‘Deep concern’ over high-tech system that allows ‘covert surveillance’ of service-users

An NHS trust has been asked why it introduced a new high-tech system that allows staff to carry out video monitoring of mental health service-users in their bedrooms while they are sleeping, without securing their consent.

The actions of Camden and Islington NHS Foundation Trust (CINFT) on one of its women’s wards have sparked fresh concerns about the use of covert surveillance by mental health service-providers.

The Oxevision monitoring system is being used by an increasing number of NHS trusts across the country to monitor patients’ vital signs and behaviour using an optical sensor.

But the system also allows round-the-clock video surveillance of the service-user’s bedroom.

The concerns about Oxevision have been raised by a group of mental health service-users in Camden, north London, after the alarm was raise by one of their members, who had spent time on the ward.

She told fellow members of Camden Borough User Group (CBUG) at a meeting that she initially had no idea that she was being recorded on video while she slept.

The meeting – attended by CINFT’s medical director – heard that the trust had consulted with a small number of service-users before introducing Oxevision, but that it had failed to warn them about the video feed.

The trust also failed to mention in the information leaflet and poster that it issued to service-users that the video footage would be recorded.

Following the concerns raised by CBUG, the pilot scheme has been put on hold in the CINFT ward.

But there are concerns that some of the many other mental health trusts that use Oxevision may also have failed to secure consent for the video element of the system.

The Oxevision system allows staff to keep track of the service-user’s pulse and breathing rate, if they are trying to leave their bed, or if someone else has unexpectedly entered their room.

But the system also includes a live video-feed of the patient, which is recorded and kept for 24 hours before being deleted, although Oxehealth says staff can only access up to 15 seconds of live video-feed at a time and only during a “vital signs observation”.

In a statement, CBUG said it had “many concerns about the safety and ethics of this system” and was particularly concerned about the implications for the “sexual safety” of service-users.

CBUG said it was concerned that Oxevision was installed on one of the trust’s wards as a pilot without key local service-user groups being made aware of it.

It added: “The patient information leaflet and poster contained no mention of the 24/7 video recording of the room and the few patients that were originally consulted about the pilot of Oxevision did not know about the video recording element of it.

“As far as we are aware, consent was not consistently obtained from patients, who were being covertly recorded as part of this pilot programme on the ward.”

Disability News Service (DNS) understands that although some CBUG members are supportive of the Oxevision scheme – including the video element – because it can mean being interrupted less often by staff at night, others are strongly opposed to the idea of video surveillance.

The National Survivor User Network (NSUN) said it shared CBUG’s serious concerns and said the lack of transparency about video monitoring was “deeply concerning” and that such covert surveillance was “not a shortcut to patient safety”.

Mary Sadid, policy officer at NSUN, said: “Surveillance is a restrictive practice and its use demands serious scrutiny.”

She said NSUN was particularly concerned that Oxevision, and its surveillance methods, were being promoted as part of the NHS Innovation Accelerator, the same programme that supported the controversial Serenity Integrated Mentoring (SIM) scheme.

Sadid said: “Blanket surveillance is never okay, and especially not as a solution to inadequate staffing levels.

“Whilst some service users may experience positive outcomes as a result of surveillance-based monitoring, this can never justify non-consensual 24/7 blanket surveillance.

“Consent needs to be specific, individual, informed and ongoing.”

She pointed out that the Care Quality Commission does not authorise the use of what it calls “covert intrusive surveillance”.

She added: “It should not be down to service-users to ensure their rights and safety are upheld by care-providers, as we saw with the StopSIM campaign.

“Oxevision is part of a wider trend in securitisation of health.

“Along with increased policing presence in mental health and practices like the use of body-worn cameras by care staff, we are seeing ethically questionable practices that may be sources of harm introduced under the guise of safety.”

NSUN has already submitted evidence to the ongoing inquiry by parliament’s joint committee on human rights into protecting human rights in care settings.

In its submission, NSUN mentions its concerns about Oxevision, warns that it is “increasingly hearing of blanket 24-hour surveillance in mental health settings including in patient rooms”, and says that it is “concerned that surveillance may be used in lieu of adequate and safe staffing levels”.

Camden and Islington NHS Foundation Trust had failed to comment on the concerns by noon today (Thursday).

Oxevision was devised by Oxehealth, a company founded by Professor Lionel Tarassenko, former head of engineering at the University of Oxford.

Oxehealth claims that its monitoring system is now used by a third of English mental health trusts as well as “acute hospitals, care homes, skilled nursing facilities, prisons and police forces in the UK and Europe”.

The company says its system “delivers a secure on demand video feed” and provides staff with “a wider range of clinically validated early warning signs and risk factors than any other technology plus the ability to check the patient visually before choosing their intervention”.

But it is not yet clear whether other trusts have secured the permission of service-users for 24-7 video recording of their bedrooms.

An Oxehealth spokesperson said that its live video feed was “not surveillance” as it can only be accessed for 15 seconds at a time, and that Oxehealth continued to support CINFT while the trust engaged with service-user groups on the concerns raised by CBUG.

He told DNS he was not aware of other trusts where similar concerns had been raised.

He said: “We know that the privacy and dignity of any person encountering Oxevision is… critically important to them, their carers and their healthcare providers.

“Promoting and protecting privacy and dignity is a fundamental design principle for us and has informed every system design decision we have made.

“There are also strict data privacy processes in place with all the healthcare providers we partner with to safeguard this.”

But he said it would not be appropriate to tell trusts to secure consent for filming service-users while they sleep, as this was “a clinical and governance matter”.

He added: “We are actively reviewing the materials we share with healthcare providers to help ensure that they have the most up-to-date versions, and are continuing to improve the accessibility of our own materials that service users may choose to access.”

He pointed to a “patient experience report” which states that eight out of 10 patients experienced a better sense of safety and seven out of 10 believed they got a better night’s sleep after Oxevision was installed, while one study showed a 22 per cent reduction in self-harm in bedrooms and a 26 per cent reduction in assaults in bedrooms in one mental health centre.

DNS has so far contacted one other NHS trust that has introduced Oxevision, Rotherham Doncaster and South Humber NHS Foundation Trust (RDaSH), which has installed it in 170 bedrooms.

The trust had not clarified by noon today whether service-users were told in advance about the video element of the Oxevision system or that video images would be recorded.

An RDaSH spokesperson said the system was a “support tool for clinicians for patient care, rather than a CCTV system used for the purposes of surveillance” and used a camera plus infrared illumination rather than being a “live video feed CCTV system”.

RDaSH claims that it carried out “appropriate risk assessments” in line with “trust, data security and individuals’ rights prior to installation and use of the system”.

She said: “The system was and is introduced to patients via patient group meetings on the ward and an information sheet is displayed and provided to patients.

“This is further discussed during the admission process.”

She added: “There is capability for staff to be able to view a patient via the camera, for a snapshot visual check, eg checking on a patient’s physical health such as taking vital signs.

“This visibility is for a total of 10-15 seconds at a time.”

She said that these images “are not stored on the device” but she also said that “salient video data is automatically deleted after 24 hours unless required to be retained for a specific purpose”.

RDaSH had not been able to clarify by noon today why images needed to be automatically deleted after 24 hours if they were not being “stored on the device”.

Picture: A staff member at another health trust (not CINFT) points to an image of a service-user in his bedroom, produced by the Oxevision system [an earlier version of this caption stated that the service-user was semi-clothed. DNS has been assured by Oxehealth that the service-user shown in the image is fully clothed.]

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