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A private spy on the ward

RUTH HUNT cautions against the rapid rollout of video-based surveillance in psychiatric wards without adequate scrutiny of the risks or consideration of patients’ privacy and dignity

WHEN Eliza was detained onto Elm ward, the cameras in her bedroom made her very concerned. She read the pack for new patients, but the information enclosed about Oxevision was extremely limited: an infrared camera that helps staff confirm a patient is safe and measure their pulse and breathing rate, without disturbing their sleep.

She told the staff she didn’t consent for this filming to take place. Staff at the time appeared flummoxed, telling Eliza she couldn’t opt out and her consent wasn’t required.

Elm psychiatric ward was very noisy, a TV blaring throughout the day and late into the night. Usually, Eliza would view her bedroom as somewhere she could retreat for time by herself. But with this surveillance in place, this sanctuary felt compromised.

While some service users might feel cameras offer safety, other patients like Eliza felt this constant monitoring was “dehumanising.” On top of this, when she tried to get staff to understand her position there was a lack of empathy or respect for her position.

Uncomfortable with the thought that she would be filmed throughout the night, Eliza was prepared to sleep in the only place that wasn’t covered by the cameras — the en-suite toilet and sink. But this area was so small, it would be impossible for Eliza, who has disabilities, to get comfortable. 

The predatory nature of this technology raises questions of safety for those being filmed. Recently revealed research jointly carried out by the BMJ and the Guardian has exposed the very real issue of sexual assaults and rape that has been a perennial issue for patients. 

For those patients who have already been subject to sexual abuse, their bedrooms on the ward should be safe spaces. But the fact they are being filmed is likely to result in feelings of being violated again.

Such surveillance is used is more commonly in the criminal justice sector, so what is the link with mental health?

The criminalisation of service users is not new, as most recently shown in the notorious Serenity Integrated Mentoring scheme (SIM), which aimed to “bring together” the police and community mental health services.

Both SIM and Oxehealth were in the same hothouse — the NHS Innovation Accelerator scheme.

Questions need to be asked about the direction of these “innovations” and how they get the green light so quickly on such limited research. 

Oxehealth now touts its wares up and down the country, making appearances at places like the recent Royal College of Psychiatrists conference in Liverpool.

Its main selling point is virtually checking on vital signs that will free up night nurses who would no longer need to do physical checks that often disturb patients. 

But, if this system was just being used to free up time for night nurses, that would be one issue, but evidence shows this system is often used 24/7 and in ways that could possibly increase risk to patients.

For example, in a pilot, staff were talking of how they could move a patient they were very “worried about” off observations, “encouraging” them to take “responsibility” and “ownership.”  

This seems to be a long way off night-time checks, and the language very SIM-like. “The ill patient that the nurses were very worried about having to take responsibility for their own actions.” 

Oxehealth keeps up with details of its progress on social media, and when new NHS trusts or other providers come on board they are proudly announced.

The problem is this rollcall of NHS providers includes many notable names.

The backlash against this system has been fierce. The campaign @StopOxevision has said: “The experience of being in hospital, often detained and unable to leave can be a hugely frightening, isolating and dehumanising ordeal. By adding video-based surveillance into that environment, hospitals risk compounding an already restrictive and traumatic experience. 

“We cannot be assured that patient privacy and dignity are being upheld, that their consent is being freely given, or their data protected.

“We are also concerned that this technology is being used as a response to inadequate staffing and that is compounding poor practice on wards potentially enabling unsafe care.

“Oxevision’s rapid rollout raises questions about how public funds are being spent to promote ‘innovations’ without adequately scrutiny of the possible risks.

“We call on NHS England and individual mental health trusts to halt the rollout of Oxevision while an independent review is conducted into its legality and potential harms associated with its use.”

The campaign has written an open letter on the use of this technology (bit.ly/OxevisionOpenLetter).

When new technology is introduced, we need to ask whether it really adds value. The very real concern is in some trusts such technology will simply divert much-needed funds, prop up poor working cultures while demeaning patients in the process.

When Eliza was discharged from Elm Ward, she thought that the monitoring from Oxevision did nothing to improve the culture or practices on the ward.  

As the campaign group Recovery in the Bin (@RITB_) says: “Oxevision holds out a promise of improved care but patient experience suggests this is an illusion and will simply support cultures of neglect. Cultures of neglect and unwanted surveillance that undermines our dignity.”

RF Hunt is a columnist and freelance journalist.

Stop Oxevision has a petition at bit.ly/OxevisionPetition.

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