Michael Rigby
Also:
Visiting Professor, Section of Paediatrics, Imperial College London; and
Adjunct Professor,
School of Nursing and Human Sciences,
Dublin City University
Phone: 00353 87765 3399
Address: Lavender Hill,
6 Carrighill Lower,
Calverstown,
Kilcullen,
Co. Kildare,
Ireland
Visiting Professor, Section of Paediatrics, Imperial College London; and
Adjunct Professor,
School of Nursing and Human Sciences,
Dublin City University
Phone: 00353 87765 3399
Address: Lavender Hill,
6 Carrighill Lower,
Calverstown,
Kilcullen,
Co. Kildare,
Ireland
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Books by Michael Rigby
and care services due to demographic change,
being at the beginning of a large and continuing
rise in the number and proportion of older citizens,
while advances in healthcare mean that an
increasing number of these and other adults will
have enduring chronic health conditions. But for
all citizens with actual or potential health problems,
the maintenance of optimal health depends
not just on healthcare services, but on support for
nutrition, hygiene, mobility and shopping, socialisation,
warm dry housing and other aspects of daily
living, as without these health will be compromised
and deteriorate. This demand surge is happening
at a time when Information and Communication
Technologies (ICT) are increasingly being used in
other service sectors to enable consumer customisation
and better resource management.
An objective for all health systems, and for
patients, is to minimise hospital stays and maximise
care at home, but hitherto the practical need to
observe the patient’s state of health has extended
hospital stays. Similarly there is a drive to minimise
– for quality of life and economic reasons
– admission to long-term institutional care and
instead extend support to enable living at home.
Traditionally any support needed by an individual
has normally been provided by family members,
often assisted by the local community, while social
services have been the fall-back provider when the
family cannot support, either by direct provision
or by mobilising specific services such as delivered
hot meals. Housing agencies and other bodies
have also had an important role. However, other
demographic changes are significantly reducing
the capacity of families to provide daily ongoing
support.
This means that health services are increasingly
providing long-term monitoring and support to
those living with chronic disease and frailty, while
social services are increasingly needed to provide
ongoing support. Many individual citizens are necessarily
in receipt of both health and social care
support, yet in all but a very few European countries
these services are provided quite independently one
from another, with minimal day to day liaison.
A number of drivers for change are now necessitating
significant change, and the social sciences
have a key role to play in enabling successful progress.
At a macro level, across Europe the combination of
the economic downturn and the demographic-led
increase in demand means that health and social
care services are under ever increasing pressures,
while constant growth of services is not affordable
nor will the labour market support ever continuing
expansion.
6
Meanwhile, at citizen and societal levels two
further and partially interlinked drivers are operating,
but much less uniformly or equitably in
their potential or their effects. The first is a general
increase in consumer awareness of achievable
personalised service standards, and availability of
information both from service providers and from
social and comparison sites and social networks as
to reasonable expectations. Strong examples come
from the holiday and civil aviation sectors, banking
and insurance, and the retail sector including
home shopping. No longer do consumers in general
meekly accept what is offered, but instead seek what
they desire from what they themselves can find out
is available, related to published professionally set
standards and from comparison of providers, and
increasingly they are starting to expect a similar
approach in the health and social care sectors. The
second, and enabling, driver, is the rise in e-services
and mobile devices, ranging from personalised
monitoring devices, smart phone applications and
service provider customer portals, through to the
global unorganised but powerful knowledge base
of the Internet. There are specific evidence sources
on health and care matters, consumer-orientated
and disease-specific internet sites, and a variety of
blogs and chat rooms – the great majority helpful
and well-intentioned, though with the ever-present
risk of malevolent presences too.
This paper presents the case for systematic
research activity in the social sciences, at European
and national levels, to further the interlinked citizen-
focused objectives of:
• close integration at delivery level of health care
and social care support of individual’s health,
• personalisation of care delivery including reasonable
accommodation of individual choice,
• ensuring effective use of ICT applications based
on user acceptability,
• bringing processes of consent, delegation, representation,
coordination and privacy into the
electronic era,
• ensuring respect for and teamwork with formal
carers and the informal care team,
• ensuring equity in an electronic era regardless of
digital literacy, assets and connectivity,
• examining stable and sustainable models of
trusted infrastructure provision,
• establishing governance, authentication, management,
and sustainability principles.
These are important research areas to ensure good
delivery of services to people. They complement,
and are as important as, health sciences research
and health technology research including informatics
research, since if the services do not reach the
patient they do not have any effect.
The workshop’s goal was to discuss strategic directions for the future of health and wellness, from both a technological and a policy viewpoint. To this end, a group of experts, including economists, policy makers, social scientists, researchers and representatives of private sector, professional and other associations, were brought together to consider a broad range of issues which are listed under the following guiding questions:
• What are the key drivers of the emergent new technologies, smart models of care, networks and social behaviours? What are the associated challenges?
• What are the extent and form of social, cultural and economic opportunities and impacts?
• How are these developments accommodating innovation at different levels of the healthcare value chain, from new product development to medical practice?
• What can hinder or slow down innovation?
• What are the key issues that deserve further research?
• What roles do economic, social and regulatory factors play in driving and enabling these developments?
• Are there “good practices,” particularly in terms of governance that facilitate accelerated technology adoption and social/organisational innovation?
• How effective can government’s action be?
• How can countries coordinate research and development efforts?
Despite its potential importance, Social Care informatics does not yet have an identity, an organization, or a champion – by examining the issues this workshop will seek to form a platform for action. The Workshop was intended to identify the key issues, the main aspects needing further study and action, and potential means of progressing initiatives. It was also intended to provide analysis, illumination, and advocacy for the development of ethically and scientifically underpinned action.
Sponsor: Hospitaller Order of St. John of God, Stillorgan, Dublin, Ireland.
Papers by Michael Rigby