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David Oliver: Will robotic automation solve social care?

BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4854 (Published 21 November 2018) Cite this as: BMJ 2018;363:k4854

Re: David Oliver: Will robotic automation solve social care?

David Oliver asks and answers the wrong question. Robotic automation will not “solve social care”, but it can contribute to improving the lives of people with care needs.

In the report for the EPSRC Robotics and Autonomous Systems (RAS) Network (1) we considered the state of social care in the UK, where standards of care are falling dramatically, even compared to ten years ago, and as evidenced by charities such as Age UK (2). We then explained the potential of robotics and automation to address some of the challenges that arise in care where technology could make a difference. We gave details of state-of-the-art systems, noting that that these are mostly early stage, explained some of the technical and research challenges to be overcome, and proposed a research roadmap for the next two decades, by which time the UK’s over 65 population will have increased by a further five million. A key focus of that paper, and of other international efforts in this area, is on the need for an interaction between designers, carers, and people in need of care in developing new technologies for care. Adopting design and development models that are responsive to the needs, priorities and values of end-users, such as co-creation and participatory design, will serve to ensure that emerging robotic solutions are needed, accepted and beneficial to all (3).

While David Oliver is correct in stating that evidence of impact is limited to date, the RAS Network White Paper did not attempt to quantify the benefits that these technologies will bring precisely because the research to demonstrate such impacts lies ahead of us. Funding for social care robotics, in the UK and abroad, increasingly requires careful, thorough and embedded evaluations of the effectiveness and acceptance of these solutions in addition to analyses of their economic benefit and commercialization potential. Furthermore, guidelines and frameworks for robotics development, deployment and implementation increasingly incorporate key ethical considerations, to ensure that these solutions lead to maximum benefit and that potential harms, including those raised in this piece, are minimized (1, 3).

David Oliver notes the alarmingly high levels of social isolation among older people. What should be palpably clear is that loneliness among people in need of care is not due to robots, that do not exist yet, but to systematic and societal issues in how their needs are valued. As other forms of work become automated, we consider that the activity of providing human care to others can and should be increasingly valued and better rewarded. There is little evidence, as yet, that speaks to the concern that introducing robots in care could increase social isolation, and there is certainly no inevitability that the use of automation in care will reduce human contact. Nevertheless, in the RAS Network white paper we advocate, as a precautionary measure, that the right to human contact in social care should be protected by legislation to ensure against any such eventuality. Loneliness is a complex phenomena, for which the presence of other people is not a guaranteed solution (4). In our view, social robots could play a role here, for instance by providing forms of interaction that help to break cycles of low self-esteem, or by providing a ‘social bridge’ to friends and relatives.

Compared to the billions we spend on medical research, the UK has invested, at most, some tens of millions in exploring the potential of assistive robotic technologies for social care, at a time when it is estimated that around 1.2 older million people in the UK have an unmet social care need (2). There are few areas of modern life where people do not consider that the introduction of better and appropriate technologies could improve lives. However, in the area of social care, there are a significant number of voices advocating for the status quo, in terms of technology, even while the quality of care is falling rapidly. Faced with this challenge, the responsible course of action is to explore all possible courses of action to achieve the highest standards of evidence-based care.

REFERENCES
(1) Prescott, T. J. and Caleb-Solly, P. (2017). Robotics in Social Care: A Connected Care EcoSystem for Independent Living. UK EPSRC Robotics and Autonomous Systems Network White Paper. https://www.ukras.org/wp-content/uploads/2018/10/UK_RAS_wp_social_spread...

(2) Age UK. Briefing: Health and Care of Older People in England 2017. February 2017. https://www.healthierfuture.org.uk/publications/2017/february/briefing-h...

(3) Robillard, J.M., Cleland, I., Hoey, J., Nugent, C. (2018) Ethical adoption: a new imperative in the development of technology for dementia. Alzheimer's & Dementia 14(9):1104-13. https://www.alzheimersanddementia.com/article/S1552-5260(18)30139-0/abstract

(4) Cacioppo, J. T. and Patrick, W. (2008) Loneliness: Human Nature and the Need for Social Connection. New York: Norton.

Competing interests: Tony J Prescott is the Director of Sheffield Robotics, a multidisciplinary institute research across two universities in Sheffield UK, he is also a director and shareholder in Consequential Robotics a UK SME developing assistive and companion robots. Julie Robillard is an Assistant Professor in Neurology at the University of British Columbia. She has no competing interests.

23 November 2018
Tony J Prescott
Professor of Cognitive Robotics
Julie Robillard, University of British Columbia
University of Sheffield
Sheffield, UK; Vancouver, Canada