CCTV for communal areas of care homes

Over the years, there have been a number of reported cases of abuse in care homes, sometimes exposed by secret filming. In particular, BBC Panorama’s Behind Closed Doors (2014) exposed cases of abuse, neglect and poor care. There have also been instances where individual families have secretly filmed inside care homes to expose poor practices and stealing from patients.

This has led to calls for better supervision of practices within care homes, including the use of CCTV. The Care Campaign for the Vulnerable has been campaigning for “safety monitoring to be made mandatory in communal areas in ALL dementia care homes across the UK.” Its website highlights the coverage of this campaign in the media.

In the 2015-17 session, an online petition to Install CCTV cameras in all care homes to protect the vulnerable people gained 12,896 signatures. In response, the Department of Health said:

The Government does not object to the use of CCTV cameras in care homes on a case by case basis. Care home owners should consult with and seek the consent of residents and their families on their use.

The abuse or neglect of vulnerable people is deplorable. The Government has strengthened the powers of the Care Quality Commission (CQC) to prosecute providers for unacceptable care, including abuse.

The Government recognises that cases of abuse and neglect have been exposed as the result of hidden cameras. We acknowledge that there are occasions when it may be appropriate for their use to be considered.

Closed circuit television (CCTV) should not be regarded as a substitute for proper recruitment procedures, training, management and support of care staff, or for ensuring that numbers of staff on duty are sufficient to meet the needs of users of services.

It is a legal requirement that care providers must ensure that the safety, welfare, privacy and dignity of service users at all times. The Government considers that the widespread introduction of CCTV into care homes would raise important concerns about residents’ privacy, as well as practicality.

The use of CCTV and other forms of covert surveillance should not be routine, but should be considered on a case by case basis. The Government does not object to the use of CCTV in individual care homes or by the families of residents, provided it is done in consultation with and with the permission of those residents and their families.

The CQC has published guidance for care homes and the families of residents on the issues that should be taken into account when deciding whether or not to use CCTV or other forms of covert surveillance. The guidance is available on CQC’s website at http://www.cqc.org.uk/content/using-surveillance-information-service-providers.

Care provision is often personal, even intimate in nature. Filming or recording the more than 400,000 people who live in care and nursing homes whilst they are receiving personal care – being bathed, helped to dress and eat, etc. - would represent a major intrusion into their privacy. For the great majority, whose care is good, such an intrusion could not be justified.

Care providers and members of the public, including care service users and their families, are free to decide whether or not to employ CCTV or covert monitoring. However, they should be aware of requirements, including legal protections, around ensuring the privacy and dignity of those who are being filmed/observed.

- Install CCTV cameras in all care homes to protect the vulnerable people, Online petition response, 25 May 2016

Current guidance

When asked whether they had assessed the potential of CCTV to tackle abuse in care homes, the Government said in February 2018:

No assessment has been made of the potential effect of installing CCTV cameras in care homes, however, we expect serious allegations of abuse and neglect to be thoroughly investigated and prosecutions to be brought where this is warranted.

The abuse of people who depend on care services is completely unacceptable, and we are determined to stamp it out.

That is why we introduced the new wilful neglect offence which came into force in April 2015.

We have made it clear, in statutory guidance to support implementation of the Care Act 2014, that we expect local authorities to ensure that the services they commission are safe, effective and of high quality. We also expect those providing the service, local authorities and the Care Quality Commission to take swift action where anyone alleges poor care, neglect or abuse.

- Written PQ 127916 [Care Homes: CCTV] 22 Feb 2018

In a previous answer to a parliamentary question, the current Government said that it:

believes strongly that closed circuit television (CCTV) should not be regarded as a substitute for proper recruitment procedures, training, management and support of care staff, or for ensuring that numbers of staff on duty are sufficient to meet the needs of users of services.

It is a legal requirement that care providers must ensure that the safety, welfare, privacy and dignity of service users at all times. The Government considers that the widespread introduction of CCTV into care homes would raise important concerns about privacy, as well as practicality.

The use of CCTV and other forms of covert surveillance should not be routine, but should be considered on a case by case basis. The Department does not object to the use of CCTV in individual care homes or by the families of residents, provided it is done in consultation with and with the permission of those residents and their families.

The CQC has published guidance for care homes and the families of residents on the issues that should be taken into account when deciding whether or not to use CCTV or other forms of covert surveillance.

- Written PQ 20518 [Care Homes: CCTV] 05 Jan 2016

The social care regulator for England, the Care Quality Commission (CQC), has published guidance on this matter entitled Using Surveillance (June 2015). It provides advice to providers of health and social care who are considering the use of CCTV in their working environments, but the CQC does not recommend that an institution should or should not use CCTV – rather, it states that providers should consider whether less intrusive surveillance could achieve the desired effect, before resorting to the use of cameras. The ‘key points’ of the guide are:

• Covert and overt surveillance can have legitimate uses. You should weigh their benefits against the impact on people’s privacy, and other issues set out in this document, in deciding whether to use them.
• The use of surveillance in places where people are receiving health and social care services is likely to raise greater privacy concerns than many other kinds of business – especially where the care service is also a place where people live.
• Wherever possible, providers should consult with the people who use their service, families, other regular visitors, trade unions and staff when deciding about whether and how to use surveillance.
• The guidance on conducting a Privacy Impact Assessment, produced by the Information Commissioner’s Office (Annex 1), is helpful for working through and recording privacy issues when considering surveillance.
• Transparency and openness are vital in order to meet legal requirements, and to maintain the trust of people who use services and of care staff. However, there may be limited circumstances where the legitimate use of covert surveillance prevents such openness for a short time.
• Providers must ensure that all staff (including contractors) involved in the use of surveillance systems are properly trained and supported to use them.
• The equipment used must be suitable, safe and properly maintained.
• Information obtained or recorded through the use of surveillance must be kept secure, and anyone with authorised access to that information must understand their legal responsibilities.
• Where people lack mental capacity to understand or consent to the use of surveillance, providers must make decisions in accordance with the statutory principles of the Mental Capacity Act 2005 […]
• […]
• You should document the steps you have taken when deciding to use surveillance, as evidence of these steps may be required by a CQC inspector.

The CQC also highlights that providers “must ensure that they (and anyone acting on their behalf) comply with the Data Protection Act 1998 [now replaced by the Data Protection Act 2018], and all other relevant legislation, at all times.” Other relevant legislation includes the Human Rights Act 1998 and the Regulation of Investigatory Powers Act 2000.

The CQC recommends that it might be pertinent to seek legal advice and gain guidance from the Information Commissioner’s Office and the Surveillance Camera Commissioner.

Comments

Pressure groups such as the Care Campaign for the Vulnerable see CCTV as an effective way of gathering evidence against negligent staff and ensuring that care workers are not falsely accused (as suggested in this Daily Express article). As Kevin Macnish, writing in The Conversation, suggests, the presence of CCTV is likely to act to some extent as a deterrent to abuse; studies have shown it to do so in other environments.

The idea, according to a study reported in the Times, is particularly popular amongst families of care home residents. Dominic Grieve MP has publicly offered his support for the campaign: talking to the Daily Express, he said,

Seeing potential problems that exist in care environments, the arguments in favour are very strong. I think this is achievable and could become law.

We have large numbers of vulnerable people in care homes and we want to provide them with proper standards of care. Incidents of them being abused are scandalous.

They are also criminal offences, so we have a strong incentive for trying to make sure it doesn't happen.

Other stakeholders and commentators have voiced concerns about mandatory CCTV. Issues of privacy have been raised, given that sensitive activities such as bathing and washing are carried out in care homes: indeed there are cases where residents have voted against the idea (as discussed in the Times). Some fear that the installation of CCTV will lead to a negative atmosphere amongst personnel; polls of staff show mixed feelings towards the notion (see for example survey results reported by The Conversation and the Guardian).

Kevin Macnish, writing in The Conversation, argues that although high profile, the shocking cases of abuse in care homes have only occurred in a small minority of institutions, so it does not seem to be worth the risk of increasing the feeling of distrust and vulnerability amongst staff and patients via CCTV.

Furthermore, it has been suggested by organisations such as Age UK that while CCTV might make it harder to people to abuse or take advantage of tenants, it will not make such actions impossible, and might provide “false reassurances”. Professionals, such as Dr Peter Carter (former Chief Executive of the Royal College of Nursing) has highlighted that CCTV will only pick up gratuitous cases of abuse, whereas more subtle cases of neglect will be harder to detect: better recruitment, training and managerial supervision of staff in this case would be better to monitor such behaviours.

These arguments are discussed in the articles below.

Press releases

Age UK comments on installation of CCTV in care homes

• Caroline Abrahams, Charity Director at Age UK, argues that CCTV might provide false assurances whilst also invading people’s privacy.

Independent Age's comments on this week's Panorama -Behind Closed Doors: Elderly Care Exposed, 20 April 2014

• Independent Age Chief Executive, Janet Morrison, believes that CCTV can help but should not be a routine part of care homes.

News articles

Former Attorney General backs campaign for CCTV in every care home, Care Home Professional, 18 May 2018

MP vows to get new law-making CCTV in care homes compulsory, Carehome.co.uk, 23 July 2018

Hope of law to put CCTV in all care homes, Daily Express, 23 July 2018

Daughter’s petition to get CCTV installed in all care homes reaches nearly 10,000, Metro, 7 January 2017

Why CCTV in care homes could cause more harm than good, Conversation, 25 February 2016

Nurses vote against covert filming in residential homes, Guardian, 22 June 2015

Covert filming 'should be banned from care homes as spycams puts nurses off', Telegraph, 22 June 2015

Residential care workers ‘relaxed’ about CCTV in care homes, Guardian, 12 February 2015

CCTV in care homes: secret cameras are not the way to improve care, Guardian, 8 October 2014

We don’t want secret cameras in care homes, say residents, Times, 7 October 2014

I wouldn’t send my granny to a home that relied on CCTV, Times, 1 May 2014

Care homes: CCTV 'could be considered', BBC News, 30 April 2014

• After a story of abuse is uncovered by a BBC Panorama probe, Norman Lamb, the then Care Minister, suggests using CCTV would be one tool to use. However he warned that it is not the way to create a “good culture and compassionate care.”

Private care homes: Only cameras in rooms will end patient abuse, Telegraph, 31 March 2014