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New development: Digital social care—the ‘high-tech and low-touch’ transformation in public services Higor Leite a, Ian R. Hodgkinsonb and Ana V. L. Volochtchuk c

aSchool of Management and Economics, Federal University of Technology Paraná, Brazil; bSchool of Business and Economics, Loughborough University, UK; cBiomedical Engineering Postgraduate Research Programme, Federal University of Technology Paraná, Brazil

IMPACT This article introduces new technological developments transforming social care and enabling better care for vulnerable populations. While acknowledging traditional technologies already used in digital social care, the authors move beyond these passive technologies and show the benefits of the next- generation and the generation-after-next assistive technologies in supporting older people and people with disabilities. The reliance of social care on technology comes with challenges, such as cost, technology illiteracy and social workers’ skills. The authors propose further empirical studies to address these challenges, and urge policy-makers, scholars and practitioners to collaborate and develop policy and regulations for new digital social services.

ABSTRACT Social care is one of the fundamental services provided by governments worldwide. Nevertheless, austerities, workforce crises and an ageing population are challenging social care provision. One of the ways to improve this situation is to adopt technology-infused services. To date, the digitalization of social care has been mainly focused on organizational benefits from passive technologies, with scant attention to the end-users needs. The authors discuss several opportunities and challenges to move towards active and autonomous digitalization to support public social care. Drawing upon the public service ecosystem, the authors develop a research agenda to advance policy and practice in social services.

KEYWORDS Assistive technologies; digital social care; ‘high-tech and low-touch’ service delivery; policy; public services; social care; vulnerable population

Introduction

Public services organizations (PSOs) are often pressured to provide equitable services to citizens while simultaneously facing government budget reductions, workforce crises and an increasingly ageing population (Dromey & Hochlaf, 2018). These conditions impact health and social care services acutely, with the latter affecting the most vulnerable individuals in society. According to the WHO (2015), social care services are responsible for optimizing the social protection of disadvantaged individuals and their social networks. Thus far, social care activities have been carried out by carers and social agents; however, technological innovations, such as assistive technologies (ATs), are providing new means of service provision— bridging the growing gap between individuals’ needs and social care provision.

ATs in the form of smart homes, the Internet of Things (IoT), and voice assistants (VAs) provide more efficient ways to perform many day-to-day activities, positively impacting the lives of individuals with disabilities and the elderly (Vieira et al., 2022). Yet, the use of these ‘high-tech and low- touch’ ATs is not a common practice in social care; the adoption of ATs has been limited by a lack of understanding of how these technologies can effectively support social organizations and vulnerable populations (Bhattacharya et al., 2022; Vieira et al., 2022). This is a major missed opportunity, given the current pressures on governments to both minimize social care costs while increasing the well-being of their citizens (Wilberforce et al., 2012; Dromey & Hochlaf, 2018). To illustrate, according to the Local Government Association (2022), the United

Kingdom’s social care service is underfunded by £6.1 billion, with service satisfaction levels at their lowest in 10 years (see Statista, 2022).

Although digital technologies in social care are not new, their current applications have been focused on the ‘passive’ technologies associated with information management that primarily support organizational needs (for example electronic patient records, use of data for prediction and monitoring). The user-perspective has been largely overlooked, as have the roles of ‘active’ ATs and even more advanced technologies such as the generation- after-next of ‘active and autonomous’ ATs. It is therefore timely to put a spotlight on the role of technology for the digitalization of social services, and answer the key question of how to expand the use of ATs for the benefit of social care provision? In response, this article presents the state- of-the-art in high-tech and low-touch digital social care, discusses the current state-of-the-art of social care digitalization, and illustrates the value potential of active and autonomous ATs. To guide future research, we present a research agenda for further investigations into digital social care and policy development.

High-tech and low-touch social services

The increasing use of ATs to support vulnerable users is becoming an appealing strategy to reduce staff burden and enhance users’ independency. As technology evolves, users become more aware of the benefits of its adoption to support their daily activities. The adoption of technology to support traditional service delivery is related to a

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PUBLIC MONEY & MANAGEMENT 2023, VOL. 43, NO. 2, 183–186 https://doi.org/10.1080/09540962.2022.2140897

phenomenon known as high-tech and low-touch service delivery (Wunderlich et al., 2012), and its applications in health and social care have never been more salient (Leite et al., 2020).

The use of ATs in social care can provide several social and economic benefits. For example, observed social benefits reported in the literature include reduced loneliness, improved quality of life, and increased self-esteem and independence as immediate positive impacts (Abdi et al., 2018; Dratsiou et al., 2022). Moreover, the benefits of enhanced support services can transcend a single vulnerable service user, since the service will meet ‘the needs not only of these adults but also of their families, friends, and carers’ (Osborne et al., 2022, p. 4). From an economic perspective, positive impacts reported are cost reduction while maintaining personalized care, time-saving and a reduced burden on the workforce and wider carers such as family members (for example Lancioni et al., 2015; Wittich et al., 2016).

In the literature, there are different studies related to high-tech and low-touch ATs adopted by vulnerable populations, with several examples of their impact on users’ daily life (for example Wittich et al., 2016; Yachnin et al., 2018). Though the use of ATs in digital social care to date does hold wide-ranging benefits for vulnerable service users and wider service stakeholders, they are deemed to be a type of ‘passive’ ATs. Passive ATs include online platforms, electronic patient records, digitally supported diagnoses, and data protection, which ultimately focus on the organizational side of care (NHS Digital, 2021). Conversely, ‘active’ ATs focus more directly on users’ needs and they can be integrated into public policies to enable vulnerable individuals access to technology to support their activities of daily living (ADLs). Examples of active ATs are service robots, smart homes and IoT devices (Prescott & Caleb-Solly, 2017; Cimini et al., 2021). Currently, the use of passive ATs is well embedded in digital social care, however the use of active ATs by social care organizations is sparse, with piecemeal adoption of such technologies, despite these being a source of huge value potential for the future.

Digital social care: from passive to active and autonomous ATs

With the significant underinvestment in public social care services, it is time to invest in innovation to improve performance while reducing costs. The adoption of active ATs in public social services is just a harbinger of things to come in this sector; other technologies are already

emerging which have the potential to change how services are delivered in the future. For instance, ‘generation-after- next’ technologies (Defence and Security Accelerator, 2022) are based on ‘active and autonomous’ technologies that rely heavily on artificial intelligence (AI), such as in the case of autonomous robots (humanoids) to support ADLs. Table 1 displays the three categories of ATs showing progress to date and where the future of digital social care may lie; they are:

. Traditional generation of ‘passive’ ATs.

. Next-generation of ‘active’ ATs.

. Generation-after-next of ‘active and autonomous’ ATs.

The traditional generation of ‘passive’ ATs is what has ‘paved the way’ for the digitalization of social care in the past. Although they have represented a significant technological development for the sector, these technologies are mainly focused on information management in social care organizations, and some are used to support users with basic ATs (for example assistive hardware and software). The next-generation of ‘active’ ATs have already been adopted by a restricted number of users who can afford them. These ATs are what we expect will become more established in general practice and public policy in the coming years and where we believe there is a vast potential for applications by social care organizations. A common example of an active AT that has already been adopted in social care is the use of voice assistant devices—these are applications of AI that use voice commands to help people to carry out ADLs (for example sending messages, making calls, controlling lights and room temperature). They impact social care by helping disabled and elderly people with limited mobility to control their home environment, enhancing their independence and well-being (for example Vieira et al., 2022). Currently adopted sporadically, and in a piecemeal way, these active ATs are the immediate future of digital social care.

The concept of generation-after-next of ATs is based on ‘active and autonomous’ technologies to enhance users’ experience and independence. This is the most underdeveloped and promising generation of ATs for the long-term future of digital social care. For instance, the use of autonomous robots (for example the combination of an exoskeleton and AI) might support physically-impaired users to regain a degree of independence, while reducing the burden on care staff (for example Cimini et al., 2021). Currently, most of the applications of generation-after-next technologies are focused on the defence industry; however, commercial models of autonomous robots are already

Table 1. Generations of ATs applied to digital social care.

Traditional generation of ‘passive’ ATs: digital social care using established tried and tested tech (< 5–10 years)

Next-generation of ‘active’ ATs: digital social care developed using the latest technology

available (current)

Generation-after-next of ‘active and autonomous’ ATs: digital social care of the future based on tech currently

developing (> 5–10 years) . Electronic patient records . Online platforms . Mainstream technology (for example tablets,

accessible smartphones, apps) . Computer software—magnification and

screen reading . Powered wheelchairs . Indoor and outdoor navigation (GPS) . Wearable technology (analogue)

. Service robots

. Smart homes

. Activity monitors (smartwatches)

. IoT devices

. Video calling hubs

. Voice assistants

. Assistive exoskeletons

. Virtual and augmented reality

. Metaverse environments

. Autonomous robots (humanoids)

. Wearables for body fluids monitoring

. General AI-based technologies

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emerging. For instance, Tesla recently presented the prototype of a humanoid, and it is expected that they will start selling the first units in a few years (BBC, 2022).

ATs are not a panacea for social care issues, nor are they a one-size-fits-all digital strategy. However, optimizing the use of ATs could be a way forward to ease the impact of austerities, workforce crises and an ageing population, while maximizing the value created in social care for all.

Challenges and research agenda

Although we agree that digital social care provides several individual and collective benefits, this does not come without some caveats, and we strongly urge further investigations to help make the most of the potential we have shown. Several challenges must be addressed before ‘active’ ATs become a common practice in social care. For instance, digital services require new skills that users and social workers might not be fully prepared for (for example technology illiteracy). In this vein, Nunan and Di Domenico (2019) find that elderly people cannot keep up with the pace of technological innovation, leading to older generations facing an increasing ‘digital divide’. Among other potential challenges, we draw attention to the cost of some ATs and their affordability for users, broadband access issues, low human contact and the potential for social isolation, and ethical issues related to privacy and data protection (Ariani et al., 2016; Yachnin et al., 2018). Together, these represent potential barriers to scaling up digital social care services and the generation-after-next of digital social care.

One of the ways to address these challenges is to bring together practitioners and scholars to explore new opportunities to expand the use of ‘active’ ATs for the benefit of social care provision. Furthermore, developing research initiatives with government, service professionals,

and AT providers might shed light upon the low inclusivity of these technologies. Drawing on Osborne et al. (2021) public service ecosystem (PSE), we propose a research agenda that raises pertinent areas for future research across the three levels of the social care ecosystem: macro-level (institutional), meso-level (service delivery system) and micro-level (individual). Osborne et al. (2022) reveal the complexity of value creation conflicts for public services across these levels and emphasize the need for practitioners to work across the three levels ‘to embrace the design and delivery of public services in innovative ways’ (p. 9). It is, therefore, an appropriate framework to consider how transformational change towards a digital social care service of the future may be enacted by the service actors across all levels (for example Trischler & Westman Trischler, 2022). By ‘zooming in and zooming out’ at different layers of the PSE, Table 2 highlights the challenges at each level and outlines our suggestions for future research to advance digital social care.

Following the prescriptions of Osborne et al. (2021), at the macro-level of the PSE, in this article we have addressed the need for public policy development and its impact on value creation from institutional and societal perspectives (value-in-society). Next, we have provided opportunities to understand the PSOs’ role in co-designing and delivering public social care services (value-in- production) and actors’ impact on value creation and destruction at the meso-level. Finally, we have explored the micro-level, which considers the needs of users and stakeholders, and the relationships between public service agents and the individual users (value-in-use and in- context). For digital social care, these research opportunities advance the implementation of new services in social care. Nevertheless, when adopting the PSE

Table 2. Research opportunities for digital social care.

Ecosystem level Digital social care

challenges Research questions

Macro-level (institutional/ societal)

Privacy and data protection

. How can organizations, society and policy-makers work together to co-design policies for transparency in data protection?

. What privacy trade-offs are service users and organizations willing to accept to attain better service provision?

. How should the digital data collected during service interactions be managed? Broadband access and Affordability

. To what extent do digital public services create social inclusion/exclusion?

. What does the digital divide look like in different country contexts?

. What is the long-term impact of public sector austerity for ATs in social care? Meso-level (service system) Resistance to technology . How can PSOs engage with stakeholders to co-design and co-produce user-friendly services?

. What is the impact of the service user, family, friends and carers’ acceptance of the technology on value creation and destruction?

. To what extent might technology resistance deteriorate value?

. What are the strategies to overcome digital services resistance? Social workers’ training . What is the role of technology acceptance in enhancing value creation processes within public

services? . What is the new role of carers in the digital social care space? . How can PSO networks (for example service process, organizational actors and local

community) develop collaborative governance of digital social care? Micro-level (individual service users/ stakeholders)

Technology illiteracy . How can technology illiteracy be overcome in the adoption of active and autonomous ATs in social care?

. What does technology use for value creation/destruction look like for service users with impairments and social vulnerabilities?

. What is the impact of individuals and public service agents co-designing new digital services? Low human contact (social isolation)

. How does a transition from human-assisted service to technology-infused impact social isolation?

. How might digital social care improve life-long experiences at a distance?

. What are the implications of service separation for value-in-context? Access to digital social care . To what extent does the digital divide create value destruction in digital social care?

. What forms and generations of ATs should be used, in what circumstances, and for whom?

. To what extent can technology-infused services enhance access to social care?

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framework, we expect that new ATs will be designed not just for vulnerable users but also with them.

Concluding remarks

In this article, we have explored the phenomenon of high- tech and low-touch social care services and we have shown possible paths forward for digital social care of the future through the adoption of next-generation and generation- after-next ATs. We have provided arguments and suggestions to enhance technology in social care from the PSE perspective—outlining research priorities. We acknowledge that the multi-level framework suggested by Osborne et al. (2021) overlaps to some degree, and some research priorities might resonate with other levels of the PSE; however, the fundamental concept of value creation/ destruction in different domains is preserved.

Finally, our future research agenda aims to further investigation of the emerging generation-after-next ATs in social care services, for instance AI (for example machine learning), metaverse (for example virtual reality and augmented) and autonomous robots (for example relationship building), which will require collaboration between scholars, practitioners and policy-makers to develop new digital social care services fit for the future.

Disclosure statement

No potential conflict of interest was reported by the author(s).

ORCID

Higor Leite http://orcid.org/0000-0002-2451-4124 Ana V.L. Volochtchuk http://orcid.org/0000-0003-1161-8730

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