A healthier, greener and fairer world will only be achieved if we level up digitally
“Only connect,” wrote EM Forster in 1910. “Nothing gets through like a letter,” purred the Royal Mail in the late 90s. “Making the World more open and connected,” was Facebook’s mission statement from 2007. The need for us to link up and get it together has never been more pressing than in 2021 – 18 months into a global pandemic which has turned all our lives upside down.
Connecting and communicating is what makes us and keeps us human. We only know ourselves and the world in relation to others. Our interconnections enable our inter-reliance – a state that has been laid bare by the virus.
Today the means of connection are overwhelmingly digital. And those who cannot connect into the 21st-century digital world will be left behind – disconnected, isolated and marooned. This is why Openreach’s goal to reach 25 million premises in the UK with ultra-fast and reliable full-fibre broadband is critical – the project will benefit communities of all size across the UK, and is only behind HS2 and Heathrow expansion in terms of the size and scale of infrastructure build.
Early this summer Jericho and Openreach hosted a series of dedicated roundtable conversations within a national coalition of critical deciders and doers – as an opportunity for fresh, inspiring and practical thinking around the possibilities of a joined-up digital future in which all can connect with all. These scoping roundtables bought together politicians and pollsters, tech. disruptors and teachers, business leaders and think tanks to explore how best can we utilise better digital connectivity to create a Greener, Healthier and Fairer Britain that closes the gaps between rural and urban economies, between the regions, and supports the nation’s creativity and ambition.
Digital exclusion is one facet of the inequalities which run through Britain’s social fabric. It goes beyond the North/South divide and under The Red Wall. But there are now real opportunities to address these widespread inequalities through delivering improved digital connectivity.
Lockdown has certainly served to highlight our reliance on virtual means of staying in touch with work, friends, family – the outside world. Our roundtable conversations took place on Zoom rather than around a table.
Since the onset of social distancing in the UK, some semblance of normality – or at least of productivity – has been possible to maintain only because of the networks of digital technologies and platforms already in place. The existing network has proved amazingly robust and those who go out daily to maintain it are among the heroes of the last year. So, there is praise to be given to a network, without which, the nation would have foundered over the last difficult 18 months.
The network was built to cope with peak time demand without it failing. This is just as well. Pandemic increased usage hugely as people worked from home but also watched Netflix and played online games in the evenings rather than leaving the house for work or pleasure. It’s a mark of the robustness of the network that an increase from 22,000 to 50,000 petabytes of data in the UK occurred from 2019 to 2020. The network was always on. Imagine what could be possible with greater reach, speeds and access.
However, the pandemic has illustrated ongoing inequalities.
Matt Painter of Ipsos MORI has been studying the societal trends: “The pandemic has accelerated some trends such as digitalisation, remote working and online retail, but it’s also revealed systemic inequalities. I’ve seen lockdown defined as middle-class people working from home, and working-class people delivering products to their homes. Are we going to see a two-tier workforce? Women have also shouldered a disproportionate burden due to the pandemic. Younger people put more priority on the social capital of working in offices, as compared to older people.”
Polly Mackenzie of DEMOS also emphasised how Covid has brought us together to combat the virus: “A community response is absolutely essential to protecting the community, but social capital is hugely unequal. Rich people are much more likely to have a friend in the local area or make one. We need to find a way to invest in social capital building and remote working capability for those who don’t get it by default. This involves looking at the role of the state in connecting people together.”
The knock-on regional effects of increased levels of remote working are yet to be seen. David Dunn of Sunderland Software City said he now knows numbers of people who live and work in rural Northumberland for Silicon Valley companies. “Better digital infrastructure can both be an accelerator of change and a solution to the problems that change creates. Small employment ecosystems have massively changed in last year and a half because companies are fighting for staff across the UK and the world.”
This is true. There are now hundreds of thousands of people working for businesses where they have not only never been into the office or indeed never seen their work colleagues and bosses in the flesh. How these people build social capital, get noticed and climb the ladder will be fascinating to observe.
Even now. many offices still remain sparsely populated. But our offices, homes and public places – our built environment – are probably responsible for 40% of the UK’s carbon emissions. The conversation on using digital connectivity to build a greener future saw a measure of optimism and realism.
Mark Enzer, Director of the Centre for Digital Built Britain at the University of Cambridge was an optimist up for the challenge of building better. “Net Zero is a systemic challenge that can’t be solved in silos – we need a connected view. Digitally we’re talking about applying the fourth industrial revolution to the built environment. Porting across from manufacturing to construction. Bringing the virtual and physical together. Information shared across the silo boundary eliminates silos.”
Several participants mentioned the vital role of a circular economy in building back better. A system that recycles the earth’s natural resources rather than extracting more and more of them is at the heart of the circular mission. A truly circular economy won’t be possible with very high levels of data connectivity. Take the example of Depop. The online marketplace for used designer clothing which recently changed hands for $1.6 billion and is hugely popular with Gen Z requires all the internet can offer to bring together buyers and sellers.
Enzer continued: “Having digital infrastructure is vital – but there’s a distinction between digital and data infrastructure. Digital is the physical infrastructure but what flows through is where the value is – the data – and in order for that to make sense, we need a data infrastructure that joins it all up. The physical world is connected but not the data sense – the thing that connects them together is Openreach! It’s the Information Value Chain that leads to outcomes. And we need to start from outcomes for both nature and humans. How do you make better decisions? Better insight from better data? We need to see the value from better information that comes from better fibre.”
Paul Morrell who was the government’s Chief Construction Advisor or “Czar” for three years offered sage advise for making it happen. “We need simple solutions for people, simple incentives for people to change their behaviour. When I worked in construction, I had to make it comprehensible – you can’t specify a particular piece of software for example. How do we set the parameters around something we can do now?
“Kennedy said let’s put a man on the moon with a broad idea of how to do it. The cutting edge has moved too far ahead of the mass. Grenfell was a systematic problem but how do we bring it down to clear solutions. The big question is ‘so what do I do now?’
“It’s about people and behaviours, not technology. The problem in construction reminds me of what they used to say about student sex – everyone’s talking about it, but doing it wrong. It’s not either-or complex or simple but it has to be comprehensible for action. We need an honest plan and understanding of the challenges. We’re not going to clad Anne Hathaway’s cottage with insulation!“
The introduction of tech innovation in healthcare has been widely trumpeted. A Track & Trace system that relies on piecemeal not comprehensive data cannot give a proper picture. The list goes on – from isolated rural communities to the often-promised Green Industrial Revolution that itself will require comprehensive digital and data connectivity to make it work. If technology is to make a contribution to wellbeing in the 21st century then lower-income households who are often sicker cannot be left behind. There is real opportunity for meaningful change here.
Anna Dixon from The Centre for Ageing Better goes out to bat for the ageing and elderly – they are the most intensive users of healthcare and have sadly borne the brunt of Covid morbidity and mortality. “We’re interested in what healthy ageing means. How do you encourage people to stay physically active and how to help workers be active in the labour market? Even pre-pandemic we recognised that digital exclusion is an issue. Through Covid that digital exclusion widened.”
Clearly getting people online will be critical to ensure everyone is able to benefit from these changes. A lack of access of devices such as a laptop or tablet, or lacking the skills and confidence to use the internet, remain two of the largest barriers to some people being online. Ofcom have also found that some people are unconnected because of cost. Openreach recently announced that they were waiving connection fees for low income households in receipt of Universal Credit and with no other income in an effort to tackle this issue, but a holistic approach is clearly required to address all of the reasons people may remain offline.
Richard Sloggett, the founder of Future Health and one-time government Special Advisor on Health said, “Covid has changed the rules of the game in how technology is used in healthcare. How can you use technology to deliver care while carefully considering the issues around continuity of delivery, risk management and the management of data? The new technologies need to be inclusive. But we’ve seen a lot of those coming through in the last months.
“The whole treat or prevent argument has been there for years but is now definitely back in the realm of public health and wellbeing. Prevention is important, but it rarely happens. The way the system works is that it’s most often seen that we treat instead of preventing. In Liverpool, there is a great example of a community database. There are fantastic opportunities around the new innovations in artificial intelligence and robotics that will transform the ways healthcare is delivered.
“Public health and the whole prevention agenda, how can new devices help us identify and increase people’s level of activities, help people’s mental health. On the back of Covid, these are opportunities for the role of technology.
“One of the big challenges is the adaptability of the systems to talk to each other. We should be focusing on the challenges around social care services. How can you work with the providers to get them to digital maturity?”
Rosemary Kay is Project Director at the Liverpool 5G Testbed and eHealth Cluster. She has been on the sharp end of putting many of these ideas into action. “We’ve done more in social care than health. We worked with the city council on the digitization of the social care records. It was interesting how it improved the quality of care from the commissioning point of view but it did not save money. It only moved money around the system.”
“The project was driven by the city council social care department. We built a millimetre microwave tech. on council-owned lamp posts that utilised the CCTV network. It is the largest millimetre wave in Europe. There was a whole range of uses – devices that addressed medication management, loneliness, sensors in people’s homes, pub quiz that connected people in the community etc.
“We did all that in the backdrop of the pandemic and that really supported what we’re doing as the need for connectivity was really high. The remote consultations will need good connectivity on both sides and if you don’t have that you don’t have access to the service. We are working with GPs and care homes to get them on the network.
“The focus should be in the home not in the hospital – how to make people live longer in their homes using technology. The technology is the easy bit, but the human side is the hard part – the adoption of it.
“However, you need to remember how far there is to go. Seventy-five percent of social care providers have only one home. They don’t have an IT department – why would they? They have no idea what they want or need.”
Primary care is where the action will be in coming years not simply because it is cost-effective and makes consummate sense but because out there in the community is where the locus of sickness is and where its reverse, wellness and health, should and will be.
A visit to a family doctor in 2031 is likely to look somewhat different from the present which is how it looked in 1955 and 2005. And the same trip in 2041 will be more altered still. Things are changing apace in healthcare. Who would have thought sixteen months ago that so many GP consultations would be conducted remotely by Zoom or Facetime?
Why is this? Partly because visits to the hospital will become increasingly less necessary. And the family doctor will be the centre of health maintenance – both physical and mental. We know that technology and sensors which detect all manner of processes in our bodies – and seek to maintain the correct equilibrium in their ecosystem – are well on the way. It will be far more than blood sugar or blood pressure that will be measured at your own kitchen table.
So, the GP of 2041 might be more of a health coach. A guide, an assessor, a counsellor who helps maintain her patient’s wellbeing, thus avoiding the diseases which routinely occur in the first place.
This will become a person-centred model, not the provider-centric health model we know currently. What could be more provider-centric than a hospital to which you have to journey, where you sit dolefully and sometimes for hours in a waiting room for the consultant to see you, which harbours unwanted and harmful infections, which are factories of the sick.
It’s also highly likely that the power relationship between the doctor or nurse and patient will subtly alter. Sure, a sense of the bedside manner and the magical placebo effect will remain but empowering choice will lie in the hands of the patient. We are likely to be far more in control of our medical destinies. Less “our life in their hands” more “your life in your hands”. Prediction and prevention of disease will take over from trying to pick up the pieces once things have gone awry. It’s digital connectivity that will make this possible.
A famous paper published in the Public Library of Science in 2010 reviewed 148 studies, involving 300,000 people, and discovered that those with strong social relationships had a 50% lower chance of death across the average study period (7.5 years) than those with weak connections. “The magnitude of this effect,” the paper reported, “is comparable with quitting smoking”. Cigarettes used to offer the solace of connecting up with something hence the famous slogan “You’re never alone with a Strand.”
That increased connectivity will play a huge role in both the public and private sector in the next decade is a given. Our common global experience of the last 18 months means nothing will be the same again. Our relationship to digital connections has been accelerated dramatically.
A “Manifesto for the Digital Common Good” that could be acted upon to the benefit of all is not the pipedream it may have appeared in November 2019 before any of us had heard of the virus that currently holds all our attention. We have the chance to build back better, digital connections will be at the heart of that process – the healthier, greener and fairer world will only be achieved if we level up digitally. Openreach, all the participants that came together to scope such a society and millions more are up for the challenge. Let’s make it happen.
Participants in the Roundtables included:
Building Back Greener – 27th May 2021
- James Alexander, Director, Future Agenda
- Karen Alford, Flood and Coastal Risk Manager – Digital Asset Data and Information, Environment Agency
- Will Black, Head of Policy, Openreach
- Stephen, Brenninkmeijer, Chair, European Climate Foundation
- Mark Enzer, Director, Centre for Digital Built Britain, University of Cambridge
- Enrique Fernandez-Pino, Senior Partner,Digital Works Group (UK)
- Shamir Ghumra, Director of BREEAM, BRE
- Matthew Gwyther, Partner, Jericho Chambers
- Colin Hines, Co-Founder, Green New Deal (UK)
- Neal Lawson, Partner, Jericho
- Paul Morrell. Chartered quantity surveyor, Paul Morrell Consulting
- Chris Richards, Director of Policy, ICE
- Michael Salter-Church, Director, External Affairs & Policy, Openreach
- Katy Taylor, Chief Strategy and Customer Officer, Go-Ahead Group
Building Back Healthier – 8th June 2021
- Ahmed Abdulla, CEO, Digipharm
- Will Black, Head of Policy, Openreach
- Alan Davies, Director of Innovative Programmes and Partnerships, Health Education England
- Anna Dixon, CEO, Centre for Ageing Better
- Matthew Gwyther, Partner, Jericho Chambers
- Rosemary Kay, Project Director, Liverpool 5G Testbed at eHealth Cluster
- Neal Lawson, Partner, Jericho Chambers
- Kwame Lowe, Social Programmes Manager, Publica
- Mavis Machirori, Senior Researcher, Ada Lovelace Institute
- Henrietta Mbeah-Bankas, Head of Blended Learning, Health Education England
- Andrew Russell, Growth Director, Nyby
- Steve Sadler, TSA Associate – Technology Strategy
- Michael Salter-Church MBE, Director of External Affairs & Policy, Openreach
- Richard Sloggett, Founder, Future Health
- Emma Stone, Director of Design, Research & Communications, Good Things Foundation
Building Back Fairer – 10th June 2021
- Will Black. Head of Policy, Openreach
- Nathan Brown, Innovation and Digital Senior Policy Adviser, CBI
- Danny Dickinson, Policy and Research Programme, Digital Catapult
- David Dunn, CEO, Sunderland Software City
- Anna Grant, Senior Policy and Development Officer, Carnegie
- Matthew Gwyther, Partner, Jericho Chambers
- Mike Hawking, Acting Head of Policy and Partnerships, JRF
- Indy Johar, Co-Founder, Dark Matter Laboratories
- Neal Lawson, Partner, Jericho
- Polly Mackenzie, Chief Executive, Demos
- Matt Painter, Managing Director, IpsosMORI
- Andy Russell, Growth Director, Nyby
- Michael Salter-Church, Director of External Affairs & Policy, Openreach