Using technology to address the demographic time bomb

The big challenge for 2019 is not Brexit. It is the demographic time bomb. Britain can no more leave “Europe” than it makes sense to tie our economy to a protectionist “ever closer Union”. I will not attempt to discuss how best to delay the decision process until the European parliamentary election, coupled to growing regime change across the members states, enables us to have constructive dialogues with new negotiating teams on both sides. Instead I would like to take the opportunity of the current CPF consultation on Disability policy to take a look at an issue that has been taboo for 30 years too long. It also happens to be an area where the more imaginative use of technology turns problems into opportunities on a massive scale.

“Simple demographics show that over the next few decades our workforce will shrink and the number of pensioners to be supported will grow. Meanwhile the cost of energy and raw materials will continue to increase. If we do not make better use of technology to create more wealth and simultaneously release and equip manpower to take better care of the elderly, you and I will grow old and cold alone, in the dark.” No End of Jobs, CPC 1984.

Since that was written we have imported millions of health and care workers from around the world to plug the gap the UK demographic gap. But birth rates are now falling around the world. We can no longer use immigrants to postpone the inevitable.

We have to use technology, including robotics and artificial intelligence, as prosthetic extensions to human ability, to harness the talents of those who previous generations might have regarded as “disabled”. We should remember that we too will be disabled for the final months or years, (perhaps even decades), of our lives. We need those supposedly job-threatening technologies to extend the period in which we can look after ourselves and enable a shrinking number of careers to look after the growing number of us when we can no longer do so.

This gives a very different perspective to debate over robotics, AI and the effect on employment. The over 55s control over 80% of the nation’s disposable wealth (and funds for investment). We should empower them to use it change the economics and structures of our fragmented care system at all levels. Shuffling us between domiciliary care, care home, nursing home. hospital and hospice according to regulatory structures may be egalitarian (equality of suffering) but is neither humane nor a good use of public funds. We should make effective use of technology to join up our care systems in the patient’s interest, while making the savings that will enable us to better serve everyone – whether or not they can afford to pay for themselves.

Below is the  Conservative Science and Technology Forum response to the Conservative Policy Forum Disability and Inclusion Discussion Paper.

The CSTF exists to advise the party , at all levels, on the impact of scientific research and new technologies on society, exploiting the benefits and avoiding the risks. It welcomes the impact of experts, whatever their politics and also aims to provide well informed inputs to the consultations of the Conservative Policy. Membership details are here .

The CPF aims to involve party members across the UK in discussing the major policy issues that will face us over the years ahead. CPF has also taken a decision to encourage its groups to welcome inputs from non-members with relevant experience and expertise. This draft includes comments from the first round of consultation, including over Linked In.

The subject of the discussion brief may look narrow but the open-ended questions below offer the opportunity to juxtapose muddled thinking about the “Fourth Industrial Revolution” with the need and opportunity to redefine what we mean by “disability” in the face of global, not just UK, demographic time-bomb.

1. Housing: How might we better build homes and buildings that everyone can access and use, so as to build a society in which all can participate fully?

New technology enables us to bring many of the jobs of the future to where the workers wish to live, provide they have full fibre and 5G to the home. It enables us to bring telemedicine diagnostics and treatment equipment to the care home or surgery and can empower domestic carers (under remote supervision) to do much of that which currently requires a visit to the surgery or hospital.

We need to consider the homes that workers with limited physical mobility wish to inhabit. They need secure parking outside and/or wide doors, corridors and lifts for their mobility buggies inside. They also need space, power and monitoring connectivity for a variety of automated devices to aid domestic life (robotics for rheumatics and AI for the forgetful).

A first step might be to expedite DHCLG approval for the Ashford local plan (with its requirements for the broadband connectivity of new developments. Another step could be to publicise the authority-wide Access and Wayleave arrangements being pioneered by, for example, Southwark, to enable full-fibre broadband to existing social housing at no extra cost to Council or tenant.

2. Transport: How might we better adapt our transport systems so as to offer people with disabilities the same access to transport as everyone else?

The first and most important action is to stop removing inner city parking suitable for use by the disabled and/or those providing them with personal transport. If there has to be choice, disabled parking spaces should have priority over cycle lanes.

Providing more space on buses and trains for mobility scooters to compete with baby buggies and bicycles is a stop gap unless we replace fixed seats with folding seats that are also easy to use by those with limited ability to stand for long. We also need to look at how to encourage Uber, the licensed taxi trade and others (including those employing drivers who are themselves disabled) to provide customised mobility services.

3. Health: How might we more effectively reduce the health gap experienced by people with a learning disability, mental health conditions or autism, so as to help everyone to live full, healthy and independent lives?

We need to encourage the creation of joined up on-line care monitoring and delivery systems, akin to those for diabetics which were presented to MPs decades ago by St Thomas’s. They had brought together medical, welfare and care practitioners, across professional and organisational boundaries, in the interest of the patients. There are issues of access to sensitive information but the gap will not be bridged without continuity of locally joined up care and support.

The ban on using services like Babylon GP at Hand https://en.wikipedia.org/wiki/Babylon_Health to support such groups needs to be reviewed. Properly used (and there are indeed issues of privacy, security, audit, testing and peer review hat need to worked through) the underlying approach can be used to deliver significantly improved care at significantly lower cost provided the diagnostic systems are linked to joined-up records under patient control. There is also a significant body of research to indicate that many members of such vulnerable groups can be happier dealing with well-programmed avatars (synthetic human beings with infinite time, patience and predictability) than with genuine human beings.

In this context the ai-based, commoditised voice control/synthesis services (Alexa, Echo, virtual assistant etc.) available from Google, Amazon and others may have issues (some of the parodies of their behaviour are very funny) but they have taken such technologies from the expensive niche to the common place and could/should be used to enable the disabled to be control their own lives and/or be better cared for and supported at much lower cost.

4. Employment: How might we work more effectively with employers and people with health conditions so as to help as many as possible to get into and stay in employment?

We need to distinguish between those health conditions which limit employment prospects and those which make individuals well suited to particularly types of employment. Thus GCHQ and some other cybersecurity employers are happy to cover the cost of clinical care and pastoral supervision and care for those with particular neuro-diverse conditions. Meanwhile call centres and monitoring centres (e.g. those providing real-time surveillance on shopping malls) find the physically less mobile an able and loyal workforce. The need is to support intermediaries motivated to place the “disabled” into work (including part-time for when they are able) not just to assess them.

5. Participation in Society: How might we better support candidates with disabilities to stand for public office, so that those elected better reflect the diversity of society?

CCHQ should support an “Enabled 2 Win” network, akin to Women2Win.

6. Culture Change: How might we all deliver further positive change for people with disabilities, so that society does not miss out on the contribution of any person?

Publicity for those employers actively seeking to recruit those who others regard as disabled.

Publicity for services like Accessable which enable the disabled to plan their shopping and entertainment and promote the services of those who welcome them as visitors and customers. Commission them to audit the accessibility of central and local government offices, libraries, leisure centres and other facilities and include the results in their services.

Require those organising public sector websites and on- line services to make them fit for use by their target audiences, whether or not the latter can use a conventional screen and keyboard. There is a wealth of interfaces available – but few central and local government departments and agencies – design for their use.

Organisations like Abilitynet should be commissioned (i.e. paid) to provide advice when needed and audit the services of those who not think they need advice.

7. Any other question you think should have been asked or observation you would like to make?

All public on-line access and information should be fit for use by their target audiences, whether or not the latter can use a conventional screen and keyboard. There is a wealth of interfaces available – but few central and local government departments and agencies – design for their use.

There is a need for publicly accountable processes to test (including peer review) and audit the means by which we plan and deliver services to those who are socially excluded because of perceived disabilities. Commercial confidentiality should have little (if any) place in publicly funded services except during a competitive tendering process. This area needs public debate because the implications of the growth of such confidentiality in support of IPR protected business models using publicly funded research and data are not well understood.
This is particularly so with regard to Artificial Intelligence (whether rule based, derived from algorithmic searches of “big data” or hybrid) based diagnostic or control (robotics) products and services where third party testing and audit (including published peer review) are complicated by current interpretations of IPR law and non-disclosure agreements.