13 ld13
ly13
13 e13 t13 e13
s13 er13 e13
f13
rt13 13
13 13
13
r13 13
s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
e13 g13 13
e13
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13
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d13 13
s13 y13
e13
13
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13
13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
already being connected to lsquothe systemrsquo either through an online presence or through theInternet13 of Things
38 Downloading everything
Sixty years ago information was discovered by reading books often in a library wherenotes had to be made because the books or journals couldnrsquot13 be removed Then in theearly 1960s the first13 office photocopying machines were introduced into the UK theyimmediately meant13 that13 pages or articles from books could be copied and taken away to beread and summarised later Within a few years photocopying became a replacement13 forreading as researchers became less adept13 at selecting a few sentences and every deskbecame a depository for reams of printed paper Paper became the means of recordingeverything from bank statements through to music
We now appreciate that13 printing everything is a waste of both the ink (or toner) used tocreate the black print13 and of paper which requires trees to be chopped down and pulpedbefore it13 can be pressed into thin sheets Saving paper is therefore seen as green and goodfor the planet Fortunately we no longer need to print13 everything because computermemory is unlimited thanks to the cloud and we can then view pages and articles onportable or fixed screens
The internet13 has everything and it13 is all available instantly for downloading providing thereis a device available to accept13 it and there is sufficient13 communication bandwidth toperform the transfer of data13 sufficiently quickly Thus we can record all text13 articles that13 are relevant13 to us including digital records of birth certificates qualifications and passportsand the need for original printed versions will decline But13 we can also do this forphotographs Most13 handheld computing devices include at least13 one camera so they cangenerate enormous number of pictures which can be kept13 for posterity without13 having toconsume inks and special papers to print13 them
But13 the materials that13 can be downloaded donrsquot13 stop at pictures software is available that13 can grab TV shows after they air and movies as soon as theyre released In the same wayit13 is possible to schedule music comic books video games and practically anything else asa download with minimal effort People will need enormous hard drives if they want13 theirown digital copies of these files so will more than likely make use of cloud storage that13 willbe available from many organisations The location of the servers may become sensitivedue to border restrictions as will the security of the data13 and the way that13 it13 is backed up sothat13 it13 is resilient13 to failures
It may be evident13 that13 application forms for all types of welfare payment13 will be availableonly for downloading so that once digitised they can be processed by computer andrecords sent13 to various servers for subsequent13 storage and processing Some people maywant13 to keep their data13 on them once it13 has been downloaded Pen drives can already holdseveral GB of data so it13 is likely that13 people will be able to carry their downloaded data13 withthem at all times irrespective of the size and complexities of the information
36
39 Health13 and13 well-shy‐being
The general health of the population is unlikely to deteriorate noticeably within 10 to 20years Indeed expectations of the population are that13 things must13 improve as surgicaltechniques mature and as pharmaceutical interventions become more personalised andpowerful However the rising demand for health services due to an ageing population andthe increasing cost13 of providing sophisticated therapies will make delivering a free anduniversal health service difficult13 without13 substantial increases in taxation This is unlikely tohappen in the UK even though spending on health services will be protected against13 thecuts facing other services
There will have to be changes in how the NHS works For twenty years hospitals have beenclosed and replaced by fewer new facilities so that13 the bed count13 is reduced This has led toa significant13 shift13 in resources to primary care and community care supporting shorter staysin hospital and speedier transfer back home for people after surgery or illness This hasbeen13 successful but13 there remain problems with demand for GP services especially out-shy‐of-shy‐hours and at weekends Indeed despite the introduction of NHS24 and similar help-shy‐linesthe demand for GP appointments continues to increase Delays are inevitable and this willincrease system failures with more unnecessary deaths and a failure for people to access adiagnosis that13 might13 lead to early interventions and ultimately lower delivery costs Over250 more patients are added to waiting lists every day
This will lead to a new model of primary care consistent13 with existing changes which haveseen surgeries move from High Street13 locations to medical centres close to bus routes andwith more parking for patients The process of making an appointment13 is changing from atelephone-shy‐based interview process dominated by a medically-shy‐unqualified receptionist13 to achoose and book approach using an online process linked to electronic patient13 records Thiswill give patients more convenience but13 will allow priority for those who have Internet13 access at the expensive of those who are digitally excluded Making the process of bookingan appointment13 quick and easy may also increase demand from people who do not13 need tobe seen as it13 will fail to identify those in greatest13 need
A greater use of telehealth and telecare technologies will be inevitable beginning with thefirst13 contact13 as an encounter using the telephone e-shy‐mail or video conferencing -shy‐ a visit13 tothe GP surgery should be a last13 resort and should involve a nurse consultation in the first13 instance This would be consistent13 with three quarters of appointments currently involvinga chronic disease or long term condition which relates to improved self-shy‐care The support13 ofthese patients at home should be prioritised through tele-shy‐ and web-shy‐based technologies andshould involve training and coaching through a network of nurse practitioners Home visitsshould generally be unnecessary through the use of these technologies but13 could besupplemented by satellite surgeries manned by nursing in community premises or inpharmacies nurseries and Internet13 cafes
The homes13 of people who13 need13 closer monitoring can then become part13 of virtual wardswith real or electronic visits by health professionals University Hospital Southampton NHSFoundation Trust13 already looks after patients who have undergone surgery such as a hip orknee13 replacements in virtual wards with high levels of satisfaction The Royal Free London
37
NHS Foundation Trust13 offers a similar service but13 plans to add the possibility of videoconsultations between patient13 and consultant
310 Attitudes to public health issues ndash obesity smoking alcohol abuse drugs
As self-shy‐care becomes the focus of the NHS the public will increasingly understand that13 thecosts and availability of services are being harmed by the poor health behaviour ofrelatively small numbers of people The link between public health initiatives today andhealthcare needs and costs in the future will become increasingly evident13 as a result13 of theway that13 information is presented Thus the overweight13 smoker who currently attractsconcern and pity when they are diagnosed with diabetes and COPD is increasingly beingseen as the victim of their own stupidity or lack of self-shy‐discipline If they continue to neglect13 medical advice and continue with an unhealthy lifestyle then the way that13 they receivetreatment13 and consume resources will become a matter for the entire population
Obesity is seen as due to a combination of poor diet13 and a sedentary lifestyle No longer isthe idea13 that13 people are lsquobig bonedrsquo acceptable Governments will respond initially byrequiring manufacturers and food processors to provide nutritional information onpackaging and on menus in restaurants But13 people can choose not13 to read the data13 and toneglect13 both the importance of food quality content13 and quantity This will increasepressure to introduce fat13 or sugar taxes and these are likely to be in force within a decade
Although the high taxes on tobacco products has forced some smokers to reduce theirconsumption or to give up altogether the impact13 has been reduced by the smuggling ofproducts from overseas and by the availability of duty-shy‐free cigarettes for people returningfrom foreign holidays and business meetings Further measures are planned to changepackaging and to include even more graphic images and warnings on cigarette packages tomake smokers aware of the effects of smoking on their health and well-shy‐being There is asyet little evidence of how successful this might13 be More effective has been the banning ofsmoking in public places including trains and aircraft Expensive medical interventions suchas heart13 transplants will be denied to individuals until they change their lifestyle behaviourSmokers might13 therefore be increasingly ostracised leading to a loss of esteem This mayhave a particular impact13 on people who already suffer from mental health problems whoare more likely to smoke
The overuse of alcohol is being recognised as a major factor in hospital admissions withNHS figures showing an increase of over 40 in such admissions over the past13 decadeLinked to this has been a 75 increase in prescriptions to treat13 alcohol dependency Fewpeople have sympathy for those who waste their limited income on booze If they havechildren or other dependents they will be the ones who suffer and who may need thesupport13 of social care
Drug users are already significant13 users of social services as their habit13 is likely to makethem unemployable They receive little sympathy from the general public because they areseen as criminals and people who waste public resources Levels of drug abuse have been
38
slowly increasing over the years but13 this trend is slowly being reversed Indeed the numberof people using drugs during the past13 year has fallen to its lowest13 level for nearly 20 years(below 9) with cannabis being most13 likely often following excessive drinking Aselectronic noses and other technologies can detect13 traces of drugs it13 seems likely that13 success in overcoming addiction can be measured objectively This may become a two-shy‐edged sword rewarding those who can turn around their lives but13 further marginalisingthose who canrsquot13 or wont13 accept13 the lsquocold turkeyrsquo
311 Attitudes to surveillance
Issues associated with privacy confidentiality and data13 security have been discussedpreviously in the context13 of information technology the World Wide Web and the ease ofcollecting recording recalling analysing and displaying data The monitoring of individualsand their methods of using this information can be regarded as surveillance As thequantities of data13 increase along with the number of devices that13 can be used to access itthe surveillance tools will also increase in their sophistication Indeed the Big Data13 approaches described in the previous section will enable the combination of structureddata13 (such as the information held in databases) to be married with unstructured data13 fromimages in such a way that13 it13 can be mined
Whilst13 the lsquodigital surveillancersquo methods described above may cause most13 concern topeople because of its impact13 on anonymity it13 is the collection and analysis of images that13 are the major concern to people as they contemplate the ways that13 lsquoBig Brotherrsquo maydevelop to restrict13 freedom Every major UK city and town centre has an array of CCTVcameras that13 continually record activities from every angle If it13 used to be true that13 nobody in London was more than 10 yards from a rat it13 is certainly the case today that13 nobody can be more than this distance from being in view of a surveillance camera Yetthey receive so much positive publicity from TV programmes where their footage is used todetect13 vehicles close to a crime scene or to monitor the movements of suspects that13 theyare now accepted by the public as a deterrent13 in the same way as lsquobobbies on the beatrsquowere seen 25 years ago There is therefore little public reaction to the expansion in the useof video surveillance except13 for the practical observation of how so many views can beinspected and recorded
Looking to the future the tumbling cost13 of video technology will surely lead to anotherincrease in the number of devices The aerial views taken from towers will besupplemented by more local views taken by devices that13 are embedded in the fabric ofbuildings or carried by individuals either on their person (for example on clothing orspectacles) or in the bags that13 they carry The time and date-shy‐stamped images as Big Datawill be recorded to lsquothe Cloudrsquo where it13 can be added to other data It can then be usedwhen an incident13 has occurred or to provide further detail of night-shy‐time activities
It follows that13 there will be no hiding place for people who simply want13 to disappear Theymay respond by wearing clothing (such as hoodies) that13 hide their faces or which make it13 difficult13 to distinguish gait13 or mannerisms from which they might13 be identified New forms
39
of clothing may be designed to make shapes more difficult13 to analyse and these might13 become the uniforms of a class of person who wants to live in a way that13 they donrsquot13 interact13 with officials from any ministry or local government13 department If they also obstruct13 services then they will be considered to be anarchists of some form sparking protests fromother sectors of society
31213 Attitudes to driving
Motor cars have been a feature of UK roads for over a century but13 it13 is only during the past13 50 years that13 they have become a resource that13 most13 families have had access to enablingthem to travel without13 the restrictions imposed by a limited railway network and non-shy‐integrated bus transport People who have had a car throughout13 their lives often see theircars as an important13 factor in enabling them to remain independent13 and to exercise choicesrelating to where they shop and where they spend their leisure time This extends to theirspouse and to friends and neighbours that13 they might13 take with them on their variousexpeditions
Unfortunately there are incidents involving older drivers who perhaps go down amotorway in the wrong direction who are taken ill at the wheel or who are involved in anaccident13 involving no other vehicles These are small in number but13 often lead to a reactionthat13 they shouldnrsquot13 be allowed to drive lsquoat13 their agersquo Age itself is not13 an indicator ofdriving quality but13 because old age also brings more chance of having limited long termconditions and other illnesses it13 is easy to make a link between driving ability and age Thelicensing system does require continued driving to be linked with medical advice andforbids people with poor eyesight epilepsy and other conditions to hold a licence in oldage
Yet13 statistically older drivers cause far fewer accidents than younger drivers The reasonsfor this may be complex and are likely to include the fact13 that13 they drive less often covershorter distances and donrsquot13 go out13 in the dark or in poor weather However it13 does not13 wholly explain why the UKrsquos drivers aged over 70 and who represent13 some 8 of all driversare involved in only 4 of accidents that13 cause injury This compares favourably with the15 of13 drivers aged between 17 and 29 who are involved in over a third of crashes that13 result13 in injury
By 2020 the number of drivers aged over 70 on UK roads is likely to increase to over 7million This will require a new national strategy perhaps involving support13 for olderdrivers further training raising awareness of issues and making more use of adaptivetechnologies to support13 the driver in avoiding collision or forgetting to check on the statusof their vehicle Poor eyesight13 could be enhanced by camera technologies rather thanforcing people off the road if they are unable to read a licence plate
The International Longevity Centre has found that13 one in four Britons thought13 driversshould be made to switch off the ignition for good somewhere between the ages of 70 and75 The numbers may decrease as the population ages and as cars become safer Forcing
40
older people off the road may be a natural consequence of providing free bus passes andsubsidised rail fares but13 the growth in the pavement13 scooter industry demonstrates that13 older people value their independence and will do almost13 anything to get13 out13 and aboutPerhaps legislation will result13 in more regulation of electric vehicles and where they cantravel
There can be no doubt13 that13 getting out13 will be associated with better quality of life andwell-shy‐being and this is likely to be supported in the future as evidence of improvedoutcomes emerges It is to be hoped that13 positive stories will be publicised so that13 publicattitudes arenrsquot13 hardened This may be supported by more in-shy‐car monitoring of drivers andthe linking of performance with on-shy‐line driving records and licences These could throughremotely monitored ignition systems prevent13 the use of motor vehicles by people without13 a licence or without13 insurance
313 Climate change
There is a general view that13 the emissions of carbon gases are contributing to globalwarming in a manner that13 will change the UK climate in such a way that13 the climate maybecome more Mediterranean However some scientists believe that13 manrsquos impact13 on theenvironment13 may be small compared with natural variations caused for example bycyclical changes in the sunrsquos energy output13 or by the effects of volcanoes and earthquakesRecent13 evidence has suggested that13 we are going through a phase of changing extremesand that13 this is more likely to cause storms periods of excessive rainfall and unusualseasonal trends with snow and frost13 in the spring and warmer winters Considerableuncertainty remains and it13 might13 be necessary to plan for a number of different13 scenariosand for the impact13 on vulnerable people
I Colder winters UK properties are poorly insulated resulting in excess mortalitiesduring cold spells due to an increased number of people suffering from stroke aswell as bronchitis and other pulmonary diseases The cost13 of heating continues toincrease putting more households into a state of fuel poverty Any further coolingduring the winter months will result13 in more people living in unhealthy coldconditions Winter fuel payments are likely to be restricted to the poorest13 peoplebut13 this might13 exclude people who live in larger properties that13 are more difficult13 toheat
II More storms excessive winds and rain can cause flooding at any time of the yearMany UK communities are built13 close to rivers and these can surge during heavyrainfall causing houses to be filled with water and furniture and carpets lostInsurance can be problematic for properties built13 on flood plains which can blight13 properties and prevent13 owners from being able to sell and move on High winds canrip off roofs causing injury and also causing families to be left13 homeless anddependent13 on social services
III Hot13 summers Europe suffered high temperatures during the summers of 2003 and2004 leading to heat13 stroke and hypothermia The UK has not13 previously sufferedfrom such problems but13 might13 be expected to experience days of extreme
41
temperature and humidity at times Older people may not13 be prepared for suchweather Street13 dwellers may be unable to find shade and supplies of drinkingwater
Irrespective of what13 combination of weather scenarios arise it13 must13 be concluded that13 any extremes will have a major negative impact13 on vulnerable people especially if theyare not13 prepared because they havenrsquot13 received the weather warnings and advice that13 can be broadcast13 using the TV radio and online services Once again the digitallyexcluded will suffer and will pay a high cost Society will continue to pick up the bill interms of demands on social care services unless preventive actions are taken in theform of connecting these people to each other and to formal services
42
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
s13 13
13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
n13 13
13 s13
r13 n13
e13 at13
e13 y13 e13 ld13
ly13
13 e13 t13 e13
s13 er13 e13
f13
rt13 13
13 13
13
r13 13
s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
e13 g13 13
e13
13 13 ial13
13
d13
13 d13 h13 r13
d13 13
s13 y13
e13
13
rd13 r13 e13
13
13
13
e13
e13
d13 13
13
13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
39 Health13 and13 well-shy‐being
The general health of the population is unlikely to deteriorate noticeably within 10 to 20years Indeed expectations of the population are that13 things must13 improve as surgicaltechniques mature and as pharmaceutical interventions become more personalised andpowerful However the rising demand for health services due to an ageing population andthe increasing cost13 of providing sophisticated therapies will make delivering a free anduniversal health service difficult13 without13 substantial increases in taxation This is unlikely tohappen in the UK even though spending on health services will be protected against13 thecuts facing other services
There will have to be changes in how the NHS works For twenty years hospitals have beenclosed and replaced by fewer new facilities so that13 the bed count13 is reduced This has led toa significant13 shift13 in resources to primary care and community care supporting shorter staysin hospital and speedier transfer back home for people after surgery or illness This hasbeen13 successful but13 there remain problems with demand for GP services especially out-shy‐of-shy‐hours and at weekends Indeed despite the introduction of NHS24 and similar help-shy‐linesthe demand for GP appointments continues to increase Delays are inevitable and this willincrease system failures with more unnecessary deaths and a failure for people to access adiagnosis that13 might13 lead to early interventions and ultimately lower delivery costs Over250 more patients are added to waiting lists every day
This will lead to a new model of primary care consistent13 with existing changes which haveseen surgeries move from High Street13 locations to medical centres close to bus routes andwith more parking for patients The process of making an appointment13 is changing from atelephone-shy‐based interview process dominated by a medically-shy‐unqualified receptionist13 to achoose and book approach using an online process linked to electronic patient13 records Thiswill give patients more convenience but13 will allow priority for those who have Internet13 access at the expensive of those who are digitally excluded Making the process of bookingan appointment13 quick and easy may also increase demand from people who do not13 need tobe seen as it13 will fail to identify those in greatest13 need
A greater use of telehealth and telecare technologies will be inevitable beginning with thefirst13 contact13 as an encounter using the telephone e-shy‐mail or video conferencing -shy‐ a visit13 tothe GP surgery should be a last13 resort and should involve a nurse consultation in the first13 instance This would be consistent13 with three quarters of appointments currently involvinga chronic disease or long term condition which relates to improved self-shy‐care The support13 ofthese patients at home should be prioritised through tele-shy‐ and web-shy‐based technologies andshould involve training and coaching through a network of nurse practitioners Home visitsshould generally be unnecessary through the use of these technologies but13 could besupplemented by satellite surgeries manned by nursing in community premises or inpharmacies nurseries and Internet13 cafes
The homes13 of people who13 need13 closer monitoring can then become part13 of virtual wardswith real or electronic visits by health professionals University Hospital Southampton NHSFoundation Trust13 already looks after patients who have undergone surgery such as a hip orknee13 replacements in virtual wards with high levels of satisfaction The Royal Free London
37
NHS Foundation Trust13 offers a similar service but13 plans to add the possibility of videoconsultations between patient13 and consultant
310 Attitudes to public health issues ndash obesity smoking alcohol abuse drugs
As self-shy‐care becomes the focus of the NHS the public will increasingly understand that13 thecosts and availability of services are being harmed by the poor health behaviour ofrelatively small numbers of people The link between public health initiatives today andhealthcare needs and costs in the future will become increasingly evident13 as a result13 of theway that13 information is presented Thus the overweight13 smoker who currently attractsconcern and pity when they are diagnosed with diabetes and COPD is increasingly beingseen as the victim of their own stupidity or lack of self-shy‐discipline If they continue to neglect13 medical advice and continue with an unhealthy lifestyle then the way that13 they receivetreatment13 and consume resources will become a matter for the entire population
Obesity is seen as due to a combination of poor diet13 and a sedentary lifestyle No longer isthe idea13 that13 people are lsquobig bonedrsquo acceptable Governments will respond initially byrequiring manufacturers and food processors to provide nutritional information onpackaging and on menus in restaurants But13 people can choose not13 to read the data13 and toneglect13 both the importance of food quality content13 and quantity This will increasepressure to introduce fat13 or sugar taxes and these are likely to be in force within a decade
Although the high taxes on tobacco products has forced some smokers to reduce theirconsumption or to give up altogether the impact13 has been reduced by the smuggling ofproducts from overseas and by the availability of duty-shy‐free cigarettes for people returningfrom foreign holidays and business meetings Further measures are planned to changepackaging and to include even more graphic images and warnings on cigarette packages tomake smokers aware of the effects of smoking on their health and well-shy‐being There is asyet little evidence of how successful this might13 be More effective has been the banning ofsmoking in public places including trains and aircraft Expensive medical interventions suchas heart13 transplants will be denied to individuals until they change their lifestyle behaviourSmokers might13 therefore be increasingly ostracised leading to a loss of esteem This mayhave a particular impact13 on people who already suffer from mental health problems whoare more likely to smoke
The overuse of alcohol is being recognised as a major factor in hospital admissions withNHS figures showing an increase of over 40 in such admissions over the past13 decadeLinked to this has been a 75 increase in prescriptions to treat13 alcohol dependency Fewpeople have sympathy for those who waste their limited income on booze If they havechildren or other dependents they will be the ones who suffer and who may need thesupport13 of social care
Drug users are already significant13 users of social services as their habit13 is likely to makethem unemployable They receive little sympathy from the general public because they areseen as criminals and people who waste public resources Levels of drug abuse have been
38
slowly increasing over the years but13 this trend is slowly being reversed Indeed the numberof people using drugs during the past13 year has fallen to its lowest13 level for nearly 20 years(below 9) with cannabis being most13 likely often following excessive drinking Aselectronic noses and other technologies can detect13 traces of drugs it13 seems likely that13 success in overcoming addiction can be measured objectively This may become a two-shy‐edged sword rewarding those who can turn around their lives but13 further marginalisingthose who canrsquot13 or wont13 accept13 the lsquocold turkeyrsquo
311 Attitudes to surveillance
Issues associated with privacy confidentiality and data13 security have been discussedpreviously in the context13 of information technology the World Wide Web and the ease ofcollecting recording recalling analysing and displaying data The monitoring of individualsand their methods of using this information can be regarded as surveillance As thequantities of data13 increase along with the number of devices that13 can be used to access itthe surveillance tools will also increase in their sophistication Indeed the Big Data13 approaches described in the previous section will enable the combination of structureddata13 (such as the information held in databases) to be married with unstructured data13 fromimages in such a way that13 it13 can be mined
Whilst13 the lsquodigital surveillancersquo methods described above may cause most13 concern topeople because of its impact13 on anonymity it13 is the collection and analysis of images that13 are the major concern to people as they contemplate the ways that13 lsquoBig Brotherrsquo maydevelop to restrict13 freedom Every major UK city and town centre has an array of CCTVcameras that13 continually record activities from every angle If it13 used to be true that13 nobody in London was more than 10 yards from a rat it13 is certainly the case today that13 nobody can be more than this distance from being in view of a surveillance camera Yetthey receive so much positive publicity from TV programmes where their footage is used todetect13 vehicles close to a crime scene or to monitor the movements of suspects that13 theyare now accepted by the public as a deterrent13 in the same way as lsquobobbies on the beatrsquowere seen 25 years ago There is therefore little public reaction to the expansion in the useof video surveillance except13 for the practical observation of how so many views can beinspected and recorded
Looking to the future the tumbling cost13 of video technology will surely lead to anotherincrease in the number of devices The aerial views taken from towers will besupplemented by more local views taken by devices that13 are embedded in the fabric ofbuildings or carried by individuals either on their person (for example on clothing orspectacles) or in the bags that13 they carry The time and date-shy‐stamped images as Big Datawill be recorded to lsquothe Cloudrsquo where it13 can be added to other data It can then be usedwhen an incident13 has occurred or to provide further detail of night-shy‐time activities
It follows that13 there will be no hiding place for people who simply want13 to disappear Theymay respond by wearing clothing (such as hoodies) that13 hide their faces or which make it13 difficult13 to distinguish gait13 or mannerisms from which they might13 be identified New forms
39
of clothing may be designed to make shapes more difficult13 to analyse and these might13 become the uniforms of a class of person who wants to live in a way that13 they donrsquot13 interact13 with officials from any ministry or local government13 department If they also obstruct13 services then they will be considered to be anarchists of some form sparking protests fromother sectors of society
31213 Attitudes to driving
Motor cars have been a feature of UK roads for over a century but13 it13 is only during the past13 50 years that13 they have become a resource that13 most13 families have had access to enablingthem to travel without13 the restrictions imposed by a limited railway network and non-shy‐integrated bus transport People who have had a car throughout13 their lives often see theircars as an important13 factor in enabling them to remain independent13 and to exercise choicesrelating to where they shop and where they spend their leisure time This extends to theirspouse and to friends and neighbours that13 they might13 take with them on their variousexpeditions
Unfortunately there are incidents involving older drivers who perhaps go down amotorway in the wrong direction who are taken ill at the wheel or who are involved in anaccident13 involving no other vehicles These are small in number but13 often lead to a reactionthat13 they shouldnrsquot13 be allowed to drive lsquoat13 their agersquo Age itself is not13 an indicator ofdriving quality but13 because old age also brings more chance of having limited long termconditions and other illnesses it13 is easy to make a link between driving ability and age Thelicensing system does require continued driving to be linked with medical advice andforbids people with poor eyesight epilepsy and other conditions to hold a licence in oldage
Yet13 statistically older drivers cause far fewer accidents than younger drivers The reasonsfor this may be complex and are likely to include the fact13 that13 they drive less often covershorter distances and donrsquot13 go out13 in the dark or in poor weather However it13 does not13 wholly explain why the UKrsquos drivers aged over 70 and who represent13 some 8 of all driversare involved in only 4 of accidents that13 cause injury This compares favourably with the15 of13 drivers aged between 17 and 29 who are involved in over a third of crashes that13 result13 in injury
By 2020 the number of drivers aged over 70 on UK roads is likely to increase to over 7million This will require a new national strategy perhaps involving support13 for olderdrivers further training raising awareness of issues and making more use of adaptivetechnologies to support13 the driver in avoiding collision or forgetting to check on the statusof their vehicle Poor eyesight13 could be enhanced by camera technologies rather thanforcing people off the road if they are unable to read a licence plate
The International Longevity Centre has found that13 one in four Britons thought13 driversshould be made to switch off the ignition for good somewhere between the ages of 70 and75 The numbers may decrease as the population ages and as cars become safer Forcing
40
older people off the road may be a natural consequence of providing free bus passes andsubsidised rail fares but13 the growth in the pavement13 scooter industry demonstrates that13 older people value their independence and will do almost13 anything to get13 out13 and aboutPerhaps legislation will result13 in more regulation of electric vehicles and where they cantravel
There can be no doubt13 that13 getting out13 will be associated with better quality of life andwell-shy‐being and this is likely to be supported in the future as evidence of improvedoutcomes emerges It is to be hoped that13 positive stories will be publicised so that13 publicattitudes arenrsquot13 hardened This may be supported by more in-shy‐car monitoring of drivers andthe linking of performance with on-shy‐line driving records and licences These could throughremotely monitored ignition systems prevent13 the use of motor vehicles by people without13 a licence or without13 insurance
313 Climate change
There is a general view that13 the emissions of carbon gases are contributing to globalwarming in a manner that13 will change the UK climate in such a way that13 the climate maybecome more Mediterranean However some scientists believe that13 manrsquos impact13 on theenvironment13 may be small compared with natural variations caused for example bycyclical changes in the sunrsquos energy output13 or by the effects of volcanoes and earthquakesRecent13 evidence has suggested that13 we are going through a phase of changing extremesand that13 this is more likely to cause storms periods of excessive rainfall and unusualseasonal trends with snow and frost13 in the spring and warmer winters Considerableuncertainty remains and it13 might13 be necessary to plan for a number of different13 scenariosand for the impact13 on vulnerable people
I Colder winters UK properties are poorly insulated resulting in excess mortalitiesduring cold spells due to an increased number of people suffering from stroke aswell as bronchitis and other pulmonary diseases The cost13 of heating continues toincrease putting more households into a state of fuel poverty Any further coolingduring the winter months will result13 in more people living in unhealthy coldconditions Winter fuel payments are likely to be restricted to the poorest13 peoplebut13 this might13 exclude people who live in larger properties that13 are more difficult13 toheat
II More storms excessive winds and rain can cause flooding at any time of the yearMany UK communities are built13 close to rivers and these can surge during heavyrainfall causing houses to be filled with water and furniture and carpets lostInsurance can be problematic for properties built13 on flood plains which can blight13 properties and prevent13 owners from being able to sell and move on High winds canrip off roofs causing injury and also causing families to be left13 homeless anddependent13 on social services
III Hot13 summers Europe suffered high temperatures during the summers of 2003 and2004 leading to heat13 stroke and hypothermia The UK has not13 previously sufferedfrom such problems but13 might13 be expected to experience days of extreme
41
temperature and humidity at times Older people may not13 be prepared for suchweather Street13 dwellers may be unable to find shade and supplies of drinkingwater
Irrespective of what13 combination of weather scenarios arise it13 must13 be concluded that13 any extremes will have a major negative impact13 on vulnerable people especially if theyare not13 prepared because they havenrsquot13 received the weather warnings and advice that13 can be broadcast13 using the TV radio and online services Once again the digitallyexcluded will suffer and will pay a high cost Society will continue to pick up the bill interms of demands on social care services unless preventive actions are taken in theform of connecting these people to each other and to formal services
42
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
s13 13
13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
n13 13
13 s13
r13 n13
e13 at13
e13 y13 e13 ld13
ly13
13 e13 t13 e13
s13 er13 e13
f13
rt13 13
13 13
13
r13 13
s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
e13 g13 13
e13
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13
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d13 13
s13 y13
e13
13
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13
13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
NHS Foundation Trust13 offers a similar service but13 plans to add the possibility of videoconsultations between patient13 and consultant
310 Attitudes to public health issues ndash obesity smoking alcohol abuse drugs
As self-shy‐care becomes the focus of the NHS the public will increasingly understand that13 thecosts and availability of services are being harmed by the poor health behaviour ofrelatively small numbers of people The link between public health initiatives today andhealthcare needs and costs in the future will become increasingly evident13 as a result13 of theway that13 information is presented Thus the overweight13 smoker who currently attractsconcern and pity when they are diagnosed with diabetes and COPD is increasingly beingseen as the victim of their own stupidity or lack of self-shy‐discipline If they continue to neglect13 medical advice and continue with an unhealthy lifestyle then the way that13 they receivetreatment13 and consume resources will become a matter for the entire population
Obesity is seen as due to a combination of poor diet13 and a sedentary lifestyle No longer isthe idea13 that13 people are lsquobig bonedrsquo acceptable Governments will respond initially byrequiring manufacturers and food processors to provide nutritional information onpackaging and on menus in restaurants But13 people can choose not13 to read the data13 and toneglect13 both the importance of food quality content13 and quantity This will increasepressure to introduce fat13 or sugar taxes and these are likely to be in force within a decade
Although the high taxes on tobacco products has forced some smokers to reduce theirconsumption or to give up altogether the impact13 has been reduced by the smuggling ofproducts from overseas and by the availability of duty-shy‐free cigarettes for people returningfrom foreign holidays and business meetings Further measures are planned to changepackaging and to include even more graphic images and warnings on cigarette packages tomake smokers aware of the effects of smoking on their health and well-shy‐being There is asyet little evidence of how successful this might13 be More effective has been the banning ofsmoking in public places including trains and aircraft Expensive medical interventions suchas heart13 transplants will be denied to individuals until they change their lifestyle behaviourSmokers might13 therefore be increasingly ostracised leading to a loss of esteem This mayhave a particular impact13 on people who already suffer from mental health problems whoare more likely to smoke
The overuse of alcohol is being recognised as a major factor in hospital admissions withNHS figures showing an increase of over 40 in such admissions over the past13 decadeLinked to this has been a 75 increase in prescriptions to treat13 alcohol dependency Fewpeople have sympathy for those who waste their limited income on booze If they havechildren or other dependents they will be the ones who suffer and who may need thesupport13 of social care
Drug users are already significant13 users of social services as their habit13 is likely to makethem unemployable They receive little sympathy from the general public because they areseen as criminals and people who waste public resources Levels of drug abuse have been
38
slowly increasing over the years but13 this trend is slowly being reversed Indeed the numberof people using drugs during the past13 year has fallen to its lowest13 level for nearly 20 years(below 9) with cannabis being most13 likely often following excessive drinking Aselectronic noses and other technologies can detect13 traces of drugs it13 seems likely that13 success in overcoming addiction can be measured objectively This may become a two-shy‐edged sword rewarding those who can turn around their lives but13 further marginalisingthose who canrsquot13 or wont13 accept13 the lsquocold turkeyrsquo
311 Attitudes to surveillance
Issues associated with privacy confidentiality and data13 security have been discussedpreviously in the context13 of information technology the World Wide Web and the ease ofcollecting recording recalling analysing and displaying data The monitoring of individualsand their methods of using this information can be regarded as surveillance As thequantities of data13 increase along with the number of devices that13 can be used to access itthe surveillance tools will also increase in their sophistication Indeed the Big Data13 approaches described in the previous section will enable the combination of structureddata13 (such as the information held in databases) to be married with unstructured data13 fromimages in such a way that13 it13 can be mined
Whilst13 the lsquodigital surveillancersquo methods described above may cause most13 concern topeople because of its impact13 on anonymity it13 is the collection and analysis of images that13 are the major concern to people as they contemplate the ways that13 lsquoBig Brotherrsquo maydevelop to restrict13 freedom Every major UK city and town centre has an array of CCTVcameras that13 continually record activities from every angle If it13 used to be true that13 nobody in London was more than 10 yards from a rat it13 is certainly the case today that13 nobody can be more than this distance from being in view of a surveillance camera Yetthey receive so much positive publicity from TV programmes where their footage is used todetect13 vehicles close to a crime scene or to monitor the movements of suspects that13 theyare now accepted by the public as a deterrent13 in the same way as lsquobobbies on the beatrsquowere seen 25 years ago There is therefore little public reaction to the expansion in the useof video surveillance except13 for the practical observation of how so many views can beinspected and recorded
Looking to the future the tumbling cost13 of video technology will surely lead to anotherincrease in the number of devices The aerial views taken from towers will besupplemented by more local views taken by devices that13 are embedded in the fabric ofbuildings or carried by individuals either on their person (for example on clothing orspectacles) or in the bags that13 they carry The time and date-shy‐stamped images as Big Datawill be recorded to lsquothe Cloudrsquo where it13 can be added to other data It can then be usedwhen an incident13 has occurred or to provide further detail of night-shy‐time activities
It follows that13 there will be no hiding place for people who simply want13 to disappear Theymay respond by wearing clothing (such as hoodies) that13 hide their faces or which make it13 difficult13 to distinguish gait13 or mannerisms from which they might13 be identified New forms
39
of clothing may be designed to make shapes more difficult13 to analyse and these might13 become the uniforms of a class of person who wants to live in a way that13 they donrsquot13 interact13 with officials from any ministry or local government13 department If they also obstruct13 services then they will be considered to be anarchists of some form sparking protests fromother sectors of society
31213 Attitudes to driving
Motor cars have been a feature of UK roads for over a century but13 it13 is only during the past13 50 years that13 they have become a resource that13 most13 families have had access to enablingthem to travel without13 the restrictions imposed by a limited railway network and non-shy‐integrated bus transport People who have had a car throughout13 their lives often see theircars as an important13 factor in enabling them to remain independent13 and to exercise choicesrelating to where they shop and where they spend their leisure time This extends to theirspouse and to friends and neighbours that13 they might13 take with them on their variousexpeditions
Unfortunately there are incidents involving older drivers who perhaps go down amotorway in the wrong direction who are taken ill at the wheel or who are involved in anaccident13 involving no other vehicles These are small in number but13 often lead to a reactionthat13 they shouldnrsquot13 be allowed to drive lsquoat13 their agersquo Age itself is not13 an indicator ofdriving quality but13 because old age also brings more chance of having limited long termconditions and other illnesses it13 is easy to make a link between driving ability and age Thelicensing system does require continued driving to be linked with medical advice andforbids people with poor eyesight epilepsy and other conditions to hold a licence in oldage
Yet13 statistically older drivers cause far fewer accidents than younger drivers The reasonsfor this may be complex and are likely to include the fact13 that13 they drive less often covershorter distances and donrsquot13 go out13 in the dark or in poor weather However it13 does not13 wholly explain why the UKrsquos drivers aged over 70 and who represent13 some 8 of all driversare involved in only 4 of accidents that13 cause injury This compares favourably with the15 of13 drivers aged between 17 and 29 who are involved in over a third of crashes that13 result13 in injury
By 2020 the number of drivers aged over 70 on UK roads is likely to increase to over 7million This will require a new national strategy perhaps involving support13 for olderdrivers further training raising awareness of issues and making more use of adaptivetechnologies to support13 the driver in avoiding collision or forgetting to check on the statusof their vehicle Poor eyesight13 could be enhanced by camera technologies rather thanforcing people off the road if they are unable to read a licence plate
The International Longevity Centre has found that13 one in four Britons thought13 driversshould be made to switch off the ignition for good somewhere between the ages of 70 and75 The numbers may decrease as the population ages and as cars become safer Forcing
40
older people off the road may be a natural consequence of providing free bus passes andsubsidised rail fares but13 the growth in the pavement13 scooter industry demonstrates that13 older people value their independence and will do almost13 anything to get13 out13 and aboutPerhaps legislation will result13 in more regulation of electric vehicles and where they cantravel
There can be no doubt13 that13 getting out13 will be associated with better quality of life andwell-shy‐being and this is likely to be supported in the future as evidence of improvedoutcomes emerges It is to be hoped that13 positive stories will be publicised so that13 publicattitudes arenrsquot13 hardened This may be supported by more in-shy‐car monitoring of drivers andthe linking of performance with on-shy‐line driving records and licences These could throughremotely monitored ignition systems prevent13 the use of motor vehicles by people without13 a licence or without13 insurance
313 Climate change
There is a general view that13 the emissions of carbon gases are contributing to globalwarming in a manner that13 will change the UK climate in such a way that13 the climate maybecome more Mediterranean However some scientists believe that13 manrsquos impact13 on theenvironment13 may be small compared with natural variations caused for example bycyclical changes in the sunrsquos energy output13 or by the effects of volcanoes and earthquakesRecent13 evidence has suggested that13 we are going through a phase of changing extremesand that13 this is more likely to cause storms periods of excessive rainfall and unusualseasonal trends with snow and frost13 in the spring and warmer winters Considerableuncertainty remains and it13 might13 be necessary to plan for a number of different13 scenariosand for the impact13 on vulnerable people
I Colder winters UK properties are poorly insulated resulting in excess mortalitiesduring cold spells due to an increased number of people suffering from stroke aswell as bronchitis and other pulmonary diseases The cost13 of heating continues toincrease putting more households into a state of fuel poverty Any further coolingduring the winter months will result13 in more people living in unhealthy coldconditions Winter fuel payments are likely to be restricted to the poorest13 peoplebut13 this might13 exclude people who live in larger properties that13 are more difficult13 toheat
II More storms excessive winds and rain can cause flooding at any time of the yearMany UK communities are built13 close to rivers and these can surge during heavyrainfall causing houses to be filled with water and furniture and carpets lostInsurance can be problematic for properties built13 on flood plains which can blight13 properties and prevent13 owners from being able to sell and move on High winds canrip off roofs causing injury and also causing families to be left13 homeless anddependent13 on social services
III Hot13 summers Europe suffered high temperatures during the summers of 2003 and2004 leading to heat13 stroke and hypothermia The UK has not13 previously sufferedfrom such problems but13 might13 be expected to experience days of extreme
41
temperature and humidity at times Older people may not13 be prepared for suchweather Street13 dwellers may be unable to find shade and supplies of drinkingwater
Irrespective of what13 combination of weather scenarios arise it13 must13 be concluded that13 any extremes will have a major negative impact13 on vulnerable people especially if theyare not13 prepared because they havenrsquot13 received the weather warnings and advice that13 can be broadcast13 using the TV radio and online services Once again the digitallyexcluded will suffer and will pay a high cost Society will continue to pick up the bill interms of demands on social care services unless preventive actions are taken in theform of connecting these people to each other and to formal services
42
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
s13 13
13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
n13 13
13 s13
r13 n13
e13 at13
e13 y13 e13 ld13
ly13
13 e13 t13 e13
s13 er13 e13
f13
rt13 13
13 13
13
r13 13
s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
e13 g13 13
e13
13 13 ial13
13
d13
13 d13 h13 r13
d13 13
s13 y13
e13
13
rd13 r13 e13
13
13
13
e13
e13
d13 13
13
13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
slowly increasing over the years but13 this trend is slowly being reversed Indeed the numberof people using drugs during the past13 year has fallen to its lowest13 level for nearly 20 years(below 9) with cannabis being most13 likely often following excessive drinking Aselectronic noses and other technologies can detect13 traces of drugs it13 seems likely that13 success in overcoming addiction can be measured objectively This may become a two-shy‐edged sword rewarding those who can turn around their lives but13 further marginalisingthose who canrsquot13 or wont13 accept13 the lsquocold turkeyrsquo
311 Attitudes to surveillance
Issues associated with privacy confidentiality and data13 security have been discussedpreviously in the context13 of information technology the World Wide Web and the ease ofcollecting recording recalling analysing and displaying data The monitoring of individualsand their methods of using this information can be regarded as surveillance As thequantities of data13 increase along with the number of devices that13 can be used to access itthe surveillance tools will also increase in their sophistication Indeed the Big Data13 approaches described in the previous section will enable the combination of structureddata13 (such as the information held in databases) to be married with unstructured data13 fromimages in such a way that13 it13 can be mined
Whilst13 the lsquodigital surveillancersquo methods described above may cause most13 concern topeople because of its impact13 on anonymity it13 is the collection and analysis of images that13 are the major concern to people as they contemplate the ways that13 lsquoBig Brotherrsquo maydevelop to restrict13 freedom Every major UK city and town centre has an array of CCTVcameras that13 continually record activities from every angle If it13 used to be true that13 nobody in London was more than 10 yards from a rat it13 is certainly the case today that13 nobody can be more than this distance from being in view of a surveillance camera Yetthey receive so much positive publicity from TV programmes where their footage is used todetect13 vehicles close to a crime scene or to monitor the movements of suspects that13 theyare now accepted by the public as a deterrent13 in the same way as lsquobobbies on the beatrsquowere seen 25 years ago There is therefore little public reaction to the expansion in the useof video surveillance except13 for the practical observation of how so many views can beinspected and recorded
Looking to the future the tumbling cost13 of video technology will surely lead to anotherincrease in the number of devices The aerial views taken from towers will besupplemented by more local views taken by devices that13 are embedded in the fabric ofbuildings or carried by individuals either on their person (for example on clothing orspectacles) or in the bags that13 they carry The time and date-shy‐stamped images as Big Datawill be recorded to lsquothe Cloudrsquo where it13 can be added to other data It can then be usedwhen an incident13 has occurred or to provide further detail of night-shy‐time activities
It follows that13 there will be no hiding place for people who simply want13 to disappear Theymay respond by wearing clothing (such as hoodies) that13 hide their faces or which make it13 difficult13 to distinguish gait13 or mannerisms from which they might13 be identified New forms
39
of clothing may be designed to make shapes more difficult13 to analyse and these might13 become the uniforms of a class of person who wants to live in a way that13 they donrsquot13 interact13 with officials from any ministry or local government13 department If they also obstruct13 services then they will be considered to be anarchists of some form sparking protests fromother sectors of society
31213 Attitudes to driving
Motor cars have been a feature of UK roads for over a century but13 it13 is only during the past13 50 years that13 they have become a resource that13 most13 families have had access to enablingthem to travel without13 the restrictions imposed by a limited railway network and non-shy‐integrated bus transport People who have had a car throughout13 their lives often see theircars as an important13 factor in enabling them to remain independent13 and to exercise choicesrelating to where they shop and where they spend their leisure time This extends to theirspouse and to friends and neighbours that13 they might13 take with them on their variousexpeditions
Unfortunately there are incidents involving older drivers who perhaps go down amotorway in the wrong direction who are taken ill at the wheel or who are involved in anaccident13 involving no other vehicles These are small in number but13 often lead to a reactionthat13 they shouldnrsquot13 be allowed to drive lsquoat13 their agersquo Age itself is not13 an indicator ofdriving quality but13 because old age also brings more chance of having limited long termconditions and other illnesses it13 is easy to make a link between driving ability and age Thelicensing system does require continued driving to be linked with medical advice andforbids people with poor eyesight epilepsy and other conditions to hold a licence in oldage
Yet13 statistically older drivers cause far fewer accidents than younger drivers The reasonsfor this may be complex and are likely to include the fact13 that13 they drive less often covershorter distances and donrsquot13 go out13 in the dark or in poor weather However it13 does not13 wholly explain why the UKrsquos drivers aged over 70 and who represent13 some 8 of all driversare involved in only 4 of accidents that13 cause injury This compares favourably with the15 of13 drivers aged between 17 and 29 who are involved in over a third of crashes that13 result13 in injury
By 2020 the number of drivers aged over 70 on UK roads is likely to increase to over 7million This will require a new national strategy perhaps involving support13 for olderdrivers further training raising awareness of issues and making more use of adaptivetechnologies to support13 the driver in avoiding collision or forgetting to check on the statusof their vehicle Poor eyesight13 could be enhanced by camera technologies rather thanforcing people off the road if they are unable to read a licence plate
The International Longevity Centre has found that13 one in four Britons thought13 driversshould be made to switch off the ignition for good somewhere between the ages of 70 and75 The numbers may decrease as the population ages and as cars become safer Forcing
40
older people off the road may be a natural consequence of providing free bus passes andsubsidised rail fares but13 the growth in the pavement13 scooter industry demonstrates that13 older people value their independence and will do almost13 anything to get13 out13 and aboutPerhaps legislation will result13 in more regulation of electric vehicles and where they cantravel
There can be no doubt13 that13 getting out13 will be associated with better quality of life andwell-shy‐being and this is likely to be supported in the future as evidence of improvedoutcomes emerges It is to be hoped that13 positive stories will be publicised so that13 publicattitudes arenrsquot13 hardened This may be supported by more in-shy‐car monitoring of drivers andthe linking of performance with on-shy‐line driving records and licences These could throughremotely monitored ignition systems prevent13 the use of motor vehicles by people without13 a licence or without13 insurance
313 Climate change
There is a general view that13 the emissions of carbon gases are contributing to globalwarming in a manner that13 will change the UK climate in such a way that13 the climate maybecome more Mediterranean However some scientists believe that13 manrsquos impact13 on theenvironment13 may be small compared with natural variations caused for example bycyclical changes in the sunrsquos energy output13 or by the effects of volcanoes and earthquakesRecent13 evidence has suggested that13 we are going through a phase of changing extremesand that13 this is more likely to cause storms periods of excessive rainfall and unusualseasonal trends with snow and frost13 in the spring and warmer winters Considerableuncertainty remains and it13 might13 be necessary to plan for a number of different13 scenariosand for the impact13 on vulnerable people
I Colder winters UK properties are poorly insulated resulting in excess mortalitiesduring cold spells due to an increased number of people suffering from stroke aswell as bronchitis and other pulmonary diseases The cost13 of heating continues toincrease putting more households into a state of fuel poverty Any further coolingduring the winter months will result13 in more people living in unhealthy coldconditions Winter fuel payments are likely to be restricted to the poorest13 peoplebut13 this might13 exclude people who live in larger properties that13 are more difficult13 toheat
II More storms excessive winds and rain can cause flooding at any time of the yearMany UK communities are built13 close to rivers and these can surge during heavyrainfall causing houses to be filled with water and furniture and carpets lostInsurance can be problematic for properties built13 on flood plains which can blight13 properties and prevent13 owners from being able to sell and move on High winds canrip off roofs causing injury and also causing families to be left13 homeless anddependent13 on social services
III Hot13 summers Europe suffered high temperatures during the summers of 2003 and2004 leading to heat13 stroke and hypothermia The UK has not13 previously sufferedfrom such problems but13 might13 be expected to experience days of extreme
41
temperature and humidity at times Older people may not13 be prepared for suchweather Street13 dwellers may be unable to find shade and supplies of drinkingwater
Irrespective of what13 combination of weather scenarios arise it13 must13 be concluded that13 any extremes will have a major negative impact13 on vulnerable people especially if theyare not13 prepared because they havenrsquot13 received the weather warnings and advice that13 can be broadcast13 using the TV radio and online services Once again the digitallyexcluded will suffer and will pay a high cost Society will continue to pick up the bill interms of demands on social care services unless preventive actions are taken in theform of connecting these people to each other and to formal services
42
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
s13 13
13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
n13 13
13 s13
r13 n13
e13 at13
e13 y13 e13 ld13
ly13
13 e13 t13 e13
s13 er13 e13
f13
rt13 13
13 13
13
r13 13
s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
e13 g13 13
e13
13 13 ial13
13
d13
13 d13 h13 r13
d13 13
s13 y13
e13
13
rd13 r13 e13
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13
13
e13
e13
d13 13
13
13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
of clothing may be designed to make shapes more difficult13 to analyse and these might13 become the uniforms of a class of person who wants to live in a way that13 they donrsquot13 interact13 with officials from any ministry or local government13 department If they also obstruct13 services then they will be considered to be anarchists of some form sparking protests fromother sectors of society
31213 Attitudes to driving
Motor cars have been a feature of UK roads for over a century but13 it13 is only during the past13 50 years that13 they have become a resource that13 most13 families have had access to enablingthem to travel without13 the restrictions imposed by a limited railway network and non-shy‐integrated bus transport People who have had a car throughout13 their lives often see theircars as an important13 factor in enabling them to remain independent13 and to exercise choicesrelating to where they shop and where they spend their leisure time This extends to theirspouse and to friends and neighbours that13 they might13 take with them on their variousexpeditions
Unfortunately there are incidents involving older drivers who perhaps go down amotorway in the wrong direction who are taken ill at the wheel or who are involved in anaccident13 involving no other vehicles These are small in number but13 often lead to a reactionthat13 they shouldnrsquot13 be allowed to drive lsquoat13 their agersquo Age itself is not13 an indicator ofdriving quality but13 because old age also brings more chance of having limited long termconditions and other illnesses it13 is easy to make a link between driving ability and age Thelicensing system does require continued driving to be linked with medical advice andforbids people with poor eyesight epilepsy and other conditions to hold a licence in oldage
Yet13 statistically older drivers cause far fewer accidents than younger drivers The reasonsfor this may be complex and are likely to include the fact13 that13 they drive less often covershorter distances and donrsquot13 go out13 in the dark or in poor weather However it13 does not13 wholly explain why the UKrsquos drivers aged over 70 and who represent13 some 8 of all driversare involved in only 4 of accidents that13 cause injury This compares favourably with the15 of13 drivers aged between 17 and 29 who are involved in over a third of crashes that13 result13 in injury
By 2020 the number of drivers aged over 70 on UK roads is likely to increase to over 7million This will require a new national strategy perhaps involving support13 for olderdrivers further training raising awareness of issues and making more use of adaptivetechnologies to support13 the driver in avoiding collision or forgetting to check on the statusof their vehicle Poor eyesight13 could be enhanced by camera technologies rather thanforcing people off the road if they are unable to read a licence plate
The International Longevity Centre has found that13 one in four Britons thought13 driversshould be made to switch off the ignition for good somewhere between the ages of 70 and75 The numbers may decrease as the population ages and as cars become safer Forcing
40
older people off the road may be a natural consequence of providing free bus passes andsubsidised rail fares but13 the growth in the pavement13 scooter industry demonstrates that13 older people value their independence and will do almost13 anything to get13 out13 and aboutPerhaps legislation will result13 in more regulation of electric vehicles and where they cantravel
There can be no doubt13 that13 getting out13 will be associated with better quality of life andwell-shy‐being and this is likely to be supported in the future as evidence of improvedoutcomes emerges It is to be hoped that13 positive stories will be publicised so that13 publicattitudes arenrsquot13 hardened This may be supported by more in-shy‐car monitoring of drivers andthe linking of performance with on-shy‐line driving records and licences These could throughremotely monitored ignition systems prevent13 the use of motor vehicles by people without13 a licence or without13 insurance
313 Climate change
There is a general view that13 the emissions of carbon gases are contributing to globalwarming in a manner that13 will change the UK climate in such a way that13 the climate maybecome more Mediterranean However some scientists believe that13 manrsquos impact13 on theenvironment13 may be small compared with natural variations caused for example bycyclical changes in the sunrsquos energy output13 or by the effects of volcanoes and earthquakesRecent13 evidence has suggested that13 we are going through a phase of changing extremesand that13 this is more likely to cause storms periods of excessive rainfall and unusualseasonal trends with snow and frost13 in the spring and warmer winters Considerableuncertainty remains and it13 might13 be necessary to plan for a number of different13 scenariosand for the impact13 on vulnerable people
I Colder winters UK properties are poorly insulated resulting in excess mortalitiesduring cold spells due to an increased number of people suffering from stroke aswell as bronchitis and other pulmonary diseases The cost13 of heating continues toincrease putting more households into a state of fuel poverty Any further coolingduring the winter months will result13 in more people living in unhealthy coldconditions Winter fuel payments are likely to be restricted to the poorest13 peoplebut13 this might13 exclude people who live in larger properties that13 are more difficult13 toheat
II More storms excessive winds and rain can cause flooding at any time of the yearMany UK communities are built13 close to rivers and these can surge during heavyrainfall causing houses to be filled with water and furniture and carpets lostInsurance can be problematic for properties built13 on flood plains which can blight13 properties and prevent13 owners from being able to sell and move on High winds canrip off roofs causing injury and also causing families to be left13 homeless anddependent13 on social services
III Hot13 summers Europe suffered high temperatures during the summers of 2003 and2004 leading to heat13 stroke and hypothermia The UK has not13 previously sufferedfrom such problems but13 might13 be expected to experience days of extreme
41
temperature and humidity at times Older people may not13 be prepared for suchweather Street13 dwellers may be unable to find shade and supplies of drinkingwater
Irrespective of what13 combination of weather scenarios arise it13 must13 be concluded that13 any extremes will have a major negative impact13 on vulnerable people especially if theyare not13 prepared because they havenrsquot13 received the weather warnings and advice that13 can be broadcast13 using the TV radio and online services Once again the digitallyexcluded will suffer and will pay a high cost Society will continue to pick up the bill interms of demands on social care services unless preventive actions are taken in theform of connecting these people to each other and to formal services
42
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
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13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
n13 13
13 s13
r13 n13
e13 at13
e13 y13 e13 ld13
ly13
13 e13 t13 e13
s13 er13 e13
f13
rt13 13
13 13
13
r13 13
s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
e13 g13 13
e13
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13
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d13 13
s13 y13
e13
13
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13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
older people off the road may be a natural consequence of providing free bus passes andsubsidised rail fares but13 the growth in the pavement13 scooter industry demonstrates that13 older people value their independence and will do almost13 anything to get13 out13 and aboutPerhaps legislation will result13 in more regulation of electric vehicles and where they cantravel
There can be no doubt13 that13 getting out13 will be associated with better quality of life andwell-shy‐being and this is likely to be supported in the future as evidence of improvedoutcomes emerges It is to be hoped that13 positive stories will be publicised so that13 publicattitudes arenrsquot13 hardened This may be supported by more in-shy‐car monitoring of drivers andthe linking of performance with on-shy‐line driving records and licences These could throughremotely monitored ignition systems prevent13 the use of motor vehicles by people without13 a licence or without13 insurance
313 Climate change
There is a general view that13 the emissions of carbon gases are contributing to globalwarming in a manner that13 will change the UK climate in such a way that13 the climate maybecome more Mediterranean However some scientists believe that13 manrsquos impact13 on theenvironment13 may be small compared with natural variations caused for example bycyclical changes in the sunrsquos energy output13 or by the effects of volcanoes and earthquakesRecent13 evidence has suggested that13 we are going through a phase of changing extremesand that13 this is more likely to cause storms periods of excessive rainfall and unusualseasonal trends with snow and frost13 in the spring and warmer winters Considerableuncertainty remains and it13 might13 be necessary to plan for a number of different13 scenariosand for the impact13 on vulnerable people
I Colder winters UK properties are poorly insulated resulting in excess mortalitiesduring cold spells due to an increased number of people suffering from stroke aswell as bronchitis and other pulmonary diseases The cost13 of heating continues toincrease putting more households into a state of fuel poverty Any further coolingduring the winter months will result13 in more people living in unhealthy coldconditions Winter fuel payments are likely to be restricted to the poorest13 peoplebut13 this might13 exclude people who live in larger properties that13 are more difficult13 toheat
II More storms excessive winds and rain can cause flooding at any time of the yearMany UK communities are built13 close to rivers and these can surge during heavyrainfall causing houses to be filled with water and furniture and carpets lostInsurance can be problematic for properties built13 on flood plains which can blight13 properties and prevent13 owners from being able to sell and move on High winds canrip off roofs causing injury and also causing families to be left13 homeless anddependent13 on social services
III Hot13 summers Europe suffered high temperatures during the summers of 2003 and2004 leading to heat13 stroke and hypothermia The UK has not13 previously sufferedfrom such problems but13 might13 be expected to experience days of extreme
41
temperature and humidity at times Older people may not13 be prepared for suchweather Street13 dwellers may be unable to find shade and supplies of drinkingwater
Irrespective of what13 combination of weather scenarios arise it13 must13 be concluded that13 any extremes will have a major negative impact13 on vulnerable people especially if theyare not13 prepared because they havenrsquot13 received the weather warnings and advice that13 can be broadcast13 using the TV radio and online services Once again the digitallyexcluded will suffer and will pay a high cost Society will continue to pick up the bill interms of demands on social care services unless preventive actions are taken in theform of connecting these people to each other and to formal services
42
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
s13 13
13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
n13 13
13 s13
r13 n13
e13 at13
e13 y13 e13 ld13
ly13
13 e13 t13 e13
s13 er13 e13
f13
rt13 13
13 13
13
r13 13
s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
e13 g13 13
e13
13 13 ial13
13
d13
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d13 13
s13 y13
e13
13
rd13 r13 e13
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d13 13
13
13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
temperature and humidity at times Older people may not13 be prepared for suchweather Street13 dwellers may be unable to find shade and supplies of drinkingwater
Irrespective of what13 combination of weather scenarios arise it13 must13 be concluded that13 any extremes will have a major negative impact13 on vulnerable people especially if theyare not13 prepared because they havenrsquot13 received the weather warnings and advice that13 can be broadcast13 using the TV radio and online services Once again the digitallyexcluded will suffer and will pay a high cost Society will continue to pick up the bill interms of demands on social care services unless preventive actions are taken in theform of connecting these people to each other and to formal services
42
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
s13 13
13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
n13 13
13 s13
r13 n13
e13 at13
e13 y13 e13 ld13
ly13
13 e13 t13 e13
s13 er13 e13
f13
rt13 13
13 13
13
r13 13
s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
e13 g13 13
e13
13 13 ial13
13
d13
13 d13 h13 r13
d13 13
s13 y13
e13
13
rd13 r13 e13
13
13
13
e13
e13
d13 13
13
13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
CONCLUSIONS
It may be apparent13 from both the technology views and from the discussions about13 howexternal factors may change the face of social care that13 the dominant13 factors for changewill be access to online information and communication No longer will a digital presencebe an advantage that13 will be used exclusively by the well-shy‐educated and articulate but13 it13 will13 be a facility that13 will be available to everyone and in all places This leads to an assumptionthat13 the people who are likely to be most13 vulnerable in the future are those who aredigitally excluded for whatever reason Social workers will therefore find themselvesdealing with people who are unable to do things for themselves because they cannot13 accessimportant13 information or who need help in using this information to overcome theproblems that13 presents to them
All cases are unique but13 there are a number of groups of people whose needs should beaddressed in order to show how social workers will need to be trained to satisfy futuresupport13 needs
bull Older frail people who need physical support13 to perform activities of daily livingbull People with cognitive impairments such as memory loss who present13 safety
problemsbull Those who are socially excluded and who have little social capitalbull Visually impaired people and those with other sensory disabilities such as hearing
lossbull Adults with learning or developmental disabilities who want13 to live independentlybull People with serious illnesses who are approaching the end of their lifebull Physically disabled people who are unable to transfer without13 helpbull Victims of domestic violence and their families andbull Informal carers who are supporting any or all of the above
Technologies that13 directly support13 the groups described above are all either availablealready or will soon be available and at a price that13 makes them affordable The price ofindependence is therefore falling as a result13 of technology Many of these developmentsare examples of assistive technologies or of connected technologies that13 ensure that13 peopleare not13 alone however isolated they might13 be in a physical sense Social services cantherefore refer people to more specialist13 service providers and will need to commissionservices that13 meet13 defined needs The two major challenges that13 they face will be
(a) Being aware of all the new technologies that13 are available -shy‐ and ensuring that13 theirknowledge13 is up-shy‐to-shy‐date when items can become redundant13 within two or threeyears and
(b) Persuading the public that13 technology is reliable and an appropriate and affordablemeans of supporting independence
The former problem is to do with training and ensuring that13 databases of products areavailable online and in a form that13 can easily be searched Advice must13 be impartial andshould be rather more sophisticated than a simple comparison website as used for standarditems such as home insurance The latter problem is the same one faced by health chiefs as
43
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
s13 13
13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
n13 13
13 s13
r13 n13
e13 at13
e13 y13 e13 ld13
ly13
13 e13 t13 e13
s13 er13 e13
f13
rt13 13
13 13
13
r13 13
s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
e13 g13 13
e13
13 13 ial13
13
d13
13 d13 h13 r13
d13 13
s13 y13
e13
13
rd13 r13 e13
13
13
13
e13
e13
d13 13
13
13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
they try to persuade people that13 fewer hospitals and less beds is the way forward for theNHS at a time when the population is ageing and demand for healthcare services isincreasing rapidly It will require political resolve as well as the promotion of manyfavourable examples of benefits in order to demonstrate that13 genuinely good outcomes canbe achieved by putting more faith in technology
The Whole System Demonstrator studies undertaken in Cornwall parts of Kent13 and in theLondon Borough of Newham have proved that13 the telehealth systems can reduce thedemands of an ageing and chronically ill population on the NHS in a safe and popularmanner They did not13 show the value for money that13 the UK government13 had hopedthough this was in part a result13 of the costs involved in setting up such a researchprogramme but13 also because the equipment13 and service costs demanded by the supplierswere too high This has forced down prices and will have a future positive effect13 on the13 ATindustry as it13 will convince them that13 the way to maximise benefits and reduce stigma13 willbe to employ standard items as often as possible and to ensure that13 designs are universalThis supports the idea13 of using existing hardware items in more flexible ways especiallywhere apps can be imported to change the function of a device These will benefit13 peoplewith sight13 problems and with hearing problems because walking around with a smart13 phonein the hand is now common practice for all users -shy‐ and especially for the lsquocoolrsquo youngerusers that13 they might13 wish to emulate Of course there could be unexpectedconsequences In the case of the visually impaired will they need to learn braille whentheir cameras can read text13 and their software and read it13 out13 aloud What13 happens tothose social workers who have studied for years to learn and to teach braille Similarlywill hearing aid manufacturers and assessors be needed when an app can perform the test13 and optimise the performance of the amplification needed Will devices becomeredundant13 because people will have noise eliminating headphones that13 extract13 the desiredspeech or music from the background
The other questions that13 need to be asked will be
bull Who pays for the technologybull Who maintains it13 and provides support13 for it andbull How can it13 be provided to service users
The answer to all these questions is relatively simple -shy‐ the service users themselves usingpersonal budgets The culture of self-shy‐directed support13 must13 evolve such that13 it13 is no longerjust13 about13 paying for a person to do things for the individual but13 about13 buying a definedservice This is an opportunity for new service providers to emerge where they know thetechnologies and can set13 up cost-shy‐effective online services that13 include access to broadbandthe portable (and fixed) devices needed to display and communicate the training to showhow it13 works and the ongoing support13 that13 will respond to problems in the fastest13 possibleway If people are to depend on their technology services then their support13 structuresmust13 be sufficiently responsive to ensure that13 they have the confidence to know exactlywhat13 to do in the event13 of failure By 2020 the requirements for such services will be well-shy‐defined and there will be countless services able to support13 social care users in this wayThis will in part be due to the improving quality of all technologies -shy‐ how often do TVs carsand fridges break down today compared with 20 years ago But13 it13 will also be due to the
44
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
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13
h13
13
at13
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d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
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13
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e13 e13 13 13 13
e13
13
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13
13
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s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
n13 13
13 s13
r13 n13
e13 at13
e13 y13 e13 ld13
ly13
13 e13 t13 e13
s13 er13 e13
f13
rt13 13
13 13
13
r13 13
s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
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proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
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13
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le13
y13
o13
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le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
fact13 that13 electronic products have no moving parts any more -shy‐ and are also becoming so lowcost13 that13 they are almost13 disposable They wonrsquot13 be thrown away -shy‐ but13 they will bereplaced by new devices that13 can be programmed immediately using cloud storage
45
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
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re13 13
13 13
13
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ty13 13 13
n13
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ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
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r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
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as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
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ly13
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13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
e13 g13 13
e13
13 13 ial13
13
d13
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d13 13
s13 y13
e13
13
rd13 r13 e13
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13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
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13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
APPENDIX A
These 20 short13 vignettes offer the opportunity to think about13 how quality of life maydepend on receiving adequate and appropriate technology-shy‐based services Appendix Billustrates how these might13 be used to explore the ideas suggested in this report
1 William Johnson -shy‐ ex soldier Aged 68 divorced lost13 contact13 with 2 childrenDrinks heavily Newly diagnosed with Type 2 diabetes
2 Gillian McAndrew -shy‐ aged 82 Widowed with 2 children and 6 grandchildren Issuffering from AMD and is slowly losing her sight
3 George Brown -shy‐ aged 72 A former drummer in a successful 1960s rock bandSmoked cannabis for many years Has lost13 significant13 hearing and short13 termmemory but13 wonrsquot13 wear a hearing aid
4 Janice Wallace -shy‐ aged 75 Married to husband William for 50 years Has developedshort13 term memory loss over past13 2 or 3 years Probably has Alzheimers but13 has not13 been formally diagnosed
5 Grace McNulty -shy‐ aged 82 Very independent13 spinster who has very painful arthritiswhich is having a significant13 negative impact13 on her quality of life as it13 is limiting herability to go out13 and to go upstairs in her semi-shy‐detached home
6 Jeremy and Joanna13 Baxter -shy‐ a couple in their early 50s who have become sandwichgeneration carers Jeremyrsquos mother lives 200 miles away in a retirement13 housingscheme but13 he is her only son Joannarsquos mother lives 5 miles away and has becomedependent13 on her for shipping taking her to health appointment13 and for generallysupport13 which is increasing They married relatively late in life and have 2 childrenJohn and Ian aged 20 and 15 respectively Ian has Downrsquos syndrome and lives withthem He is also epileptic though the number of seizures that13 he suffers during theday is now quite small
7 Jennifer is aged 12 and has Aspergerrsquos syndrome8 Susan McKenzie is aged 35 and has bipolar disorder She has a daughter aged 10
who lives with her but13 who is on the at-shy‐risk register because of her motherrsquos bipolardisorder
9 Jeremy Steele is 45 years of age and has severe memory issues and mobilityproblems since suffering a motor-shy‐bike accident13 in 2009
10 Joyce Stewart is 78 and following the death of her husband last13 year is surviving onher basic retirement13 pension She has no children feels lonely and isolated andincapable of paying her bills or organising her life
11 Sandra13 Smith aged 18 She has a learning disability and lives with her parents Shehas attended college for the past13 few years but13 ends her time there in the summerShe has been offered a job in a local museum and would love to move into her owntenancy in order to become independent She has a boyfriend and dreams ofgetting married and having a family
46
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
n13
ng13 e13 13 ut13
13 s13 le13
13 e13
e13
re13 13
13 13
13
d13 13 13
ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
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13 is13 13
13 y13 d13
a13 13
13
13
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13
at13
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d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
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13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
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ly13
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13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
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e13
13 13 ial13
13
d13
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s13 y13
e13
13
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13
13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
12 Nora13 Black lives alone in a small terraced house She suffered a stroke 3 years agowhich has left13 her feeling anxious and with slurred speech She has been the victimof doorstep abuse and is fearful of being robbed again though she has little of valueto steal
13 Elvis Roberts is aged 75 and has spent13 most13 of his life in and out13 of prison for variouspetty offences mainly involving the handling of stolen goods which he tried to fencethrough companies that13 he set13 up He was declared bankrupt13 last13 year andtherefore cannot13 have a bank account
14 Pauline Wilkinson lives for her cats and her dog She has been in hospital for a hipreplacement13 and needs support13 looking after her pets She lives in a 2nd floorapartment
15 Alice13 Wilson She has 4 children and is struggling to support13 them since her latest13 boyfriend walked out13 on her and the kids (only one of which is his) She has noqualifications but13 has claimed some disability benefits after suffering from back painduring one of her pregnancies The outlook for her and her family is bleakespecially as life on the housing estate in which she lives is bleak and is driving herchildren towards crime
16 Elizabeth Cameron ndash aged 88 prone to falling Unlikely to wear any special devicesthat13 stigmatised her Yet she has plenty of money which she would use to put13 things into her house if they could make her safe there
17 Fiona Jones ndash aged 36 and mother of 3 children aged between 6 and 11 She hassuffered physical abuse at the hands of a new partner for the past13 3 years and hasrecently taken up residence in a refuge
18 Geraldine Reynolds aged 82 is a rather frail widow who lives in a detached house ina high class residential are of Edinburgh She is relatively wealthy as a result13 ofbeing careful with the money earned by her domineering husband Her 3 childrenlive in the Lothian area13 but13 they and the grandchildren only visit13 her when they want13 something Issues of financial abuse abound concerning both her family and thefriend who helps Geraldine to perform shopping and other domestic tasks
19 Jacqueline Baxter aged 63 A spinster who retired recently after a long career as aprimary school teacher Feels the cold badly because of Raynaudrsquos syndrome whichprevents her from using a mobile phone and a touch screen computer or tablet Sheworries about13 going out13 in the cold the cost13 of heating and the loss of friendsbecause she canrsquot13 communicate with them using Facebook and social media
20 Jane Doe -shy‐ she was found in a park in Aberdeen with a fractured ankle andsuffering from mild hypothermia She claims that13 she canrsquot13 remember her name orwhere she lives Her age and appearance suggest13 that13 she may be living on thestreets Her accent13 is English rather than Scottish
Fuller details for each of these vignettes are available
47
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13 e13
e13
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13 13
13
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ty13 13 13
n13
13 m13
y13 13
ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
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13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
n13 13
13 s13
r13 n13
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ly13
13 e13 t13 e13
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13 13
13
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s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
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13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
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e13
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proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
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13
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le13
y13
o13
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ar13
13 13
s13 13
le13 13 13
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13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
n13
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re13 13
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d13 13 13
ty13 13 13
n13
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ll13 13
13
t13
d13
APPENDIX B Technology-shy‐enabled care13 in practice
Using six of the above vignettes we illustrate how various technologies might13 play a part13 indelivering better outcomes
William13 Johnson an ex-shy‐soldier aged13 68 divorced13 and lost contact13 with his 2 children13 Drinks heavily and admitted to hospital several times ndash after a bout of drinking Newlydiagnosed13 with13 Type 2 diabetes
Todayrsquos13 Possible13 Outcomes Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyWilliam is not13 old but13 he has bee William needs to be connected firstly to the communi stuck in a rut13 with few interests and then to a new generation of friends and family so and little social capital for a that13 he can widen his range of interests and access to number of years It is not13 the services that13 will exist13 to support13 him If he hasnrsquot13 surprising that13 he has taken to already been shown how to use a computer then heusing drink as a method of blocki needs to take advantage of a scheme that13 usesout13 the emptiness of his existenc volunteers -shy‐ and these might13 include ex-shy‐militaryThe impact13 of years of drinking onpersonnel who will be keen to help one of their ownhis liver will eventually kill him b He will have many options to getting online includinghis current13 issue is with diabetes the use of a smart13 TV and a smart13 phone The TV optio which will affect13 all his internal could then become the basis of an online chat13 roomorgans along with his circulation using video conferencing and allowing him to meet13 up unless it13 is managed This require in virtual meetings with some of his old colleagues fro discipline which he should be ab the army This could lead to physical reunions andto manage following his military opportunities to share in activities designed specificall background However it13 is more to overcome the emotional problems that13 are found in likely that13 he will not13 measure his many ex-shy‐military people once they retireblood sugar levels he will not13 giv Although he has lost13 contact13 with his children they wi up foods that13 are high in sugar have an online presence which will enable him to find and he will not13 exercise to improvthem They might13 be prepared to give him anotherhis health His glycaemic control chance and to introduce him to their children none of will be poor leaving him even mo whom will have negative memories of himsusceptible to falls accidents and Grandchildren may give him some meaning for lifeadmissions to hospital With no especially if he asks for pictures and gives them gifts atmotivation he will either develop Christmas and on their birthdaysdiabetic ulcers which could lead toWilliamrsquos health issues will also be of interest13 to hisamputation or he will suffer a children People will recognise the importance offailure of his liver or kidneys He13 inherited genes and will realise that13 they can learn a lo will die a relatively young man about13 their future health issues by talking to theunhappy and alone His condition provider of the other half of their gene pool This coul will cost13 the NHS thousands of give them a greater understanding of the hereditarypounds in use of hospital beds anfactors associated with diabetes and will teach themmight13 also cost13 the social services best13 practice in prevention They may support13 theirbudget13 a similar sum in residentialfather and encourage him to take up Cognitive
48
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
a13 13
13
13
h13
13
at13
e13 s13
d13 13
r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
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13 r13 13
13 13
13 13
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13
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e13 e13 13 13 13
e13
13
e13 re13
13
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13 13
s13
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13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
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13 e13 t13 e13
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13 13
13
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s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
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13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
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e13
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proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
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13
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13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
13 d13 13 a13
13 13 ir13 at13
s13 13 13 lt13
at13
13
d13
13 is13 13
13 y13 d13
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13
h13
13
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r13
care home fees especiallyrequires an amputation
if he Behavioural Therapies to tackle his alcohol demonsespecially as they can now be delivered remotely via13 the smartphone that13 they might13 buy him This deviceruns apps to remind him to measure his blood sugarlevel to take his medication to manage his diet and to take more exercise William will be a different13 man an will have a quality of life that13 makes him feel better as person
Jeremy and Joanna13 Baxter13 -shy‐ a couple in their early13 50s who13 have become sandwichgeneration carers Jeremyrsquos13 mother13 lives13 200 miles13 away in a retirement13 housing13 scheme
Todayrsquos13 Possible13 OutcomesJeremy and Joanna13 are struggling with their consciences as they try to support13 their mothers and the sons They will want13 to ensure th their younger son Ian is givenevery opportunity to maximise hi independence but having looked after him well and closely for the past13 15 years are finding it13 difficu to understand his ambitionsAlthough he hasnrsquot13 had a seizurefor many years they insist13 onleaving all bedrooms doors opennight13 so that13 one of them couldreact13 quickly if they were awoken by his convulsions Meanwhiletheir older son may feel neglecte at an important13 stage of his lifeespecially if his parents are being pulled13 one way and another by h grandparents If their marriage had been weaker then the pressures might13 well have broken it13 but13 the share their love of their family an take their responsibilities veryseriously Nevertheless theirhealth is suffering under thecontinuous burden of care Joann gave up her shop assistant13 job to look after her mother but13 is
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyIan is digitally engaged and loves his Android phonetablet13 and laptop He engages with his friends everyevening through his smart13 media enabling him toparticipate in all their social activities He has used his self-shy‐directed care budget13 to buy himself an epilepticseizure detection system that13 is portable and based on his smartphone His parents can now sleep well in the13 knowledge that13 their vibrating pillow device will alert13 them if he has a convulsive seizure during the nightThe seizure detection system is entirely portable whic means that13 his telecare system can go with him if hechooses to spend the night13 away with13 his friends giving his parents regular respite opportunities The idea13 ofhim moving out13 at 18 is no longer so frightening forthemThe system works so well that13 Ian is able to suggest13 th his parents provide similar telecare facilities for hisgrandmothers They are able to choose different13 systems for the two women Jeremyrsquos mother canreturn home with monitoring of her cardiac output13 being provided remotely to her primary carer while sh is bed and through a variety of connected technologie that13 populate her GP health record Jeremy is able toconnect13 to her with a Skype system while her sociallandlord ensures that13 any emergency needs are relaye to him using a telecare systems She is empowered to use online shopping through her local Tesco store13 Joannarsquos mother is making good progress following he stroke She uses a Kinnect13 system for rehabilitationexercises and has regained much of her function
49
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13
13 r13 13
13 13
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13
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e13 e13 13 13 13
e13
13
e13 re13
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13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
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n13 13
13 s13
r13 n13
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ly13
13 e13 t13 e13
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13 13
13
r13 13
s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
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e13
13 13 ial13
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13 d13 h13 r13
d13 13
s13 y13
e13
13
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e13
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13
13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
s13 13
13
13 r13 13
13 13
13 13
e13 d13
13
n13 13
e13 e13 13 13 13
e13
13
e13 re13
13
13
13 13
s13
n13 e13
13 f13
as13 a13
becoming depressed as she misse meeting all the people who came into the shop Jeremy was maderedundant13 and feels guilty that13 he cannot13 support13 them financiallyand that13 he is unable to provide as much hands-shy‐on care as his wife o pay for them to have a holiday Ian continues to live with them after leaving college at 18 even though many of his friends have movedinto their own tenancies Johnleaves university and accepts avolunteer job in India His parents hope that13 he might13 phone at Xmas
Joanna13 monitors her using a second generation telecar system that13 alerts her if movement13 levels have decline or if her mother hasnrsquot13 gone to bed by midnight Thesystem delivers alerts to Joannarsquos phone which means that13 she is able to go out13 without13 worrying about13 hermotherrsquos well-shy‐being She has been able to restart13 herpart-shy‐time jobJeremy has decided that13 he can now retire He has acouple of new hobbies but13 also volunteers for a localcharity showing other retired men how to use acomputer He has also made some money by sellingfurniture that13 he made in his shed on eBay He andJoanna13 will be visiting their son John in India13 whospeaks to them every week using Skype They hadinvited Ian but13 he has declined as he wants to go on acamping holiday with his new girlfriend He has a job i a hotel and plans to visit13 John independently next13 year
Jennifer13 -shy‐ she is the 12 year old daughter of a young single mother13 and has been13 diagnosed with Aspergerrsquos syndrome
Todayrsquos13 Possible13 OutcomesJenniferrsquos mother Mary hasstruggled since the birth of herdaughter and has received littlesupport13 from family or friends Sh has become a loner and her whol life revolves around her daughter Unfortunately Jennifer lacks both social skills and access to learning materials that13 might13 help toexercise her brilliant13 analyticalmind She is limited to thetelevision and the channels that13 can be viewed without13 subscription In the same way sh is not13 exposed to fiction and hasfew opportunities to develop her imagination She will have tochange schools frequently becaus of bullying and her motherrsquos desi to avoid her getting too close toany friends This limits herambition and ultimately herperformance Some of her
Tomorrowrsquos13 Possible13 Outcomes through TechnologyJenniferrsquos needs are identified enabling her to receive special attention so that13 she can receive cognitivetherapies to help her to deal with her medicalproblems She is allocated a personal budget13 to enable her to buy technology services to support13 her Thesefund a number of digital devices and a fast13 broadband connection which enables Jennifer and her mother to gain an online presence She buys a new watch withGPS and mobile phone facility and a 3G tablet13 devicefor her mother It means that13 Jennifer can go offwithout13 Mary worrying where she is because she know that13 she has the means to locate herMary has no fear of the digital world because in it13 anindividual isnrsquot13 judged by the clothes that13 they wearthe food that13 they eat13 and the money that13 they have i the bank She uses the technology to develop an onlin presence through a Facebook account13 on which shepublishes pictures of Jennifer Her family find her andmake contact Before agreeing to see them she is able to check them out find where they live see pictures o their homes using Google Map and Street She is nolonger at a disadvantage and is able to apply for a joba sales assistant13 in a clothing store where she can get13
50
to13
b13 13
n13 13
13 s13
r13 n13
e13 at13
e13 y13 e13 ld13
ly13
13 e13 t13 e13
s13 er13 e13
f13
rt13 13
13 13
13
r13 13
s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
e13 g13 13
e13
13 13 ial13
13
d13
13 d13 h13 r13
d13 13
s13 y13
e13
13
rd13 r13 e13
13
13
13
e13
e13
d13 13
13
13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
to13
b13 13
n13 13
13 s13
r13 n13
e13 at13
e13 y13 e13 ld13
ly13
13 e13 t13 e13
s13 er13 e13
f13
rt13 13
13 13
13
r13 13
s13 to13
13
classmates will gain scholarshipsexcellent13 universities whileJennifer will go to the localtechnical college where she willexcel but13 end up in a mundane jo which she will hate She may find happiness if she meets a niceyoung man who appreciates herintelligence and technicalknowledge If she does it13 willshatter her motherrsquos fragileconfidence and lead to a situatio where13 she13 must choose between her boyfriend and her motherWhen she moves out13 of hermotherrsquos home Mary suffers abreakdown and is committed for her own safety She ends her day in a community care placement13 praying that13 Jennifer will call
25 discount13 on items for herself and for her daughte Jenniferrsquos mathematical and computing skills put13 her i the top 2 of people of her age She understands that13 she is different13 and decides to find out13 more byrecruiting other people with the same conditionthrough her own Facebook account She sets up chat-shy‐rooms and mutual support13 groups As a project befor going on to university she writes a number of apps th enable people with Aspergerrsquos to share theirexperiences and to seek help from the communityShe wins a scholarship to university and during thesummer break before her first13 term they co-shy‐author abook on how digital inclusion helped them to overcom the problems of social exclusion that13 were triggered b disability and single parenthood Jennifer may not13 hav all the social skills but13 she understands how she shou behave She also understands that13 shersquos an individualand can behave how she wants to
Susan McKenzie ndash a 35 year old who was diagnosed13 with bipolar disorder 8 years13 ago andwho is13 now13 struggling13 to care for13 her 10 year old daughter
Todayrsquos13 Possible13 OutcomesSusan carries the label of lsquomental illrsquo and is monitored by socialservices staff on a regular basis so that13 both she and her daughter ar safe and well She has little contac with her family and her records ar incomplete because of herprevious attempts at becominglost13 in the system Although she i normally lucid and responsible h history suggests that13 she cannot13 b trusted to self-shy‐medicate Herdaughter would be at risk in theevent13 of a depression andmanaging this risk is the priority o the social work teamBecause her condition varies sosignificantly over time the suppo she receives tends to be generally
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe mental health problems of Susan can be managed by medication if she becomes compliant13 with her GPrsquos prescriptions She may be provided with an intelligent13 pill reminder and dispensing device which alerts her to take her medication at the appropriate time Thesystem prevents her from overdosing and requires he to use a tablet13 computing device to take a photograph of her taking her medication and recording it13 to thecloud where compliance may be monitoredautomaticallyShe becomes fully engaged with the digital worldallowing her to fill in the gaps in her electronic healthrecord Her medication monitoring system also record her movement13 and activity patterns which are addedher health records to produce Big Data13 for her whichcan be analysed in order to predict13 when she might13 be feeling positive or negativeThe application learns her behaviour and is able tosuggest13 triggers for her bipolar events such as
51
13
13
13
r13
13
13 13 r13
r13 h13
13
13
r13
13
13
13 13
r13
13
13 e13
y13
13 d13
low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
e13 g13 13
e13
13 13 ial13
13
d13
13 d13 h13 r13
d13 13
s13 y13
e13
13
rd13 r13 e13
13
13
13
e13
e13
d13 13
13
13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
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13
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13
13 13 r13
r13 h13
13
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13
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13
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low but13 with the expectation that13 it13 can be ramped up if herbehaviour gives cause for concernIn practice the social work teamhas few ways of identifying theoccasions when Susan isexperiencing a high or a lowunless it13 is reported by herdaughter The result13 is that13 she is unable to hold down a job and istherefore always struggling toprovide for her daughter and for herselfDuring the course of the next13 few years she might13 find herselfarrested for performing somestupid act13 in public but13 might13 equally be at risk of self-shy‐harm orsuicide during one of her lows He daughter may stay with her but13 could be psychologically damaged by her responsibilities and byseeing her mother in extremestates
temperature changes or poor sleep patterns in orderto predict13 when her medication needs to be increased or changed The feedback means that13 her condition is genuinely13 under13 control which makes Susan feel bette in herselfHer daughter no longer feels isolated when her mothe is unwell She has joined an online support13 group whic enables her to take out13 her frustrations without13 harming her mother She has learnt13 how to help hermother through these predictions and is happy to use these big data13 apps to fulfil her own requirements ofunderstanding her motherrsquos problems Her genome has been decoded enabling her to show that13 shersquos not13 likely to suffer the same mental health problems as he mother but in order to understand what13 her mothergoes through she has undertaken an online course in cognitive behavioural therapySusan is able to find herself a job knowing that13 she isunlikely to let13 down her employer providing that13 shetakes her medication Her daughter continues tointeract13 with her mother and to support13 her in herambition to remain in employment
Geraldine Reynolds ndash an 82 year old relatively13 wealthy13 widow who is concerned13 by thepossibility that one or more of13 her13 family members is abusing13 her13 financially
Todayrsquos13 Possible13 OutcomesGeraldine is fortunate that13 she has a strong network of friends andneighbours who are available tosupport13 her when she hasproblems She also benefits from being financially independent13 and has the means to pay for everyservice that13 she might13 needUnfortunately her own childrencannot13 be trusted and wouldquickly take over responsibility fo her estate if they had a chance -shy‐especially if it13 meant13 that13 theycould milk13 her13 for cash They have
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThere are several types of telecare system availablethat13 would provide continuous and automaticmonitoring of Geraldine and her home environmentMany of them provide alerts to her (and to her friends if necessary) if there has been a safety or security issu They can include a 24 monitoring centre in theresponse loop so that13 in the event13 of an emergency acarer the police or the ambulance service can gainadmission to her home using a key held in a key-shy‐safeThis means that13 she no longer has to rely on her famil to hold a key She canrsquot13 actually ask for her key to bereturned so she decides to have a camera13 fitted at the front13 door This is linked to her new home network an transmits an image of every caller to a cloud storage
52
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proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
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s13 13
le13 13 13
13
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13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
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d13 13
s13 y13
e13
13
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e13
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13
13 a13 s13
proved to her that13 they believe facility which forwards them immediately or oneach other more than they believ demand to Geraldinersquos smart13 phone She also has aher and this is a cause of on-shy‐goin smart13 TV and can review the images of all callers allconcern to her It means that13 she date and time stamped at her leisure She takes thewonrsquot13 consider any actions that13 opportunity to call them to apologise for being out13 an could compromise13 her13 to ask what13 they wanted They quickly learn that13 they independence Thus instead of canrsquot13 call and enter without13 invitation and now askplanning to spend her final years before calling if it13 would be convenient Geraldine trie surrounded by her family she is not13 to be too flexible because she has developed man having to live without13 them as sh new friendships through her online presence Theysees no other way of ensuring thathave advised her that13 she should set13 up cameras insid they donrsquot13 attempt13 to take away her home too so that13 she can record what13 happensboth her money and her freedom when her family members call especially when theyShe might13 consider reporting her slip out13 of the living room to go to the bathroom They concerns to the police and to soc have advised her that13 social services are proactive inservices but13 she knows that13 she dealing with elderly abuse and have shown her howhas no proof and they are more easy it13 is to take charge of her situationlikely to recommend to her that13 Fearing that13 her condition is likely to decline in theshe tries to build some bridges so future she offers to provide her children with 2nd or 3 that13 she has some family support13 generation telecare systems that13 could link them to he in the future when she might13 nee over the Internet Only one of her children takes up th it She also fears that13 if she finds offer and it13 gives her great13 reassurance that13 he canout13 definitively that13 her daughter monitor her well-shy‐being The same system is part13 of ahas been robbing her then it13 coul service that13 also reminds her to take her medication to lead to either a prosecution whic put13 on her spectacles and switch on lights when she13 she doesnrsquot13 want or to one of he gets up to go to the bathroom during the night and to children being disowned by the lock all doors and windows before going to bed Shebrother and sisterrsquos families sleeps safe in the knowledge that13 an electronic safety
net13 is working alongside her family to keep herindependent and to ensure that13 she doesnrsquot13 have tomove out13 of her home in order that13 she can receive th support13 that13 she needs
Jane13 Doe13 -shy‐ a middle-shy‐aged13 lady who seems13 to have lost her memory13 but who seems13 tohave no home to call her own She is in crisis after being found with a broken ankle andmild hypothermia
Todayrsquos13 Possible13 OutcomesJane is currently at a disadvantag because neither the ambulanceservice nor the staff in AampE noranyone else knows her history an her family details Social workers therefore have to takeresponsibility for providing her
Tomorrowrsquos13 Possible13 Outcomes13 through TechnologyThe tests performed on Jane provide a wealth ofinformation that13 is included on the temporary patient13 record produced at the hospital where she is taken as an emergency They are able to use this big data13 tomatch her to an electronic patient13 record of a Linda13 Wilson who was treated by a GP in London in 2014 for skin complaint13 that13 was an allergic reaction to material
53
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54
e13
13
13 13 t13 13 at13 13
13 13 13 e13 13
le13
y13
o13
y13 e13
ar13
13 13
s13 13
le13 13 13
13
13
13
13 13
13
with a place of safety to which sh can be discharged They will trytheir best13 to find her history andher identity but13 without13 hercooperation and a name and date of birth there is little chance offinding her home address and thenext13 of kin details Consequently they are obliged to admit13 her into a residential care home for a shor stay in the hope that13 her memory will return Jane makes it13 clear th she will be on her way as soon as she can walk without13 helpThe social workers are concerned that13 she has no apparent13 income and that13 when she moves on she will live on the streets despite th cold weather and her lack of warm clothing They look throughmissing person files but13 are unab to find anyone who matches herdescription Either she has nobod who misses her or she chose tolsquodisappearrsquo so long ago that13 she n longer appears on records Janeappears unconcerned and is happ to walk out13 of her temporary hom as soon as her plaster cast13 hasbeen removed Social services he no more about13 her
used in the factory in which she worked Thisinformation was used to trace her history and to findher family connections When told about13 her pastLinda13 (who responded to the name) admitted that13 her memory was not13 impaired but13 that13 she didnrsquot13 want13 to have anything to do with her family She admitted that13 she had run away from an abusive relationship 20 year ago and that13 she was scared of her ex-shy‐boyfriend13 finding herSocial services agreed to pay for her to stay for a coup of weeks in a Bed and Breakfast13 while they looked into options for her They also looked into possible benefits that13 she could claim and showed her how she might13 use online facilities to look up her former friends andfamilyLinda13 is quite intelligent13 and quickly learns how to use the Internet13 and is excited to find that13 her ex-shy‐boyfriend13 was found guilty of a serious offence and imprisonedfor a ten year term the year after she hadlsquodisappearedrsquo She further found that13 he had beenbrutally murdered in an incident13 involving gangmembers two years ago This gave her the confidence to look for her family online -shy‐ and was thrilled to findthat13 her mother is still alive and had formed a charity to help find missing children and that13 her sister hadmarried and had three young children She found out13 where they lived and used social networks to connect13 with her sister who was thrilled to hear from her They had a Skype conversation and Linda13 was persuaded to return to London to see her motherBefore leaving Scotland she was able to enrol on an IT training course and then gain a qualification incomputing She was able to find a job close to hermother and to move in with her
54