Assistive technology - what’s its proper role in the future of health and social care?
John Woolham, Senior Research Fellow, King’s College London
We live in a technological age where technology surrounds us. Home robotics and virtual reality headsets are no longer science fiction, and researchers are already adapting and developing these kinds of technology to improve the lives of frail and disabled people. This can be seen in this year’s report of Research and Development Work Relating to Assistive Technology (AT), which was recently published.
As with previous reports, it provides a thematic summary of developments in assistive technology intended to be useful for Members of Parliament, researchers, people working in industry, AT providers and technology users. It precedes a review - published in December 2018 by NIHR – which looks at research on the use of AT to support older people to live as independently as possible.
Setting priorities and funding research
The report has three sections. The first describes priority setting and funding. Examples include work to ensure that research prioritises issues that are important to potential technology beneficiaries such as disabled and older people.
For example, the James Lind Alliance (JLA) brings together key stakeholders in Priority Setting Partnerships (PSPs) to identify generic research priorities. Although the JLA’s focus is wider than AT, initiatives of this kind are significant progress on a decade or two ago, when it was possible to come across technological innovations for which a purpose had yet to be invented.
The second offers a description of some of the research done in 2017-18 and there is a particular focus on ways technology can restore or enhance independence and mobility among older and disabled people. Research on dementia and mobility, the application of virtual reality (VR), prosthetic design and home-based AT are mentioned. Some of these refer to projects that appear to exploit the potential of existing technologies by developing a more user-friendly interface (for example, the development of a dementia friendly transport app developed by the English Department of Transport and the application of VR technology to develop therapeutic interventions for patients suffering from anxiety or paranoia).
The third offers a summary of some of the work being carried out to support uptake and use of AT and a range of initiatives, some co-operatively organised, to encourage this. There is also a very large annex listing government funded research in AT either ongoing or recently completed.
I recently led a small research study focused on telecare use for and by older people and have been interested in AT and telecare for older people in this area for almost 20 years. Reading this year’s R&D report, three things struck me especially.
First, it’s a reminder of just how significant research on AT has now become. The annex – of current or recently completed research funded by the government or its proxies – list some 148 projects and nine infrastructure projects, mostly funded between 2015 and the present time. Their diversity is impressive. Funding amounts vary, but several were over £1 million (one was £11million). This excludes, of course, other research funded by trusts and charities, and investment in R&D by manufacturers and suppliers. I suspect this may be close to, or even exceed, the amount the English government or its proxies spent on adult social care research over the same period.
Second, the priorities for AT summarised in the report suggest a general preoccupation with prevention and use of technology to promote self-management and independence. This, one assumes, is driven by a need to reduce demand on the NHS and adult social care caused principally by the UK’s ageing population and successive government austerity policies. I do wonder, though, about the proper place of self-management and independence. Valuable goals? Yes, certainly. Motherhood and apple pie? Well, yes, I also think so – and I think this sometimes prevents us from seeing that they also represent a transfer of responsibility from the state to ordinary people – some of whom may be ‘vulnerable’. In particular, I wonder if self-management and independence are always appropriate for older people or if these goals are not always realistic or fully attainable. Older people are the largest single group of NHS and adult social care users. Related to this, AT can, and is, being used to replace ‘hands-on’ care. Whether this is always desirable or even ethical is a very different question.
Third, coverage of initiatives to support uptake and spread of AT in the report is welcome, but is it only part of the solution? Technology is often not valued by those who receive it and is frequently abandoned. A solution may require a more genuinely person-centred approach to assessing for technology, rather than, as often happens, offering a ‘one size fits all’ delivery model or allowing unsupported customer choice. Could manufacturers consider how to make some AT more ‘customisable’? Could more be done by statutory organisations to provide better information to support choice? Or better still, could assessing practitioners be supported to acquire the skills and the time to carry out assessments that better match technology to need?
The role of AT
These issues raise questions about the proper role of AT. While people continue to benefit from what technology has to offer to support their independence, it’s surely important we don’t lose sight of three things.
First, that the policy goal of independence is short selling. Humans are not independent but inter-dependent upon one another - that we all give and receive care and support at different times in our lives.
Second, humans are creative. Assistive technology needs to be adaptable, and people should be supported to use it in ways that manufacturers and suppliers hadn’t necessarily considered.
Third, its primary role should be to augment care, rather than replace it. Recognising these things are likely to require changes to the way technology is developed and deployed at the present time.
The ‘Assistive technology research and development work: 2017 to 2018’ report, is available to read on gov.uk
- Summary:John Woolham discusses how researchers are adapting and developing assistive technology to improve the lives of frail and disabled people
John Woolham, Senior Research Fellow, King’s College London
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