The potential for technological innovation to exert a transformative influence on the provision of health and social care services has been acknowledged in various domains, such as mental health services (Barak and Grohol, 2011), substance addiction (Schoech et al., 2013), and assistance for individuals with disabilities (Mintz et al., 2012; Dunst et al., 2013). Alongside this recognition, there has been a growing apprehension regarding the ethical, privacy, and social justice implications associated with these technological advancements (Social Care Institute for Excellence [SCIE], 2014). This essay will delve into both the opportunities and challenges linked to the increased utilization of technology in these contexts. It will commence by outlining some of the primary challenges and subsequently endeavor to reframe them while exploring the potential for technology to revolutionize various health and social care delivery aspects. To delve into these matters in depth, this essay will scrutinize a specific and particularly contentious issue: surveillance. This examination will explore the prevailing discourses surrounding health and social care surveillance technology. It will become evident that, while challenges indeed exist in this realm, technology in itself serves as a tool that can be employed either in a transformative or oppressive manner.
One of the most fundamental challenges associated with technological innovation in health and social care is the workforce’s competency, training, and motivation (Liddell et al., 2008; Gillingham, 2015). Traditionally, health and social care provision have heavily relied on face-to-face interactions as the cornerstone of practice (Berzine et al., 2015). Consequently, any erosion of this interpersonal focus will likely encounter resistance from the established rules, particularly from professionals who harbor concerns that their skills may become obsolete in these evolving contexts (Liddell et al., 2008). Unsurprisingly, the health and social care sectors have exhibited a pronounced hesitancy in embracing new technological innovations, especially when compared to private sector organizations (Zorn et al., 2011).
In addition to these practical challenges, there is a spectrum of ethical apprehensions regarding integrating technology in these settings. Foremost among these concerns is the worry that technology may exacerbate some of the central issues that health and social care professionals routinely confront. For instance, research has indicated that excessive technology usage is associated with heightened levels of depression and a deterioration of depressive symptoms (Tong Mok et al., 2014). This is particularly disconcerting for children, where early and extensive engagement with technological devices is linked to an increased likelihood of encountering mental health difficulties (Augner and Hacker, 2012). Furthermore, the use of technology has been connected to a rise in childhood obesity, a pressing public health issue in contemporary society (Rosen et al., 2013). Other commonly raised concerns encompass cyberbullying (Office of Communications, 2015), internet addiction (King et al., 2012), and online predatory behavior (Palmer, 2015).
Nonetheless, these apprehensions mustn’t precipitate an irrational inclination towards technological skepticism, potentially negating the benefits that new technologies could offer to service users and patients. A prominent perspective presented by Welsh et al. (2003) underscores that new technologies possess moral neutrality, with ethical concerns arising from their application. Echoing this viewpoint, Greenfield (2014) emphasizes that the impact of any technological innovation hinges on its utilization, dismissing the notion of any technology being intrinsically positive or negative. For instance, while earlier discussion noted the specific risks technology poses to younger individuals, it is equally crucial to acknowledge that technology presents an avenue to engage with younger demographics, particularly young men, a group that health and social care agencies have historically struggled to reach (Ellis et al., 2012). Additionally, research has indicated that some traditional interpersonal interventions, such as person-centered counseling, can be effectively delivered through novel technological mediums (Vossler, 2010).
To bolster this discussion, a more detailed examination of one specific area, namely surveillance, proves beneficial. Health and social care services increasingly grapple with issues related to privacy, encountering competing priorities that present a significant challenge in addressing these concerns (Zwijsen et al., 2011; Mortenson et al.., 2015). On one hand, the legislative and policy framework governing health and social care delivery underscores the importance of information sharing among professionals. For instance, section 6 of the Care Act 2014 mandates local authorities, the NHS, and other relevant health and social care organizations to cooperate in sharing necessary information. Similar obligations to cooperate in information sharing are imposed by further legislation in this domain, including the Children Act 2004 and the Health and Social Care Act 2012. However, these imperatives to share information coexist with the fundamental right to family and private life, enshrined under section 8 of the Human Rights Act 1998. Concerns regarding information sharing have been exacerbated by implementing the General Data Protection Regulation 2016, which became effective in the UK in May 2018, imposing significant responsibilities on governmental and non-governmental entities regarding confidentially storing, processing, and sharing personal data.
Parallel to these competing priorities, contemporary society exhibits heightened concerns regarding surveillance, extending into health and social care contexts (Mortenson et al., 2015). Welsh et al. (2003) argue that within these settings, the focus of concerns is gradually shifting from fears of being under surveillance to worries when people are not under supervision, a shift accentuated by the widespread availability of technology enabling continuous management (Perry et al., 2010). The technological advancements facilitating sustained health and social care surveillance encompass telecare sensors, GPS devices, cameras, and intelligent health recording devices (Mortenson et al., 2015). The fact that the Care Quality Commission (CQC, 2015) and the SCIE (2014) have issued explicit guidance on using surveillance technology in health and social care settings underscores the pervasiveness of surveillance technology in these domains.
It is imperative to acknowledge that surveillance technologies can yield substantial advantages for individuals availing themselves of health and social care services. For instance, elderly individuals desiring to age in their own homes have expressed appreciation for using surveillance technology to facilitate this, preventing premature transitions to care homes (Perry et al., 2010; Andruszkiewicz and Fike, 2015). Furthermore, in recent years, surveillance technology has been instrumental in uncovering some of the most egregious abuses within health and social care services, notably exemplified by the Winterbourne View Hospital case, where traditional whistleblowing and inspections had failed to reveal the extent of the maltreatment (Flynn, 2012). Nevertheless, amidst examining these benefits, there has been a scant exploration of the ethical implications inherent to these new surveillance technologies (Perry et al., 2010; Gillingham, 2015). This point carries significance since research demonstrates that managers, practitioners, and patients often hold divergent perspectives concerning the risks associated with these emerging surveillance technologies (Essen and Conrick, 2008; Mortenson et al., 2015).
To comprehensively dissect these issues, it proves advantageous to scrutinize the discourse utilized in this domain. Foucault (1980: 93) defines discourse as “historically variable ways to specify knowledge and truth.” In the realm of surveillance, distinct discourses characterize the debate, most notably the technical discourse, which pertains to the functionality of technological systems, and the discourse on rights, which addresses the acceptability of these technological systems within these contexts (SCIE, 2014). Regarding the discourse on rights, a movement has arisen based on the principle of “no information about me without me,” rooted in the desire for health and social care agencies not to store or utilize information about service users without explicit consent and user involvement (Cantor, 2006: 49). It is recognized alongside this that concepts of privacy and surveillance are inherently intertwined with consent and capacity, as defined under the Mental Capacity Act 2005 (SCIE, 2014). While the technical discourse is invaluable for innovation and advancement, it may not adequately address these discussions. Hence, it is imperative to focus on the ‘rights’ discourse alongside it (SCIE, 2014). Technological innovation in health and social care can significantly reshape service provision. However, technology alone does not guarantee an enhancement of social justice or service provision, which should remain the ultimate objective of professionals and organizations in this domain (Goldkind and Wolf, 2015).
This essay has elucidated the evident challenges and prospects associated with technological innovation in health and social care settings, underscoring that practitioners, managers, and policymakers in this sphere will determine the impact of these emerging technological innovations. It has explored some of the commonly acknowledged challenges technology poses in this context while considering the opportunities that coexist with these concerns. The examination of surveillance, in particular, has delved deeply into how discourse influences the perception of technology within these settings. This discourse-centric approach should continue to hold a central role in technological engagement in these contexts, as there is the potential for technological innovation to be driven not by what is best for service users and patients but rather by cost-saving and the promotion of perceived efficiency (Norrie et al., 2014). Placing the discourse of rights at the forefront of all deliberations in this domain will play a pivotal role in mitigating these issues and ensuring that the vast potential offered by these emerging technological innovations is realized.