Carebnb and the law of unintended consequences

Carebnb and the law of unintended consequences

Along with the title: “NHS may rent spare rooms to ease bed crisis” The Guardian ran a story this week, on what it describes as an Airbnb style scheme designed to help alleviate pressure in the NHS, by enabling patients ready to be discharged from hospital to recuperate in a private home. The story, which was first featured in the Health Service Journal, was also covered by Roy Lilley in his regular blog where he raises a host of concerns about CareRooms including safeguarding, exploitation, safety, training and regulation. However, beyond the obvious concerns, he asks the more fundamental and interesting question:

“The real issue is not if CareRooms can be made to work safely.  The real issue is why are we even contemplating this? … Austerity is the mother of innovation and here is an innovative solution driven by the mother of all austerity.”

On its website, CareRooms offers hosts £50 per room per night, and the promise of up to £1000 a month, for providing a bedroom and three supplied microwave meals for a discharged patient. The website incorporates pictures of hotel style immaculate bedrooms along with a reassuring narrative: “We are working with the local health and care community to provide a safe, comfortable place for people to recuperate from hospital.” Co-founded by a doctor, CareRooms was conceived out of real struggles with shortages in social care, and makes a compelling case to solve what is a well-reported strain on the NHS. It has the support of the NHS clinical entrepreneur programme and I have no doubt it is positively intended. So if the concerns raised by Roy Lilley and others can be resolved, what’s the problem?

The problem is the law of unintended consequences and our ability to anticipate and mitigate them. The meta issue is whether, as tax paying citizens, we are signed up to a public sector disrupted by Silicon Valley style gig economy startups. I have previously blogged about the problematic aspects of the gig economy when applied to health and social care — balancing transactions with relationships; destabilising NHS services; and creating precarious working conditions for staff — to name a few. Problems with the gig economy in other sectors were highlighted in a recent BBC documentary about young people challenging Deliveroo on its employment practices; and the gleam of the sharing economy has similarly been dulled with Transport for London’s decision not to re-license Uber due to public safety and security concerns.

Digital innovation holds real promise for the NHS. However, it is tempting to be beguiled into its possibilities without thinking through the unintended consequences we may be sleep-walking into. This recent article about autonomous cars is an excellent piece that illustrates how embracing technology in the absence of carefully thought out policy can have disastrous effects.

As Lilley suggests, if austerity inspired lack of capacity in social care is the driver for the problem that CareRooms is endeavouring to address, then shouldn’t we be addressing the root cause rather than applying a sticking plaster? And if that sticking plaster appears to work, then isn’t there a danger that we start a flow of NHS and social care services to the gig economy that becomes impossible to stem?

Like it or not, the uberisation of healthcare is happening. In the same way that it is only now that we are beginning to wake up to the costs to civil society of the power of the big tech giants, we should be having an urgent conversation now about what this means for the NHS and social care.

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