The installation of cameras in care homes to monitor patient care is a hotly debated topic. Until the issues of leadership, pay and training are tackled, this potential abuse prevention strategy will remain so, writes Paul Ridout

We need a debate about how to protect vulnerable people

We need a debate about how to protect vulnerable people

We need a debate about how to protect vulnerable people

The installation of CCTV within care homes has been hailed as both the best way to prevent abuse and an invasion of resident privacy.

Ridouts Solicitors and the Relatives and Residents Association hosted a joint symposium, on 10 July at the Royal Society of Medicine, to enable stakeholders from all areas of the health and social care sector to debate this important topic.

‘CCTV installation in care homes has been hailed the best way to prevent abuse and invade resident privacy’

Neil Grant, a partner at Ridouts Solicitors, opened the discussion with background of what is permissible under the current legal framework.

He said: “There are tensions, certainly, but it is not insurmountable. If there is a real justification, a real pressing need to interfere with article 8 - the right to a private life - then it is acceptable, but it must be proportionate and there are mechanisms and safeguards that can be applied to the use of these cameras. Data protection is a big issue to comply with.”

Need for a code of conduct

Chair of Four Seasons Health Care Ian Smith called for an industry wide debate on this topic and well informed guidance from the Care Quality Commission and the Department of Health.

“It is very important that we have a code of conduct,” he said.

“The biggest argument against the installation of CCTV is privacy. We need to ensure we preserve people’s human dignity and privacy and observe their human rights. Otherwise, we are failing in our duty of care.

‘I worry commissioners will latch on to CCTV as a quick way to quality’

“Proper training, leadership and the encouragement of whistleblowing are crucial tools in the prevention of abuse and have a powerful effect on the quality of care.”

Debbie Sorkin, national director of systems leadership at The Leadership Centre, argued that the commissioning landscape has changed enormously, with pressure on procurement now taking precedence.

She said: “When you have a plethora of different commissioners and not enough money in the system, you might get shortcuts and people looking for easy ways to demonstrate quality.

“My worry is that commissioners will latch on to CCTV as a quick way to quality, whereas we all know that is not the case.

“If we ingrain good leadership in behaviours, then I don’t see the need for cameras in the first place. You will be treating your staff as adults and empowering them with responsibility. Leadership is the issue here.”

A need for ‘covert surveillance’?

Deputy chief inspector of adult social care for the North region at the CQC Debbie Westhead summarised the CQC’s position.

“Covert surveillance is not a substitute for wider regulation and we have neither the desire nor the resources to use these services regularly,” she explained.

“However, we know that we have to get the right balance between protecting and respecting people, and ensuring our services are of a safe and high quality.

“There are some fantastic staff working in care homes - do they really want to be watched all day?

“We must ensure that we apply the required safeguards between protection and intrusion. The most invasive types of surveillance would require external authorisation. It’s a difficult balance and something CQC is continuing to consult on to establish how and if we should use these powers more widely in our regulatory approach.”

‘CCTV used openly could be a potential way to prevent poor care and crime’

Jane Worroll used covert CCTV to record her mother’s care handling when she suspected mistreatment. She now uses it openly to manage her mother’s care and argued in favour of CCTV in care homes.

She said: “In my case CCTV provided direct evidence for disciplinary action, prosecutions and dismissals. But more generally, it can be used for training purposes to show best practice and motivate improvement, as management supervision, especially at night when managers are usually absent and it protects staff from wrongful accusations.

“It can alleviate friends and relatives’ fears by providing evidence, which is very important. Many care home residents don’t have the ability to make a complaint due to cognitive impairment and if they can, they often don’t know how.

“We are in the 21st century with a wealth of technology available to us. CCTV would play a vital role in the care system and I think it should be given a trial run – not in a covert way, but openly, as a potential way to prevent poor care and crime.”

Address leadership, pay and training

The symposium brought many opinions to the fore, both in favour of installing CCTV and against.

There was discomfort at the suggestion that cameras would be used to “spy” on staff, but others countered this with the argument that cameras would not only protect patients but also protect innocent workers accused of wrongdoing and fundamentally, serve as a deterrent to those who would commit these crimes in the first instance.

There was a great deal of support for the majority of care workers who do a brilliant and important job in caring for our vulnerable.

‘We all want the same thing: safe, high quality, compassionate and effective care’

The general consensus suggested they are sometimes unable to perform to their highest capacity due to poor leadership and the pressure and stress of rotas, long working days and low pay.

Training was highlighted as an area in need of significant improvement so care staff can specialise, become qualified and see real benefit in their career choices with clear frameworks and opportunities for progression, all while being paid at least the living wage for the work they do.  

It was agreed that we all want the same thing: safe, high quality, compassionate and effective care.

But until the issues of leadership, pay and training are tackled, CCTV will remain firmly on the agenda as a possible tool to be used in the prevention of abuse.

Paul Ridout is a partner at RidoutsLLP and is an experienced adviser for the health and social care sector