The Unanticipated Impacts of Smart City Technologies - Part 1

For over 20 years, we have been told that smart city technologies will make our cities more efficient, sustainable, and convenient. We have been told about the multitude of positive benefits solutions will bring, from reduced energy use and operational costs, to improved data-driven decision making and reliable and personalised city services. However, for any solution implemented, in addition to the well-publicised positive benefits, there are likely to be a range of unanticipated impacts, both positive and negative.

This series of articles seeks to explore the unanticipated impacts of three ‘smart city’ solutions. The selected solutions span 3 different timelines:

• Now: Remote health and social care
• 5-10 years: Airborne drones
• 10-30 years: Autonomous road vehicles

This week's article focuses on the NOW scenario: Remote health and social care.

NOW: Remote Health and Social Care

Of the three use-cases discussed in this series, remote health and social care is the closest to mainstream adoption. This is a broad category of services comprising online consultations and the utilisation of wearables to enable users to better manage their own health and wellbeing, to more formal telecare, remote patient monitoring and virtual ward use-cases. Many NHS trusts and local authorities across the UK already utilise these services, and wider adoption is being driven by the increasing budget and resource constraints in public health and social care services.??

The positive benefits of these services are being realised: reduced costs of delivering health and social care services, the reduction of pressure on overworked health and social care workers and the ability to discharge patients from hospital beds, allowing them to be used for patients requiring emergency and acute care.

However, what is rarely talked about is the wide range of secondary impacts. For example:

1. For many people receiving care at home, their carer may be the only person they see that day. Replacing these visits with technology takes away valuable social interactions and may exacerbate social isolation and loneliness. The National Institute for Aging states that the health risks of prolonged social isolation are equivalent to smoking 15 cigarettes a day and may shorten a person’s life span by as many as 15 years. Are we resolving one health issue and creating a new one?
2. The implementation of these technologies creates new health and care pathways, which must be integrated into the working practices of hospital, GP surgeries and care services. This requires significant budget which is often not accounted for in the business cases put forward by providers. Once implemented, there is the challenge of setting the alerting thresholds: too low and you become inundated with false positives, too high and you miss someone in need of support with potentially grave consequences.

It is becoming clear that remote health and social care technology will play some part in the health sector's attempts to meet ever increasing demand, but its implementation must be done sensitively and with full awareness of the spectrum of benefits and disbenefits. By fast-tracking solutions into the mainstream out of necessity, are we at risk of creating new problems while solving others??

Conclusion

The aim of this piece is not to discourage the implementation of smart solutions. Rather it is to stress the importance of considering the wide spectrum of potential disbenefits alongside benefits, and to proactively implement robust policy and governance frameworks that minimise the former and maximise the latter.

For solutions currently entering the mainstream, holistic policy and governance frameworks must be developed urgently to avoid the realisation of unanticipated impacts. For those solutions that are still some way from mainstream adoption, there are opportunities associated with a proactive approach to policy development. Early signalling may influence the direction of solution development and drive investment into these areas over others. It is also beneficial from a citizen perspective, giving them the chance to have their say and shape future deployments. This in turn should maximise user acceptance and adoption in the future, a major risk for any new technology.?