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Beyond Big Brother
The use of surveillance and monitoring in care

The use of surveillance and monitoring technology in social care has been debated for many years. However, as the sector faces increasing pressure, is there a role for such technology to support safeguarding? Philip Scott shares his thoughts.

There’s no doubt about it, society is growing older with an ageing population increasing year-on-year. According to the Office for National Statistics (ONS), the proportion of people aged 65 and over is projected to rise to more than 20% of the total population by 2024.

Whilst this has its benefits, in terms of accrued wisdom and a sharing of familial responsibilities, it is in part offset by an anticipated need for increased social and health care services.

Pressure on the system

Added to this, the ongoing cost-cutting in social care is a hurdle to change and progress. Local authorities in England are making £824m of savings in their social care budgets in 2017-18, according to research by the Association of Directors of Adult Social Services (ADASS). This takes cumulative savings in adult social care since 2010 to £6.3bn.

Although funds have been pledged to the sector, both by the Government and through the increased social care precept on council tax bills, plus the forthcoming Green Paper on social care for older people, the system ‘still remains on a cliff edge’ as a result of deep cuts in recent years, ADASS has said.

While some individuals will remain fit enough to lead independent lives, it is likely that a significant number will become frail or have health issues, meaning they will require formal care and may need to move into a care home. This will create further pressure on the sector that everyone acknowledges is already creaking at the seams.

As these factors pile pressure on the system, there are challenges around how to allocate and utilise increasingly limited care resources and ensure people receive safe, high-quality care.

A definitive, sustainable answer to the issues the sector faces has yet to be found. However, most would agree that the use of a wide range of new technologies to support managers and staff is something all stakeholders must consider, whether that’s to change working patterns, establish positive cultures or allow for the supplementing of scarce manpower resources.

Safeguarding

The rigours of safeguarding the welfare of vulnerable people, whilst maintaining high standards of care, is challenging given the unprecedented squeeze on available funding.

However, with the growing role of technology in supporting the sector, is there a growing place for monitoring and surveillance technologies to aid safeguarding?

Some sectors have made significant inroads in their use, for example, childcare provision. In America, the use of such technology is common practice in kindergartens, and this appears to be growing in UK nurseries.

Danish researchers, published in Surveillance & Society, called such technology in nurseries, ‘Just one of many modern technologies which over the next few years might change the relationship between children and parents (and parents and nursery teachers)’. The research concluded that the main ‘motives behind parents’ use of webcams are: to gain insight, to gain a feeling of presence in the nursery and to gain control’. Disciplining staff was a cited as a rare sub-motive.

Surveillance and monitoring

The use of surveillance and monitoring technology in social care is a thorny subject that generates strong opinions. Understandably, it can be an emotive subject.

For some, it conjures up negative connotations associated with a dystopian Big Brother society. However, major advances in such technologies has made intrusive ‘always on’ monitoring a thing of the past. Now, monitoring by cameras can be ‘event and trigger-based’.

With the rise in interest in such technologies, the Care Quality Commission (CQC) has taken the subject seriously enough to issue guidelines for providers considering the option. Using surveillance: Information for providers of health and social care on using surveillance to monitor services was published in 2014 and updated with the new regulations in 2015.

It sets out some of the key points to consider on the subject and signposts further resources. In the introduction, it says, ‘The decision whether to use surveillance is for care providers to make in consultation with the people who use their services, and with families, carers, trade unions and staff. This document does not give guidance on whether or not you should use surveillance systems, and CQC does not require providers to do so.’

Following an online petition to install CCTV cameras in all care homes to protect the vulnerable people, the Government responded saying that it, ‘does not object to the use of CCTV in individual care homes or by the families of residents, provided it is done in consultation with and with the permission of those residents and their families.’ It then links to the CQC guidance for providers.

Drivers for the use of CCTV in care

The movement towards embracing the technology has come from individual cases of poor care delivery being exposed. Shameful instances of abuse in care homes regularly hit the headlines and this could offer an effective solution to the issue.

Following the online petition, a Panelbase survey was carried out by Care Protect in September 2017. It found that 75% of the 1,010 people questioned were in favour of camera monitoring to safeguard residents in care homes. Indeed, according to mainstream media, many families have reverted to using hidden cameras without the consent of the elderly person being monitored.

In February 2015, CQC published information for families, carers and those who use health and adult social care services to help people make appropriate decisions on the use of hidden cameras, or any type of recording equipment, to monitor someone’s care.

Commenting on the information for families, then Care and Support Minister, Norman Lamb MP said, ‘Cameras have helped to expose terrible cruelty and neglectful care and I welcome this new advice. Decisions about using surveillance are extremely difficult – there is always a balance to be struck between protecting people and respecting their right to privacy – but this information will help families to the make the right choice for them.

‘We are committed to preventing poor care from happening in the first place and have introduced tougher standards for inspecting care services as well as measures to shut down those that aren’t up to scratch.’
Unfortunately, there is still a proportion of care providers who need to improve their standards, meaning people receive inadequate, unsafe care.

The CQC’s most recent State of Care report found more than 5,000 social care organisations were rated as either Inadequate or Requires Improvement for Safety.

Ethics and human rights

While there are, quite rightly, questions raised over the ethics of using such technology, and how, when and from whom consent is required, things have progressed far beyond a bank of screens being continually watched.

Individual privacies and liberties can be protected and respected by using intelligent cameras, which provide monitoring on an ‘events’ only basis.

Such systems can be designed to safeguard residents’ privacy and dignity in-line with the Human Rights Act Articles 5 and 8 requirements.

In addition, any camera system could and should operate independently of providers, with trained health and social experts reviewing any events. They would then use their experience to assess any incidents and recommend what action is required and within what timeframe.

Business benefits of monitoring technology

At a time when public funds are limited, investing in camera monitoring technology could be a possible economic solution to ensuring acceptable quality care is delivered every day.

Initial findings from Care Protect’s own research suggest that, in care homes it makes a tangible difference to promoting a sustainable high-quality service, and in doing so, improving its commercial fortunes.
Current providers using such technologies have reported to Care Protect that they have noticed sustained improvements in care delivery, increased fee rates and occupancy, declining agency expenditure and, on average, a 24% reduction in safeguarding events.

One example is a Birmingham care home, which has moved from being rated as Requires Improvement to Good by CQC. Its expectation at the next CQC review is to receive an Outstanding rating in at least one of the five key questions. Before the technology was introduced, the 76-bed facility regularly had resident vacancies, it now averages just two in any given week.

Another home, in the south of England, had 10 empty beds and an embargo imposed on admissions, yet a year after camera technology was installed, it achieved capacity and now has a waiting list.

A third home has increased its occupancy by 10% since embracing camera technology.

Beyond these benefits, surveillance technology also has the potential to save time, money and resources when investigating a safeguarding issue raised by a resident or family members.

Usually the process involves staff suspensions, time taken interviewing witnesses, additional agency cover, and a possible admissions embargo. These all are costs borne by a home under review. Surveillance technology, however, provides footage that could be retrospectively reviewed, and any matter addressed immediately with the appropriate action taken.

The debate is slowly but surely moving on from concerns over a Big Brother society to recognising the possible benefits of this technology including in reducing, if not completely eradicating, instances of abuse. Research into the use of such technologies in the mental health sector finds that it is a growing trend.
Smart surveillance could be a very effective answer to the issue of limited resources and safeguarding vulnerable people. Demand is growing for services, but funds and manpower resources will remain constrained.

It may be time to consider surveillance technology as part of an operational toolkit that promotes high-quality care and delivers trust, confidence, reassurance and transparency that all stakeholders want to see.

Philip Scott is Founder of Care Protect. Email: PScott@Care-Protect.co.uk Twitter: @CareProtectLtd

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