The social care White Paper focuses on technology – but does it go far enough?

A blog entry by James Wright, Kate Hamblin and Matthew Lariviere

On 1st December 2021, the government published its long-awaited 'White Paper laying out its strategy for the future of Adult Social Care in England, entitled “People at the Heart of Care'.

The plan includes a significant focus on technology and data, including £150 million investment over three years “to drive digitisation across the sector; and unlock the potential of caretech innovation that enables preventative care and independent living”. In doing so, it provides much-needed attention to key areas previously neglected. The COVID-19 pandemic has accelerated digital technology uptake by individuals and providers, and the White Paper points to the growing use of consumer technologies like iPads, voice-controlled virtual assistants and networked devices to help people control their home environments and stay socially connected via video calls and social media, as well as digital tools to facilitate the management and organisation of care.

What is the plan for technology in adult social care?

Building on this momentum, the 10-year vision of a “digitally enabled social care system” presented in the White Paper focuses on several key areas:

• “Caretech” to support independent living, including a new scheme to test and scale up new ideas, and a shared roadmap of priorities, building on best practice across the country.

• Digital social care records, with a target to increase digitisation of social care providers from the current 40% to over 80% by March 2024 by funding implementation support.

• Data and the establishment of a new national adult social care data framework with requirements for the sector to tackle “data gaps” in care and determine whether people are getting the care they need and are entitled to. This will involve developing a “data sharing solution with local authorities and providers that supports real-time decision making at local, regional and national levels”.

• Infrastructure and cybersecurity, including fibre broadband for care homes, providing home care providers with the infrastructure to work digitally, and ensuring providers meet minimum cybersecurity and information governance requirements. This includes “work underway to understand the telecare sector’s readiness for the digital switchover” in 2025.

• Digital skills, providing training and online resources as well as practical guidance on using technology in all care settings, including for senior decision-makers. Also included is a £1m investment from 2021-2 to develop a new Centre for Assistive and Accessible Technology.

• A social care technology “blueprint” to spread best practice, advising on “‘what good looks like’ for social care technology, to help everyone involved in the provision of care understand what they should be aiming for”.

What does it get right?

There are some things to applaud here. As we wrote in 2020, based on research conducted within the Sustainable Care programme at the University of Sheffield, a tidal wave of new digital care technologies has led to widespread confusion among local authorities and commissioners about what is available, what works and what doesn’t, and what is good value for money. For the first time, there seems to be an attempt to create a joined-up strategy for care technology that will include a focus on sharing best practice via the proposed roadmap of priorities and “technology blueprint”, developing standards, encouraging interoperability, and scaling up what works.

In theory, this should begin to address the patchwork approach of different local authorities towards technology, including what we’ve termed “pilotitis” – or the inability of local areas to scale up small pilots of new technologies due to lack of investment or a large enough evidence base. In helping establish and regulate a clearer market for care technologies, the government can make a real difference in encouraging the uptake of the most effective, useful and secure systems, and spreading best practice beyond local authority or provider siloes.

The White Paper importantly sets out a number of measures to tackle the “digital divide” in access to, and skills in using, technology among both care providers, care workers and older adults. It also proposes addressing weaknesses and inequalities geographically in the infrastructure needed to deliver reliable, accessible, digital care technologies, issues we have highlighted in a Sustainable Care paper published in 2021.

The focus on data could provide more opportunity to uphold care standards and identify problematic areas, while driving better integration and understanding of interactions between social care and the NHS.

What is still missing?

On the other hand, we still see several major gaps in this policy. The paper references the 2025 digital switchover, but it is extremely late in the game to be trying to understand the readiness of the local authorities and the telecare sector, as analogue phone lines are already in the process of being switched off. Research commissioned by NHSX is currently underway to examine the preparedness of local authorities, but as some areas have already experienced the analogue switch-off, urgent action is required.

Our research also raised the need to avoid creating a new technological divide based on what we call “digital ableism”: the danger that most digital tools and technologies might be aimed at keeping people living in their own homes, rather than improving the lives of people in institutional settings who are unable to live independently. The White Paper mentions a target of protecting the 20% most vulnerable residents in care homes with fall prevention technology, but does not explore what else may enhance the wellbeing of those living in residential care settings.

There are also longer-term concerns about the increasingly widespread use of mainstream consumer devices like Amazon Echos or Apple iPads. How long will they last before having to be replaced? Who will maintain and upgrade them? And how will they be regulated if used for care applications such as medicine reminders, wellbeing check-ins, or in a similar way to existing specialised telecare devices? The need for existing standards and frameworks to adapt to include a wider range of technologies was not explored in the White Paper but has been underscored in our research. Providers of services need not only to distribute digital devices, but also to provide “wraparound services”, including ongoing and technical support and information and advice about digital options.

Questions of reliability are also significant. When Storm Arwen cut power for hundreds of thousands of people in Scotland, Wales and northern England for days in November 2021, many were left without working telephones due to networks having already switched to digital phone lines. Any digital telecare systems or devices reliant on mains power would likewise have stopped working. Moreover, in December 2021 computer problems led to Amazon infrastructure such as Alexa and Ring devices not working for thousands of users, and again in January 2022, there were widespread outages affected Alexa users across Europe. These events raise questions about the resilience of digital devices, and the extent to which they can be relied on to deliver care services.

Finally, greater use of in-home monitoring devices raises privacy and data security issues, while potentially institutionalising and isolating older adults in their own homes, if intended to substitute for in-person care in a bid to cut costs. While the White Paper states “We must ensure that technology reduces rather than exacerbates loneliness and isolation, and that it supports the mental health and wellbeing of people and carers”, there is no detail on how this aspiration will be realised. Worryingly, the White Paper cites a forthcoming Ipsos Mori report that states 90% of local authorities intend “to continue using technology as they have during the pandemic”. Yet care workers and carers have expressed a preference for a hybrid approach, not digital-only delivery of support and care. We cannot simply make “digital” the default care pathway.

The White Paper is a promising starting point for some of these issues, but much of the success of the proposed measures will depend on how they are implemented and whether the resources allocated will be targeted at local authorities and providers at risk of being left behind by the move to digital. It is also important to remember that technologies always form just a part of a broader ecosystem of care. Technology should not substitute for human care, and first and foremost, it is important to support care workers and informal carers rather than starting from a technological perspective. There is little point simply collecting more data to list all the ways the system is failing due to a lack of resources, including the supply of care workers. This is a central tension within the White Paper. The Department of Health and Social Care will need to demonstrate how the investment of £150m in digital technology will support the sustainability of the care system and the wellbeing of British citizens in the months ahead.

About the authors

Dr James Wright

Dr James Wright is a Research Associate at The Alan Turing Institute, the UK’s national institute for data science and AI. He received his PhD in anthropology and science and technology studies (STS) at the University of Hong Kong in 2018. His research interests include the development and use of robots, artificial intelligence (AI), and other digital technologies for adult social care, and his current project, PATH-AI (www.path-ai.org), focuses on AI ethics and governance in the UK and Japan.

Dr Kate Hamblin

Dr Kate Hamblin is Senior Research Fellow at the Centre for International Research on Care, Labour and Equalities (CIRCLE), University of Sheffield and the Economic and Social Research Council (ESRC) funded Centre for Care. Kate’s research has focused on technology and its role in the care of older people with complex needs; the balance between unpaid care and paid employment; self-employment and ageing; and ‘active ageing’ employment and pension policies.

Dr Matthew Lariviere

Dr Matthew Lariviere is a Lecturer in Social Policy in the School for Policy Studies at the University of Bristol. His research explores the possibilities of digital technology and AI within public services to support humanity’s ageing and care futures.