Carnegie UK Trust – Written Evidence (LOL0096)
The Carnegie UK Trust welcomes the COVID-19 Committee Inquiry into the long-term impact on wellbeing of living online.
We were grateful for the opportunity to provide oral evidence to the Inquiry, particularly focusing on the foundational question of digital inclusion. We are now pleased to submit additional written evidence, to respond to a number of the wider issues that the Committee is exploring. We have responded to the questions in the Call for Evidence where we have specific pieces of evidence or perspectives to contribute.
The Trust was established in 1913 by the Scottish-American philanthropist Andrew Carnegie, with a remit to improve the wellbeing of people in the UK and Ireland. The organisation has worked on many different aspects of wellbeing over the past 100 years. Today, we understand wellbeing to mean that everyone should have what they need to live well now and in the future. We adopt a multi-dimensional ‘SEED’ approach to wellbeing, that gives equal weight to social, economic, environmental and democratic outcomes. In addition, we understand that wellbeing exists at different levels or layers: personal, community and societal.
Our response to the Inquiry is situated within this overall framework for understanding wellbeing.
The importance of digital inclusion
Our response is also underpinned by our assessment that tackling digital exclusion is of foundational importance to each of the issues being explored by the Committee through the Inquiry.
Our work with Ipsos MORI has highlighted the significant correlation between digital exclusion and social exclusion. Tackling digital exclusion is fundamental to ensuring that the long-term impact of increased reliance on digital technology has a positive impact on wellbeing, for individuals, communities and society. If digital exclusion is not tackled effectively then technology will continue to deepen inequalities, with negative wellbeing consequences for all.
Digital exclusion is a complex and multi-dimensional issue. It requires action to tackle challenges such as access to the appropriate devices, affordable connectivity and support to help people develop the skills, motivation and confidence to navigate the digital world safely and effectively. We encourage action to tackle digital exclusion that is co-produced with those who have lived experience of digital exclusion; and with those groups and organisations which have deep experience of supporting those who are digitally excluded. This action should recognise the need for both for specific digital interventions but also how systemic issues, including poverty, contribute to (and are exacerbated by) digital exclusion.
The skills and connectivity that people will require to be truly digitally included will continue to develop and change over time. We therefore need an approach which recognises that action to prevent and tackle digital exclusion is likely to be required for the long-term. If this is to be achieved, a cross-government commitment to this agenda is required, alongside effective collaboration between national and local government, and a high degree of engagement and innovation across civil society and the business community.
We encourage the Committee to consider this overall context as it carries out its work.
There are a number of potential physical health benefits that increased use of digital technology may help to support. For example:
However, medical professionals who participated in our ‘The courage to be kind’ research also highlighted wellbeing risks in increasing reliance on technology. This is particularly the case if technology is operationalised with a primary goal of improving efficiency. We heard in the research how during the pandemic a lack of human connection with health professionals has had a negative wellbeing impact for some patients. We also heard how doctors found that they were less able to identify other issues or difficulties that a patient might be experiencing, as telephone or virtual consultation led to a tendency to focus on the specific health problem being presented, rather than the whole person.
The research also highlighted that a lack of in-person care during the COVID-10 lockdown had implications for the wellbeing of health care practitioners themselves. They told us of the emotional toll of feeling that they worked in an ‘unkind’ environment, unable to provide the type or nature of care that they would like.
Our study on digital inclusion and health services in Wales (2018) also highlighted challenges in the greater reliance on technology to deliver health services in future. In particular, it noted that people with long-term conditions, who account for a very significant proportion of GP, in- and out-patient appointments, are the least likely to be digitally included. Therefore, unless digital exclusion is tackled, increasing the provision of digital health services will not reach those who could benefit the most; and will not bring the greatest benefit to the service.
The same report also noted other potential risks with increased reliance on technology in health services. These include the proliferation of ‘fake news’ and poor quality health information online. They also include the harmful content and public health risks that people may be increasingly exposed to online. For example, the report highlights the Chief Medical Officer for Wales Annual Report for 2016-17, which focuses on gambling-related harm, and the rapid rise of online gambling, as an emerging public health issue. We say more about these issues later in our response.
Mental health and Social Interaction
The Trust has worked on the concept of ‘radical kindness’ for a number of years. Through this work we have highlighted the importance of relationships to wellbeing, including the critical role of physical places in providing spaces for people to ‘bump into’ each other. These informal encounters offer opportunities to build belonging, connections and allow for the possibility of relational help and support.
During the COVID-19 pandemic, many of these physical spaces and opportunities for connection have temporarily been lost. We have undertaken a number of studies to examine the impact of the COVID-19 pandemic and the radically different context it has created, with reduced communal physical space. This includes: our COVID and Communities Listening Project, which explored how organisations and communities across the UK adapted and responded to the emergency phase of the COVID-19 pandemic; and our Making a Difference study into how UK public library services have responded to the pandemic.
In both of these studies, digital technology emerged as a positive factor, which helped to mitigate some of the effects of the pandemic and provided opportunities for services and communities to maintain connections during an extremely difficult period.
However, both studies also highlighted the limitations of digital technology in delivering truly relational services. Encounters between people were diminished in both scope and time. Engagements were more transactional, focused on the specific activity or aspect of service delivery in question, with limited opportunity for wider engagement, conversation and relationship building. This has implications for both social interaction and mental health.
Looking to the future, it is clear that there is considerable potential for greater use of technology in a wide range of settings, and there is significant learning to be drawn from the delivery models deployed during the pandemic about how this can be done most effectively. However, we are concerned that because technology provided a reasonable substitute during the emergency phase of COVID-19, there is likely to be pressure in many settings, driven by the need for cost savings, to permanently close or reduce physical services and replace these with more widespread digital provision. We are concerned that this trend, if it plays out, will have a number of negative implications for wellbeing, in terms of reduced social interaction, poorer mental health, narrower service provision and greater inequality experienced by those who are digitally excluded.
We also want to raise caution around the assumed cost savings of moving services online. Since the pandemic we have been convening a number of youth organisations around the topic digital exclusion, many of whom raised concerns about the ‘unseen’ costs of developing, facilitating and maintaining services online. This is echoed in a recent project case study. Added to this, many practitioners have spoken with us about the challenge of transitioning back to face-to-face service provision and how to manage in-person and digital channels concurrently (now that an online service many be expected by or necessary for some their users). There is apprehension that in the medium to long term, services will be required to deliver more with less funding.
To mitigate these risks, we would encourage the Committee to consider how the right balance or blend can be struck between greater use of technology and the maintenance of vital face-to-face physical interaction.
We can see evidence of how such a balance may be achieved through previous studies that the Trust has undertaken. For example, our Living Digitally (2018) study, referenced above, identified improvements in average life satisfaction and subjective happiness scores amongst housing and care customers using a new technology system. There was also a reduction in the number of customers reporting feelings of boredom; and in the number of customers reporting feelings of anxiety, following the introduction of this new system. Crucially, however, in this setting the technology did not encourage isolation amongst residents, but often provided a focal point for shared interests and purpose that brought people together. In a separate study, in Glasgow (2019), with young people who did not have access to internet-based TV, we identified how digital exclusion may inhibit social interaction, as a lack of access to these services meant that young people missed out on conversations regarding online content that they had been unable to watch.
It is well established that digital technology has radically altered the UK labour market, and the relationship between work and wellbeing, over the past 25 years, long before the COVID-19 pandemic.
From our prior work in this field, we would highlight the following points to the Committee:
Reflecting these points, we would encourage the Committee to promote actions to support improved, more sophisticated decision-making processes around technology deployment across the labour market, which give due consideration to the multi-dimensional impact of these decisions on work and wellbeing.
The COVID-19 pandemic has, of course, accelerated a number of aspects of the relationship between work and technology. Our Good Work for Wellbeing in the Coronavirus Economy report examines the impact of the pandemic on the UK labour market and considers the medium-term implications for the future of work, including how technology has affected the nature of work during the crisis. We have also undertaken work with a number of frontline service providers, to capture their stories of delivering services during the pandemic and a number of their reflections also highlight key issues around digital technology.
We would draw the Committee’s attention to the following key points from our work:
We also want to highlight that greater use of digital technology cannot, in many circumstances, overcome other basic skills issues essential to most employment, including English language, literacy and numeracy. The crisis has served to both shine a light on existing digital inequalities and further exacerbate many issues within these, including English literacy and language challenges being intensified in digital-only support contexts.
Finally, we would highlight, that in relation to the geographical consequences of increased reliance on digital technology, this may present an opportunity to improve wellbeing across towns in the UK. However, further action is likely to be required to help facilitate this shift, not least a shift of greater powers and resources to local areas and improved digital connectivity in a range of settings.
Ownership of digital technology
Drawing on evidence from across a number of our projects we offer the following comments on the relationship between the ownership of technology and wellbeing:
Should digital technology companies have a duty to consider their users’ wellbeing? If so, what would that duty consist of and how would it be regulated?
A duty to consider the wellbeing of users should be seen as an integral part of digital technology companies’ duty of care to protect those users from harm.
We have been working since 2018 on a proposal for a statutory duty of care to reduce online harm. This work has influenced the recommendations of a number of Parliamentary Committees, civil society organisations and advisory bodies. Those with most relevance for this Committee’s deliberations include the Commons Science and Technology Committee inquiry into the impact of social media and screen use on young people’s health; the DCMS Select Committee’s inquiry into Immersive and Addictive Technology; and the UK Chief Medical Officers’ recommendations on screen time. It has also been adopted – in part – by the Government in its development of its Online Harms proposals, although we await the final proposals before the end of this year.
Our proposal is for social media companies to design and run safer systems – not for government to regulate individual pieces of content. Companies should take reasonable steps to prevent reasonably foreseeable harms that occur in the operation of their services, enforced by a regulator. Our work draws on well-established legal concepts to set out a statutory duty of care backed by an independent regulator, with measuring, reporting and transparency obligations on the companies. An orientation towards the outcome (harm reduction) makes this approach futureproof and necessarily systemic. We propose that, as in health and safety regulation, companies should run their systems in a proportionate, risk-based manner to reduce reasonably foreseeable harm.
Prevention of harm to children is at the heart of the focus on online harms. In respect of children, risk assessments and mitigation measures under a statutory duty of care should include a wide range of measures, including whether children should be allowed to use them at all. The celebrated ‘move fast and break things’ method has had its day. Broadcast regulation demonstrates that a skilled regulator can work to assess harm in context, regulate it and balance this with maintaining free speech. Proportionality in regulation allows for innovation and market entry by SMEs. Indeed, there is a significant market opportunity around competing on wellbeing and the development of safety tech, as DCMS has recently recognised.
We have published a draft Online Harm Reduction Bill to demonstrate that such a regime could be legislated for in quite a simple way. We dovetail online harms into an existing, proven regulatory regime (the Communications Act 2003). We are also supporting Lord McNally on his Online Harm Reduction Regulator (Report) Bill – a short paving Bill that would give powers to Ofcom to prepare for the introduction of an online harms regime – and await a date for its Second Reading in the Lords.
The Covid19 pandemic and subsequent lockdown have seen the increased prevalence of online harms, whether through an increase in child abuse and grooming online, large volumes of scams and fraud, rising levels of online abuse targeted at minority groups and the spread of conspiracy theories and disinformation, which has led to real world harms (such as the destruction of 5G masts) and an increase in anti-vaccine sentiment. The latter – as we set out in two recent blog posts – is a significant risk to public health as we look to large-scale vaccine deployment as a route out of the pandemic.
Had a systemic statutory duty of care already been in place prior to the pandemic, it would have required social media companies to be accountable for the design of their platforms and the actions taken to limit the spread and reach of these harms. The Covid 19 Committee is right to look at how regulation might enshrine a duty on digital technology companies to protect users’ wellbeing. This should not stand in the way – indeed it could be incorporated into – the more pressing priority to ensure that robust, systemic and proportionate Online Harms legislation is introduced as soon as possible.
 Our proposal has been developed through a series of blog posts, roundtables and submissions to Parliamentary and other consultations and the detailed proposal is set out here in our Full Reference Paper of April 2019: https://d1ssu070pg2v9i.cloudfront.net/pex/carnegie_uk_trust/2019/04/08091652/Online-harm-reduction-a-statutory-duty-of-care-and-regulator.pdf
 For example: the Digital, Culture, Media and Sport Committee, the Lords Communications Committee, the APPG on Social Media and Young People and the Labour Party have all recommended a duty of care, along with the NSPCC, the Children’s Commissioner, the UK Chief Medical Officers, and the Centre for Data Ethics and Innovation. The House of Lords debate on the Online Harms White Paper was significant for the level of agreement on the regulatory way forward
 Our submission to the Commons Science and Technology inquiry is here: https://d1ssu070pg2v9i.cloudfront.net/pex/carnegie_uk_trust/2018/11/13162510/Impact-of-social-media-and-screen-use-on-young-peoples-health1.pdf; their final report is here: https://publications.parliament.uk/pa/cm201719/cmselect/cmsctech/822/82202.htm
Our submission to the DCMS Select Committee inquiry is here: https://d1ssu070pg2v9i.cloudfront.net/pex/carnegie_uk_trust/2019/01/25150207/DCMS-Select-Committee-Immersive-and-Addictive-Technologies.pdf; and their report is here: https://www.parliament.uk/business/committees/committees-a-z/commons-select/digital-culture-media-and-sport-committee/news/immersive-technology-report-17-19/
 https://www.carnegieuktrust.org.uk/blog/regulation-misinformation-and-covid19/ (April 2020) and https://www.carnegieuktrust.org.uk/blog/addressing-the-infodemic-through-a-focus-on-online-system-design/ (October 2020)
11 December 2020