When it comes to supporting individuals with complex care needs and conditions such as epilepsy, technology like video monitoring can be incredibly beneficial, offering enhanced safety, autonomy, and peace of mind. However, the use and management of such technology is not without its complexities—especially when it comes to balancing safety with the privacy, dignity, and rights of those we support.
In this post, I'll be breaking down this multifaceted topic and share our best practice approach. Our goal is to ensure that professionals working with clients who use video monitoring systems follow a well-considered, ethical approach that respects both the potential benefits of the technology and the legal and moral obligations to safeguard our clients' rights. Let's dive into how we can navigate these challenges together, ensuring that every decision made is in the best interest of the individuals we care for:
Benefits and Use Cases:
At access:technology we make recommendations for video monitoring to complement in-person support for the following client centred reasons only:
Medical Monitoring: For individuals with medical conditions like epilepsy, video monitoring can be a game-changer. Cameras allow for continuous monitoring, especially overnight, offering a less invasive alternative to in-person checks that might disrupt sleep. This technology enables parents and care staff to respond swiftly to any changes in the client's condition. Additionally, recorded footage can be invaluable for healthcare professionals, aiding in diagnosis and the development of more effective care and treatment plans.
Enabling Autonomy: Clients with complex care needs often have limited opportunities for time alone, which is crucial for fostering independence and self-confidence. Video monitoring can provide a safe way for clients to engage in activities independently, without the constant presence of another person. This not only supports their mental well-being but also empowers them to take control of their own space and time.
Behaviour Support: For clients who may pose a risk to themselves, others, or property during moments of dysregulation or crisis, video monitoring can be an essential tool. It can allow for safe de-escalation by enabling clients to be left alone when beneficial, with the assurance that emergency support can be provided if needed. Additionally, footage can help identify triggers, inform behaviour support plans, and guide more effective care strategies.
Navigating the Legal Landscape
While the benefits of video monitoring are significant, it's important to remember that its use is governed by key UK laws designed to protect privacy, dignity, and human rights. The Data Protection Act 2018 and UK GDPR ensure that any video footage captured is handled responsibly, with a strong emphasis on consent, transparency, and secure storage. The Human Rights Act 1998 guarantees the right to privacy, meaning that any use of cameras must be justified and proportionate. Additionally, the Mental Capacity Act 2005 plays a critical role when working with individuals who may struggle to make decisions about their care, ensuring that actions taken are in their best interest and the least restrictive option available.
Depending on the age and needs of our clients, we may also be obligated to ensure our practice and processes relating to video monitoring comply with the Care Act (2014), Equality Act (2010), Safeguarding Vulnerable Groups Act (2006) and Working together to safeguard children (2023)
(You'll notice I've only talked about client facing benefits of video monitoring, if you have intentionally or unintentionally ended up using video monitoring for surveillance of care staff, then you will want to get some advice from surveillance specialists and be checking in with the Information Commissioners Office Guidance on CCTV too!)
Key Considerations
Assessing Capacity: Before implementing video monitoring, it must be assumed that clients aged 16 and over have the capacity to make their own decisions unless it is established otherwise. This means that every effort should be made to help clients understand the implications of video monitoring, including how it works, the benefits, and any potential downsides. If a client has the capacity, they must give informed consent for the use of video monitoring.
Supporting Decision-Making: If a client has limited understanding, they should still be supported in the decision-making process as much as possible. This could involve explaining the technology in simpler terms, using visual aids, or involving a trusted family member or advocate. The client’s views, preferences, and feelings should always be taken into account, even if they cannot fully grasp the technical details. Compliance should not be confused with capacity or mistaken for agreement.
Best Interest Decisions: If it is determined that a client lacks the capacity to make an informed decision about video monitoring, a decision must be made in their best interests. This involves consulting with family members, carers, and other professionals involved in the client’s care. The use of video monitoring must be the least restrictive option available and its should be regularly reviewed to ensure it continues to meet the client’s needs without infringing on their rights. Remember, just because cameras can be installed, it doesn't always mean they should!
When Deprivation of Liberty Safeguards (DoLS) Apply: If video monitoring is deemed necessary for a client who is over the age of 16 and lacks capacity, and its use could be considered as amounting to continuous supervision or control— and is arguably being utilised to prevent the client from leaving their home—this could amount to a deprivation of liberty. In such cases, appropriate legal authorisation is required to ensure the client's rights are protected. This process involves applying for a DoLS authorisation. For most of our clients, who live in their own homes, this should involve an application to the Court of Protection.
Safeguarding: It's essential that we're super critical about the nature of the footage we intend to capture, store and share. Particular attention must be paid when monitoring occurs in private spaces like bedrooms or bathrooms, especially if the footage may capture the client undressed, receiving personal care, in a state of distress or sexually expressing themselves. How long the footage will be stored, who can access it and when must be agreed before any video monitoring solution is implemented.
Managing who has access to video footage is crucial—it should be limited strictly to those who need it. Additionally, ensuring the security of that access is essential. In today's digital world, consider the serious consequences if this footage were to fall into the wrong hands.
Capability of devices and incidental use: When using video devices for client-centered care, it’s important to recognise that these tools can sometimes be used in ways not originally intended. For example, devices meant to monitor a client’s well-being might, over time, also end up being used for general surveillance of clients, staff, or family members, staff training, or even video calls.
It’s essential to keep the client’s best interests, rights, and freedoms at the forefront. Any additional uses or changes in how their devices are utilised should be carefully reviewed and managed by the client’s family and professional team. This ensures that the original intent of the device remains aligned with the client’s needs while safeguarding their privacy and dignity.
Nothing replaces "eyes-on" in person support: While video monitoring can be a valuable tool in supporting client care, it should never replace "eyes-on" in-person support. The purpose of video monitoring is to complement the care already being provided, not to take its place. It might seem obvious, but video monitoring only reduces risks and enhances quality of life when there’s someone actively watching the footage and able to respond effectively. You'd be surprised how often this crucial point gets overlooked!
Adolescence and transition to adult services: As clients transition from childhood to adulthood, the use of video monitoring requires thoughtful consideration to ensure a balance between safety, autonomy, and privacy. Adolescence is a critical time of development, where nurturing independence and honoring the growing need for privacy are key. The horrified reaction of my 13-year-old son when he learned that some teenagers I work with have cameras in their bedrooms says it all! It's crucial that we don’t wait until someone is on the brink of adulthood to start addressing these concerns. The earlier we engage in these conversations, the better we can support a respectful and appropriate transition.
Review, review, review!!!! To ensure that video monitoring remains appropriate and effective, regular reviews are crucial. At a minimum, we recommend that video monitoring be fully reviewed every 12 months. However in my opinion, if footage is being captured, it’s vital that video monitoring becomes a key agenda item in any multidisciplinary meeting. This approach helps to safeguard clients' rights, ensure that the use of cameras continues to serve their best interests, and adapts to any changes in their care needs
If you’d like to explore how video monitoring can enhance your clients quality of life, feel free to get in touch at domore@accesstechnology.co.uk. We’re here to help you navigate this important aspect of tech supported care.
