Debate: Unclear who is responsible for technology solutions in welfare
To meet the growing care needs of an ageing population, we need to increase the use of technology in welfare. But what happens when complex technology solutions do not work, and who is responsible? We need a public conversation about the division of responsibilities, write Lars Liljedahl, Swedish Association of Social Welfare Managers and Lars Lundberg, IT&Telecom companies.
Demographic trends, with an ageing population that is living longer, are placing dramatically increased demands on society to provide easily accessible, high-quality welfare. At the same time, the shortage of staff with the right skills, which is already evident today, is growing. The government's long-term study shows that the increased cost of future care cannot be covered by higher taxes. The Swedish Association of Local Authorities and Regions (SALAR) states in its financial report from October 2017 that the increased cost requires new ways of financing and working efficiently in future health and social care.
To meet these challenges, we need to make even greater use of technology in welfare than we do today.
It is not only desirable but absolutely necessary. Used in the right way, welfare technology will contribute to better service, greater security, increased independence and more freedom in everyday life for those who are dependent on care.
To get the maximum value from technology, it needs to be well integrated in society and in the activities where it will be useful. Several actors will use or deliver digital technologies in the future welfare that society will provide. The municipality, the user, system providers, suppliers of products and services, prescribers of assistive technology and mobile operators. Yes, the list is long.
It is important to understand that for each individual, there are many people who contribute their part of the health and social care. A chain of actors where everyone is needed for a functioning whole. But what happens when the chain breaks? Who is then responsible?
Today, many of us use digital technologies to make our lives easier and manage our health. We can track how we sleep, eat and exercise with our mobile phones. We can read our medical records, book appointments at the health center and renew prescriptions via Mina vårdkontakter. We can meet with doctors, psychologists and nurses without having to go to a health center or similar. All this with the help of our own digital technology, which we are also responsible for ensuring works, is updated, charged and has coverage.
The county councils' health services are slightly more advanced than the municipalities in providing services accessible via digital technology. The municipalities have focused more on getting digital technology out to those covered by social services for the elderly and disabled and municipal healthcare (for example, social alarms, keyless locks and surveillance cameras), and to employees (for example, tools for planning and follow-up). Here, municipalities place demands on the reliability and dependability of products/services vis-à-vis suppliers. If something goes wrong, liability is not too difficult to clarify. However, the chain of responsibility is becoming more complex as the population expects all welfare services to be accessible via their mobile phone or computer.
Municipalities and county councils, as principals in their areas, have the ultimate responsibility for citizens' welfare. Based on this, we could say that municipalities and county councils are responsible for all health and social care, including all possible welfare technology applied in the area, as well as its accessibility.
But is it that simple?
Let's take an example:
Today, the market can deliver mobile social alarms that enable people to live a more independent and autonomous life, where both the individual and their loved ones can feel safe when their orientation skills start to deteriorate. This technology can be acquired by the individual themselves. The technology can be integrated and linked to the municipality's activities and operational systems.
For everything to work, everyone needs to do their part to make the whole thing work. On the one hand, the individual, on the other hand, relatives, the manufacturer of the product, those who supplied the operating systems, service providers of mobile phone networks and GPS connections, the municipality's IT unit, alarm receivers and home care services.
One challenge is that there is not enough broadband connectivity everywhere in our country. Living in special housing and having access to broadband is not a matter of course either. Welfare technology, with its potential for security and participation, simply does not reach everyone in the country.
Another challenge is the necessary security and other updates that are constantly taking place in digital technology. When updates are made, there is a risk that the flow will be interrupted, so that the service as a whole stops working. The individual may also have to make updates, which can be both complicated and time-consuming for those who are not used to it. This requires coordination between everyone in the chain and a clarification of the division of responsibilities.
As long as the issue of responsibility is not resolved, we see a great risk that the actors will blame each other if an incident occurs. This would primarily affect the individual, and by extension also damage confidence in welfare technology.
In its spring budget, the government has allocated SEK 350 million in 2018 for the continued development of welfare technology in the municipal sector. This is very welcome. But if this government investment is to have the desired impact, it is necessary to immediately highlight and clarify the issue of responsibility: Who is responsible when welfare technology does not work?
We who are suppliers of welfare technology (IT&Telecom companies) and the Swedish Association of Social Welfare Managers (FSS) lack the public conversation about the division of responsibilities in the use of welfare technology.
That's why we're launching a dialogue:
We invite SKL, Pensionärernas riksorganisation (PRO), SPF Seniorerna, Riksförbundet för social och mental hälsa (RSMH), Funktionsrätt Sverige and Myndigheten för delaktighet, together with the responsible ministers Peter Eriksson, Mikael Damberg and Ardalan Shekarabi. We must jointly develop a basis for future guidelines!
If the issue of responsibility is not investigated, we will prevent the necessary development that is required for Sweden to maintain its good welfare and the security of the individual. This will have a major impact on citizens' access to good healthcare in the future.
Lars Liljedahl, Chairman of the Swedish Association of Social Directors, FSS
Lars Lundberg, industrial policy expert at IT&Telecomföretagen