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Safeguarding the Vulnerable, Frail and Elderly in the Care setting

A few years ago, following successful conviction of two carers mistreating a resident at Oakfoss House Residential Care Home, Pontefract, a member of staff who beat an elderly lady in Ash Court Care Centre, Kentish Town, London, and those who were filmed by BBC who carried out a regime of abuse at the Winterbourne View care unit in Hambrook, near Bristol, I presented as the Safeguarding Adult Lead for NHS Leicester City CCG Board a paper to debate the use of CCTV monitoring in care and residential homes.

In the Ash Court case, the Care Quality Commission awarded the care home an ‘excellent’ rating just three months before the attacks. It was also claimed that a subsequent report, produced four months after the incidents, also failed to mention that charges were pending over the incidents, and both Ash Court and Oakfoss continue to operate. Only Winterbourne View has been closed.

In these cases, successful prosecutions were secured by CCTV. Understandably, there were calls for CCTV surveillance in every care home across the country to prevent abuse of the elderly and vulnerable.

No law exists that requires or prohibits CCTV cameras in nursing and care homes. Physical abuse, sexual abuse and theft are the most common forms of crimes, yet proving the acts have occurred is difficult. Indeed, many victims are not mentally or physically able to tell others about the abuse and others are afraid or feel as if they have no one who would receive their report as credible.

Campaign group NO CCTV said such a demand represented excessive use of surveillance cameras and degraded the quality of life for care home residents. CCTV would assuage the conscience of relatives. Devon and Cornwall Police said installing cameras and storing the footage would make it difficult to protect residents’ privacy.

Mental Welfare Commission (MWC) and Social Care and Social Work Improvement Scotland (SCSWIS) have been aware of the use of closed circuit television (CCTV) in a very small number of individuals’ rooms in a registered care facility.

According to Article 8 of the European Convention for Human Rights, the disproportionate use of CCTV is an intrusion into an individual’s privacy and dignity. The presence of a camera, whether or not it is activated, may be deemed a threat to individual privacy, while any such interference must be proportionate and lawful for a legitimate aim. It must only be undertaken where there is the proper legal authorisation in place, e.g. authorisation via a guardianship order with the specific power to use CCTV in respect of the individual’s welfare. My view is that the facility should be offered as an option with informed consent from the resident and next-of-kin, even if the resident has mental capacity, and that the facility should be withdrawn upon request by them.

MWC’s publication “Rights, Risks and Limits to Freedom” has guidance on general use. The Scottish Human Rights Commission “Care about Rights” resources also give some guidance on the human right to privacy which is at stake when CCTV is used. There may be limited situations where it can be helpful in communal areas of care facilities but this must be justified by, for example, the protection or safety of individuals, and be proportionate; that is to say the minimum necessary intrusion into the privacy of individuals. I believe, however, that these sources of guidance need to be updated and strengthened. Only cogent measures can reassure vulnerable residents and their families.

Although my proposal for CCTV is not intended as a blanket measure to observe people, the advantages in terms of protecting carers against false allegation and keeping residents safe cannot be overlooked. This is in principle no different from CCTV monitoring in cells at police stations where I worked as a Police Surgeon. Its introduction in a care home setting should form part of a planned programme of care, recorded and regularly reviewed by the service provider and multi-disciplinary team, and destroyed at regular intervals with mutual agreement between the management and the resident and family. The information gathered should only be viewed by named people trained in the legal obligations.

Nursing homes can protect patients and their own reputations by installing CCTV cameras. CCTV cameras can record interactions between the staff and the patient and the staff and the patient’s family. With this, nursing home abuse can be deterred or eliminated altogether. Most importantly, the abuser can be identified and prosecuted by using CCTV camera recordings as evidential proof.

Why are there no resignations from the CQC or Castlebeck who owned Winterbourne View? I heard the one main reason for this type of failure often. Lessons will be learned.

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