Comment & Opinion

Dr Malcolm J Fisk, Senior Research Fellow, Centre for Computing and Social Responsibility, De Montfort University, Leicester


If we consider the role of one kind of camera use, in CCTV (closed-circuit TV) systems with 24 hour viewing, it is not as if anyone concerned for care homes or other care settings could for most circumstances seriously consider their use for anything other than matters of  security– and then only in public areas or externally. Were CCTV to be used in such a way in the private areas of care homes there would be a clear and unacceptable threat to people’s privacy. But some people who are against the ‘idea’ of cameras, generalise about them as if they all operate like this -sending images in ‘real time’ (constantly)for someone, whether in a care home itself or at some remote centre, to view. It is not surprising, therefore, that many people, nurses among them, set their faces like flint against cameras as if they are the tools of the devil and would inevitably undermine their caring work.

But if we pause to consider cameras in another way, we can open up a wider debate. This debate invites us to regard cameras simply as tools that gather and store images. By appreciating this we can imagine circumstances, such as those relating to abuse, where subject to clear provisos that we’d need to agree about, cameras or other surveillance technologies could in special circumstances become ‘technological witnesses’.

The provisos we would put in place would come in the form of clear rules and regulations that set out technical and operational frameworks to determine the types of cameras to be used, their function, the way in which images are treated and the conduct of those who manage them. Alternative ways of using cameras in private areas, overtly or covertly, would be ruled out. In this context we can side-line the more commonplace use of CCTV to corridors, foyers, lifts, offices, bin stores, entrances and car parks. Our attention can then shift to the rules and regulations for overt camera usage. And, more to the point, we can focus not just on the cameras (whether or not they operate within CCTV systems) but also on the way that the images gathered are processed, stored and used.

But we are still some way from having that debate. It was the use of cameras in a covert, not overt, way that was the focus of discussion at the 2015 RCN Congress. Four out of five participants (79.5%) agreed that the Council should ‘oppose the covert use of video and audio surveillance and recording in nursing and residential homes’ but the questions about overt camera use were left open. What appeared on the face of it (and was widely publicised in the media) to be an anti-camera stance was, therefore, actually only against a particular type of CCTV. Other aspects of camera use (and the issue of images), though touched on, were not the subject of a motion. We can note, in addition, that the RCN’s report of the debate states that surveillance ‘should be considered alongside other measures such as recruitment training and improved leadership’. This impliesthat there is a role for cameras that we should at least consider. But what form should the use of cameras (or, indeed, other surveillance technologies) take?

This brings us to the crux of the much needed debate. In their work, nurses and other care staff ‘keep an eye’ on, or observe, those for whom they care. Cameras can be a tool that helps with this observation. My ‘Ageing Bite’ video sets out this argument and can be viewed on YouTube (best accessed via the British Society of Gerontology website). Let us not forget, in addition, that the key reason for this debate is about combatting abuse. Therefore the big question is, could cameras (or the images captured by them) bear witness to incidents of abuse (or, indeed, to falls or thefts)? Could they, in addition, provide a deterrent?

We don’t fully know the nurses’ views on such matters, but we can note from the results of the 2014 Britain-wide ComRes survey involving over 2000 adults that four out of five people (79.8%) favoured visible cameras in care homes ‘to protect residents from abuse’. In addition, in a survey of staff in HC-One care homes, most (at 63% out of over 7,000) responded ‘yes’ to the question ‘would you like HC-One to offer residents and relatives an opt-in scheme for visible cameras?’ albeit that in a parallel survey undertaken by the GMB Union, 87% agreed with the composite statement that ‘cameras don’t tell the whole story … good care requires enough staff and proper training’ (Fisk, 2015). Residents in HC-One homes were (at 87% out of over 1,500) even more strongly in favour of ‘visible cameras’.

These figures start to give us a feeling for the views about cameras in a broader context than that provided by the 2015 RCN Congress. But alas, the studies do not give any precision regarding the views obtained. We can only guess, therefore, about how nurses and others think about the specifics of how and where we might use cameras within care homes and their views on the options for the treatment of, storage and access to images. And it is not just the views of staff and family members that count here. More work is definitely needed with care home residents.

But moving forward, if we accept that there is some support for cameras, then we can at least begin to work on the operational frameworks to make sure that there are clear benefits to nurses and other care staff as well as providing much needed reassurance for residents and family members. To help with this I have set out some initial principles for such camera use [1] that suggest that care homes ‘should be able to provide or should be willing to permit or facilitate, the use of surveillance technologies (including cameras)’ not just in public areas but also ‘within a resident’s room or other private areas’. The key premise within these principles is that when images are gathered, access to these is absolutely and clearly restricted ‘to authorised persons or agencies in particular, defined circumstances’.

This, and the other principles, help to move us away from any focus on the more commonly understood use of CCTV to the notion of cameras simply as tools that can gather information which we can fully control. Indeed, with new technological procedures and operational frameworks in place, most images (or, for that matter audio recordings or other information gathered by surveillance technologies) would never seen or accessed by anyone. What is more, additional technological safeguards can now be ‘built in’ to the process through the fragmentation or blurring of images. This means that they could only be accessed at different levels of clarity through use of appropriate codes. Responsibility for the safe storage of such images could, at the same time, be vested in carefully vetted agencies [1].


With these kinds of procedures and frameworks in place, the generalised arguments against cameras in care homes can be countered. And, given the manner in which images can now be treated and stored, the privacy and safety of residents could, in fact, be enhanced rather than diminished.

Therefore the big question is, could cameras (or the images captured by them) bear witness to incidents of abuse (or, indeed, to falls or thefts)?