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28th February 2022

Is there a role for remote surveillance in care settings?

Several recent abuse scandals in the social care sector have ignited the debate as to whether CCTV cameras should be installed in residential, domiciliary and supported living settings. The CQC has published guidance and some of the larger residential providers such as HC One, offer surveillance technology in their services to those who want it.

In this article, Barry Price, QCS Specialist Contributor who has more than 15 years’ experience of management in social care settings, explores whether CCTV – in any form - really is the answer.

The issue of installing CCTV is an emotive one. Many justify the need for surveillance by referencing recent scandals in the media that have exposed cases of neglect. The latest is the appalling story of a 99-year-old woman in Blackpool who’s family installed a secret device - and then watched in horror as she was raped in her own home by her carer, who was given a life sentence.

But I believe that providers, service users and their families, and employees need to seriously consider how their use may impact privacy and dignity concerns of residents, as well as the behaviour of care staff, in the search for a solution in this debate.

Many campaigning for legislation for mandatory use of CCTV cameras in care homes argue they are essential to provide reassurance for families and to avoid the worst cases of abuse. On the other side of the debate, many believe that compulsory adoption is a step too far, and their use should be an exception to the rule.

An industry survey in July 2019* found that nearly one third of care staff support the use of cameras in both the communal areas and bedrooms of residential settings. Having worked in care homes for much of my career, I believe that they are useful in providing staff reassurance and protection, on top of the obvious peace of mind gained by families and their loved ones.

But placing surveillance systems in public areas is one thing. Having mandatory CCTV in bedrooms is quite another story as the privacy of residents is compromised. There will always be some family members who are worried about a loved one being adequately cared for and who install secret cameras. Where people have these concerns, I fully support this action.

This is allowed as long as they have genuine concerns, and they follow certain procedures and guidance from the CQC. The same applies to placing hidden cameras in domiciliary care settings. It’s worth noting that with some of the remote monitoring systems available, families can use a phone app to watch and talk with their loved ones live from anywhere at any time.

But for me the point is if we are going to install CCTV, we need to be clear what is it for. If providers and family members believe there is a problem with staff not doing the right thing, and they suspect maltreatment issues (in the very rare event it happens) then that is a very different story. Providers then have a much bigger issue to address.

In that case, providers and managers need to take responsibility by ensuring strict guidelines are followed in terms of safe recruitment, hiring qualified staff, and observing behaviour while at work. They have to take a strong leadership role in promoting a positive, open culture within the setting, while demonstrating best practices which are the norm, not the exception.

For me the whole debate of CCTV is an all or nothing argument. If you don't have it in every single part of the care setting then there's no place for it. It’s either everywhere and it's monitored properly in line with the Information Commissioner's Office (ICO) and UK GDPR regulations to protect people's dignity and privacy. Or it’s nowhere.

That’s because if you have CCTV in corridors, dining areas and communal lounges, any bad behaviour will go behind closed doors, to areas where there is no surveillance, and that's the biggest concern for me.

In terms of the benefit of putting it in all service-user, resident-accessible areas, it would provide reassurance all round. Staff would know that they've got back up if something went wrong. If there was an incident where a resident reacted in a violent way, for example, investigations would be more credible as there would be a video evidence trail, something tangible you can look at. It would provide peace of mind for residents’ family and friends who can see for themselves that their loved one is being taken good care of.

It can also be a robust monitoring tool. For example, if a person kept falling out of bed, the cameras might explain what the cause was – and the issue could be resolved. The same applies to trips, slips and falls in public spaces. Where there is CCTV, improvements can be made to the layout in response to incidents, and future occurances would be less likely to occur as a result of remedial action taken.

It can also make residents feel more secure, knowing that if they did have an accident, someone would come immediately. If the carers are watching the residents remotely on CCTV screens, there would be no need to enter the room to check on the resident, which can disturb sleep.

The major challenge is how do you then make it palatable in bedrooms and bathrooms to protect the privacy and dignity of the resident? What safeguards are in place and who can view the recordings? How do you monitor them, how do you control the data and how long do you keep it for? Providers would need tightly governed policies procedures in place to answer these questions.

There are guidelines that QCS lists on its system. The ICO provides specific guidance on what you can use CCTV for because it's classed as person identifiable data. UK GDPR regulations need to be observed.

A provider can’t just say that they are going to put CCTV in place, 24 hours a day, 365 days a year. They need to consult with all their staff, and with all service users and their families. If a provider put cameras in in all the rooms, they would have to define who will monitor them.

Moreover, a factor that is often overlooked is that there are significant costs involved. These include the camera system and TV monitors, maintenance, and enough trained staff to monitor footage day and night. Many residential care homes won’t be able to afford to pay. And it’s a fallacy that the more CCTV cameras you have installed, the fewer staff you need.  Surveillance is no substitute for excellent person-centred care and a friendly face.

So, to conclude then, all concerned have to think seriously about what they want to achieve from installing remote surveillance systems. Is it about reassurance or is there a bigger maltreatment issue? Is the plan just to have it in public areas? If cameras aren’t installed everywhere, how do you stop bad behaviour going into unmonitored areas?  How will providers pay for it? How do you protect the dignity and privacy of the individuals concerned? What are the consequences? There are many questions to answer.

It's an important issue, one that is not going to go away.

For QCS customers carrying out developmental research, the following policies and guidelines are essential reading:

  • Use of CCTV and hidden cameras policy
  • Care planning
  • UK GDPR, Data Protection policies and procedures
  • Mental Capacity Act policies and procedures

*Carehome UK survey link

*All information is correct at the time of publishing. Use of this material is subject to your acceptance of our terms and conditions.

Barry Price

Specialist in Adults with Learning Disabilities and Complex Needs

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