Wednesday 16 October 2013

Caught on camera

CQC’s launch of their document ‘A fresh start for the regulation and inspection of adult social care’ has created a barrage of debate. Amongst the raft of changes and proposals to overhaul the inspection and regulation of care services for adults are some ideas that CQC want to discuss with the public, including the “Potential use of mystery shoppers and hidden cameras to monitor care”. Concerns have been raised about whether hidden cameras are ethical, if their use would be legal, and whether we even need them.

To begin to illustrate my views, I want to pose a scenario to you:

A man of 84 is living in a care home. He has advanced dementia, and requires all of his needs to be met by a skilled team of care professionals, assisted by his family. His family are not present 24 hours a day, so much of his care is provided by different care professionals. His family become concerned for his welfare when the ownership, management and staffing of the home changes . The home is frequently short-staffed and running on agency staff (who don’t even know who each resident is). The man becomes more frail, has more infections, begins to develop pressure sores and is being kept in bed more than normal. This is also true of other residents. The few remaining regular staff, including the man’s keyworker, express concerns about the way that they are being instructed to care for the man and how new staff are caring for him. The man is eventually admitted to hospital with pneumonia after aspirating on his own vomit five times. The hospital are so concerned about the condition of the man that they make him the subject of a safeguarding order. He never fully recovers from the pneumonia and passes away four weeks later, less than two weeks after his 85th birthday.

That man was my dad.

I repeatedly raised concerns about my father’s care with the care provider after the changes in ownership, management and staff. Eventually I had to resort to phoning CQC three times before they would take my complaint seriously. They inspected, but then took two months to produce a report. It was too late for my dad. His keyworker, a wonderful care professional who had diligently looked after my father for eight years, was as heartbroken by the way in which the care deteriorated as we were. Indeed that care professional, and his colleagues who had  assisted with looking after my dad for many years, found alternative employment and left the home: they simply could not stand to deliver care in the way that the management wanted it delivered.

On the night my father aspirated on his own vomit, we believe he was put to bed too early and given a milky drink in bed without being properly upright – all of those actions going directly against our wishes and the recommended advice for his care from doctors (the management made their own care plans without our consent). The doctors treating my father at the hospital didn’t believe he would pull through the night – aspirating on your own vomit is a bit like pouring acid into your lungs they said. Imagine how that felt.

We will never really know what happened that night, because despite asking the staff on duty, no one could explain. I dearly wish we had had a hidden camera in my father’s room that night, and indeed in the months leading up to that fatal incident. I know it would have proven the poor care my father was subjected to, and it would also have proven some of the good care people like his keyworker provided, often fighting against the management to do what was best for my dad.

Do I think cameras should be routinely installed into care homes? No I don’t. But potentially they do have a value in certain specific circumstances when there are grave concerns for a person’s welfare that only indisputable footage can prove. Currently surveillance is limited to the few families who have installed hidden cameras to prove that their relative is being abused, or places like Winterbourne View that needed Panorama cameras to expose the appalling treatment being meted out.

It must be remembered that some people don’t have a family to monitor their care. People with dementia, learning disabilities and other conditions cannot always articulate what is happening to them. Proving how injuries are sustained can sometimes be one person’s word against another’s. Poor care many only really come to light following a crisis point when a person is admitted to hospital in a condition that no amount of treatment can cure, or it many only become evident on investigation after death.

I want to pose another scenario to you:

A lady living with dementia in a care home, almost completely deaf and blind, begins to lose a dramatic amount of weight and is always thirsty when her family visit. The family suspect she isn’t being fed enough. They often find drinks that have been left out of her reach, and suspect that staff aren’t communicating with her appropriately. She eventually passes away at a weight that would be considered severely malnourished.

I knew this lady, and her family agonised over what happened to her – a camera would have given them answers, and potentially ensured she received better care.

Dignity, privacy and respect are all vital in any care setting, but there is nothing dignified or respectful about elder abuse or premature death from negligence that hides behind a veil of privacy. Such practices – that are in the minority - must be rooted out: they taint the vast majority of wonderful care that is being provided. A hidden camera can prove or disprove allegations and suspicions, and it could potentially work in many different ways. For example: It can prove that a care worker is acting inappropriately. It can prove when a provider is negligent in not giving their staff the equipment or training needed to perform a task or to keep a person safe. It can assist a care provider to root out poor practice that they suspect an individual employee of but need to prove. It can show if a person receiving care has had a harmless accident or is self-harming. It can provide evidence if a family are being abusive, either towards their own relative or towards staff (yes, it does happen).
Cameras could also be helpful in certain specific circumstances in people’s own homes, where they are receiving home care or care from a family member, friend or neighbour.
Consider this scenario:
Two elderly sisters live alone at home. A neighbour ‘befriends’ them. That neighbour manages to persuade them to sign a Power of Attorney and then gets control of all of their money. She tells them that they are now so poor they cannot afford heating. Professional carers often come in to find these ladies cold and hungry. One of the sisters develops hyperthermia. Eventually they end up in care, virtually penniless.
I knew these ladies – could a camera have helped them, and brought the person who prayed on them to justice?
Clearly there are huge ethical, moral and legal issues with the use of cameras in any setting, particularly if those cameras are hidden. Whether a policy allowing the use of hidden cameras in adult social care will ever be created and implemented isn’t yet decided – this is merely an idea that has been put into the public domain for debate. Personally I welcome healthy discussion on any proposal that could help to safeguard our most vulnerable people and stamp out elder abuse. I don’t believe sensitive use of such cameras in a minority of isolated cases would undermine the morale of social care professionals. In my mind, those who are providing good care have nothing to fear.
Until next time...
Beth x

You can follow me on Twitter: @bethyb1886


  1. Beth,

    First off, I'm very sorry to read about your personal experience with your father's appalling situation, and please accept my condolences on your loss.

    As a CCTV Advisor, I thought you might be interested to hear an independent view on what would or would not be perhaps a more appropriate response to the recent proposal, considering the installation of covert CCTV cameras in care homes across the country.

    Does the idea have merit?, well yes to a very limited degree, but perhaps more importantly, would installing surveillance cameras address the issues that are of most concern .... probably not.

    Unfortunately I only have a few minutes to post, so you'll have to forgive me if I rush through the few points which immediately spring to mind.

    The basic difference between using hidden covert cameras, and visible overt cameras, are that the former is specifically intended to identify and hopefully prove the extent of a suspected issue, and in so doing identify the individuals concerned. The latter is more often regarded as a deterrent, although in practice this aspect of using CCTV is actually far more complex than most people would believe.

    That said, if we consider the objectives, ideally we'd want a situation where dedicated 'professional' care workers are appreciated and not disadvantaged, and poor quality service providers are dissuaded from entering or working in the profession.

    Privacy and dignity for the patients are a given, so you'll forgive me if I don't dwell on that point for the moment.

    From a purely practical perspective, installing cameras extensively in a home would prove expensive to the service provider, and given there will always be locations that are not covered (toilets and bathing areas being an obvious example), there is still the potential for abuse to take place out of sight of the camera system.

    If hidden cameras are deployed, unless they are specifically being used for the investigation of possible abuse / criminality ( or journalistic investigation ) then there are specific (but not insurmountable) legal implications.

    Similarly there is the issue of oversight, given that unless the cameras are regularly monitored and recordings carefully reviewed, it's unlikely that the system would prove to be terribly effective in the longterm.

    As a more workable and lower cost alternative, I would propose that video equipped ID cards might be a more practical and acceptable alternative. The technology falls into the category of Body Worn Video (BWV), and in practice, provides highly dependable video and audio capture of all activity taking place immediately in front of the carer (as the name suggests the camera is secreted inside a lapel worn ID card).

    On the basis that recordings would only ever be reviewed where there are concerns over an individuals performance, I would imagine that the technology would be welcomed by dedicated professionals, and provide a very effective deterrent to undesirable workers, who wouldn't want to work wearing a camera in the first place.

    From a privacy perspective, there is no need to review recordings routinely unless specific issues are raised. Cost wise, it is far more affordable than a dedicated cabled system.

    Also from the carers point of view ( pun not intended ), the technology also provides an ideal mechanism for them to refute and disprove any potential allegations of poor care or abuse, particularly as the units are quite capable of recording to an evidential standard, for periods of up to eight hours.

    There's probably loads more I could waffle on about, but hopefully there's enough already to provide some food for thought.

    Doktor Jon - CCTV Advisor - London

  2. "using hidden covert cameras, and visible overt cameras, are that the former is specifically intended to identify and hopefully prove the extent of a suspected issue, and in so doing identify the individuals concerned". ---- I would have thought that by identifying the individual, would be the main objective of the exercise.. Just think - if the resort where the Mcanns (Madeline) were staying was equipped with CCTV.. they would now have known what had happened and with time would have moved forward with their lives.. no one wants to see harm to their loved ones..from a social perspective CCTV is one way of providing a visual into real life situations.

  3. As it happens Lorraine, according to very recent press reports, the resort was equipped with CCTV but unfortunately the recordings of the main suspect in Madeleine's abduction were automatically deleted, before detectives could recover the footage.

    Ideally, the main objective of our current deliberations should really be the most effective methods for preventing or deterring abuse in a caring environment, rather than having to deal with the consequences.

    On a practical note, most video recordings of abuse are generally captured using hidden camcorders ( or an equivalent ), rather than fixed CCTV cameras.

    If cameras were to be seriously considered as part of an effective abuse reduction or prevention strategy, then a workable and affordable approach would need to be very carefully considered, and that would almost certainly have to be optimised for each individual location.

    Apart from the ongoing spot use of hidden cameras to catch a suspect, the wider application of larger structured CCTV camera systems in care establishments across the country, is not something that I could readily foresee as happening anytime soon.

    Doktor Jon - CCTV Advisor - London