Under surveillance: how cameras improved a care home's practice
Filming vulnerable people in healthcare settings is controversial, but a Birmingham care home has found surveillance cameras protect residents and staff.
Filming vulnerable people in healthcare settings is controversial, but a Birmingham care home has found surveillance cameras protect residents and staff
When the owner of Bramley Court in Birmingham mooted the idea of installing surveillance cameras inside the care home, manager and nurse Ann Willey was unenthusiastic. 'It felt like Big Brother was watching you,' she says. But then she considered how cameras might reduce the risk of poor practice and the potential benefits for vulnerable residents. After meetings were held with the residents, their families and staff to discuss any concerns, 120 cameras were set up in June 2015.
'We reassured them that it wasn't snooping,' says Ms Willey. 'It's more about providing care of the highest standard, where residents are safe and free from harm. It isn't just preventing abuse, but falls too.'
Just eight of the home's 76 residents have capacity to make decisions about their care and treatment. After one-to-one meetings, all eight agreed they would have the cameras switched on in their private rooms, although three said that they didn't want to be recorded during episodes of personal care. 'We made certain that they understood exactly what they were agreeing to,' says Ms Willey.
For those with dementia or lacking capacity, the home made applications under the deprivation of liberty safeguards (DoLS), even in cases where family members with a lasting power of attorney had agreed to the plans. DoLS applies to care homes and hospitals in England and Wales, protecting the rights of those whose liberty is deprived as they lack capacity to consent.
So far, every application made under DoLS to use the cameras in these residents' rooms has been rejected. For now at least, cameras must be switched off in their rooms, although they remain on in communal areas. 'We still believe it's in each of these patient's best interests,' says Ms Willey. 'If I didn't think it was necessary, I wouldn't ask for it.'
This refusal also applied to cases involving residents with a repeated history of falling, where family members and the home had set up cameras to alert staff when the person sat up in bed. During the month in which the cameras were used there were no falls involving these residents, but the application to continue the surveillance was still turned down. Ms Willey believes it is an issue that may have to be resolved by the Court of Protection, which makes decisions on financial and welfare matters for those who lack mental capacity.
The cameras record data that is securely stored offsite, with privacy settings allowing any agreed zones or areas of view to be blocked. Staff don't know which cameras are switched on or off, with the system administered solely by the manager.
A team of experienced health and social care professionals, employed by the installation company Care Protect, remotely monitor the film and audio footage, providing regular reports. This includes highlighting incidents of poor practice.
Reporting began in November 2015. Initially, Ms Willey was receiving 15 to 20 incident reports each month; now she receives just one or two. 'The quality of care has definitely improved as a result,' she says. 'Staff wouldn't dream of cutting corners now.' Among the benefits has been tackling unsafe drag lifts. 'I think we’ve eradicated these completely,' says Ms Willey. 'Every time they have been picked up, we've been able to show the person what they're doing wrong and provide training.'
The reports don't just focus on the negative, but identify examples of good practice too. 'When the weather was warm, the report said they could see the home was trying hard to keep residents cool and hydrated by using fans, opening windows and providing regular drinks,' she says.
Protection for staff
Staff also feel better protected through the use of the cameras, says Ms Willey. 'If there is any conflict, I can go back and find out exactly what happened, and it's not all "he said, she said". I no longer feel like I am making a decision on the basis of limited information.'
In some significant instances, where residents have fallen and injured themselves, the home has been able to show that staff could not have prevented what happened. 'We've been able to resolve issues straight away, so the family's confidence in the home hasn't been knocked,' says Ms Willey.
As part of her work as an executive officer of the Institute of Ageing and Health, Nottingham University associate professor Ruth Pearce has carried out a literature search on surveillance.She found evidence that some people will accept a form of surveillance, such as telehealth, if it helps them stay in their own homes and avoid unnecessary hospital admissions. But the use of surveillance technologies in residential care for vulnerable people generates considerable ethical debate, mostly around the moral acceptability of the practice.
‘Surveillance can be used to support those who are cognitively impaired, but they are the least likely to be able to understand and consent to it,’ says Dr Pearce. ‘Some nurses welcome it because they think it will save them from any accusations of abuse, protecting them from litigation,’ she adds.
Ms Willey says that of the 87 staff at Bramley Court, 13 of whom are nurses, only one has left because the cameras made them feel uncomfortable.
So does the need to protect people from abuse outweigh the right to privacy? Ms Willey takes a pragmatic approach. ‘My feeling is that the system is a deterrent,’ she says. ‘The most vulnerable people are at the mercy of staff who are looking after them.’
'Eyes and ears'
For Gillian Lee's mother, Joan, things began to go wrong shortly after she changed rooms at the Old Deanery care home in Braintree, Essex, to get better access to a shower. 'We have an extremely close relationship and I knew in my gut that something was wrong,' recalls Ms Lee. 'Mum’s personality changed and she started to be aggressive. Everyone put it down to dementia, but I knew it was something else.'
She was right. Her mother was being abused by care staff - abuse that was uncovered by the BBC's Panorama programme, which had been covertly filming repeated incidents at the home. The programme showed Joan being slapped. 'There are no words for how I felt when I saw it,' says Ms Lee. In February 2016, three care workers were jailed for the assaults. 'I'd like to see all care homes having surveillance cameras,' she says. 'Even if you're a good manager, you can't have eyes everywhere. This is just another tool for the bag.'
She dismisses the idea that the use of cameras in healthcare settings risks crossing the line from safeguarding to voyeurism. ‘Ask yourself what’s worse: a person being harmed or someone seeing it,’ says Ms Lee. ‘If we can't trust ourselves to do the job properly, then we can trust what we see and hear with our eyes and ears.'
Lynne Pearce is a freelance health writer