Towards 'The Hospice Without Walls'; How Could Robotics and Human Centred Design facilitate 'Enhanced Independence' and 'Alternative Access' in Future

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By 2040, 160,000 more people in England and Wales will need palliative care, provided the current mortality trendscontinue. This means an increase of 42.4% in palliative and end-of-life care needs, within the next 20 years.Healthcare systems must start to transform, adapt and prepare now, as the urgent need for well designedtechnologically enhanced health and care solutions towards the end of life is inevitable. Hospices are one mainavenue for provision of palliative and end-of-life care. However, they are deemed expensive and essentiallyunsustainable in current form, especially in the face of the growing demand. A reform is inevitable;Where and how could a symbiosis of Robotics and Human Centred Design facilitate alternative and novelfuture hospice care scenarios - focusing on 'enhanced independence' and 'alternative access'?There is evidence that Artificial Intelligence can improve the quality and efficiency of healthcare; including quickidentification of symptoms and mapping societal health, smart sensors to help with diagnostics, and trackingpatients' physical and mental wellbeing. Palliative & end-of-life care is delicately, and rather uniquely, positionedon one end of the healthcare provision spectrum. With its holistic and multi-faceted network of physiological,psychological, social, and spiritual support, and complex patient pathways, Palliative care exposes majorchallenges as well as unique opportunities for introduction of AI, particularly robotics. Major opportunities ofrobotics in Palliative care include Assistive, Therapeutic, Social, and Educational uses. Additionally, there arewider calls to reclaim and reimagine end-of-life as a 'human', rather than a mere 'medical' domain8. Hence, movingto 'humanise' death. Both the robotics and human centred approach need a wider transdisciplinary discourse,outlook and collaboration.2. Research Challenge in the Context of the State-of-the-artMarie Curie is a registered charitable organisation in the United Kingdom, providing care and support for peopleliving with terminal illness and their families, since 1948. Marie Curie has nine hospices across the country andprovides the largest number of hospice beds outside the NHS. Marie Curie is also a leading funder of palliativecare research to find better ways of caring for people with terminal illnesses.Responding to growing demand and unsustainable current provision costs across the Palliative care sector, MarieCurie and Palliative care as a whole, are keen to explore alternative future models such as 'Hospices WithoutWalls'; allowing for monitoring and support of patients in alternative and enhanced settings. Having conducted apreliminary study, Marie Curie is interested in further investigating robotics and human centred design. Primaryavenues include:A. Predicting needs and triggers for services[robotics: active and passive data capture]B. Monitoring and support of patients in alternative settings including home and care homes[robotics: wearable assistive robotics, social and therapeutic robotics, ambient care robotics]C. Enhancing the care for those who do access hospices directly[robotics: wearable assistive robotics, virtual and mixed reality robotics, ambient care robotics]3. Problem StatementMost hospices in the UK are cutting beds and other services, others are closing altogether. The major problem forthe hospice sector is that it is expensive and essentially unsustainable in current form, especially in the face of thegrowing demand described above. Alternative and enhanced scenarios of hospice care are needed with a keyfocus on 'improving independence', and 'redefining access'. Accordingly, two research questions are outlined,asking where and how could Robotics and Human centred design, help develop the concept of 'Hospice withoutWall':RQ1. How might we enable people to remain as independent as possible, for as long as possible, usingro