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

By 2040, 160,000 more people in England and Wales will need palliative care, provided the current mortality trends
continue. 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 designed
technologically enhanced health and care solutions towards the end of life is inevitable. Hospices are one main
avenue for provision of palliative and end-of-life care. However, they are deemed expensive and essentially
unsustainable 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 novel
future 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 quick
identification of symptoms and mapping societal health, smart sensors to help with diagnostics, and tracking
patients' physical and mental wellbeing. Palliative & end-of-life care is delicately, and rather uniquely, positioned
on 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 major
challenges as well as unique opportunities for introduction of AI, particularly robotics. Major opportunities of
robotics in Palliative care include Assistive, Therapeutic, Social, and Educational uses. Additionally, there are
wider calls to reclaim and reimagine end-of-life as a 'human', rather than a mere 'medical' domain8. Hence, moving
to '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-art
Marie Curie is a registered charitable organisation in the United Kingdom, providing care and support for people
living with terminal illness and their families, since 1948. Marie Curie has nine hospices across the country and
provides the largest number of hospice beds outside the NHS. Marie Curie is also a leading funder of palliative
care 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, Marie
Curie and Palliative care as a whole, are keen to explore alternative future models such as 'Hospices Without
Walls'; allowing for monitoring and support of patients in alternative and enhanced settings. Having conducted a
preliminary study, Marie Curie is interested in further investigating robotics and human centred design. Primary
avenues 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 Statement
Most hospices in the UK are cutting beds and other services, others are closing altogether. The major problem for
the hospice sector is that it is expensive and essentially unsustainable in current form, especially in the face of the
growing demand described above. Alternative and enhanced scenarios of hospice care are needed with a key
focus 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 without
Wall':
RQ1. How might we enable people to remain as independent as possible, for as long as possible, using
ro