This guide sets out what our inspectors and Mental Health Act reviewers look at when assessing or inspecting services that use digital contactless patient monitoring technologies.
It applies to mental health in-patient settings only.
We have written this guidance because some people with lived experience have said these technologies are an unauthorised and unjustifiable surveillance and restrictive practice.
As part of this work, we carried out a literature review to gather positive and negative points of view about use of this technology. We used the results of the review to inform this guidance.
Digital contactless patient monitoring technologies
These technologies monitor a person’s health and safety without requiring a device to be in physical contact with them.
They include tools that are sometimes called vision-based monitoring systems (VBMS).
Use of these technologies has been widespread in England since at least 2018.
Functionality
The functions of these systems can include:
- infrared cameras to monitor vital health signs remotely (sometimes with a regulated medical device)
- the ability to record video clips of up to 15 seconds, showing either clear or blurred images
Systems are being developed that offer an advanced sleep-monitoring function. These models have been cleared for use as a regulated medical device in the UK. They are currently being tested on a small scale in some NHS trusts.
New technologies are being developed that use radar instead of an infrared camera. These systems will display an image of a stick person or a dot, instead of offering a clear or blurred image of people.
Uses and intended benefits
Intended uses of these systems include:
- helping staff to monitor people’s health and wellbeing without contact, including taking vital health observations without disrupting sleep
- collecting remote monitoring information about people’s vital health signs to help staff make decisions about intervening.
Intended benefits include:
- improved safety and fewer adverse events (such as self-harm, assaults, falls)
- reduced use of restraint
- reduced patient sleep disturbance
- more efficient delivery of services
- better experiences for people from providing more person-centred care
- improved staff experience
- improved data for clinical decision-making.
Concerns
Stakeholders and campaign groups allege that the blanket deployment of this technology is an unauthorised and unjustifiable restrictive practice. This risks breaching people's human rights and ignores their right to privacy and dignity.
Campaigners also argue these systems can create safeguarding issues and cause people undue emotional distress. This can exacerbate existing fears, leading to poor care outcomes.
Other risks and challenges include:
- data protection issues
- a reduction of in-person care, leading to an impact on the overall quality of care
- the lack of guidance about use, functionality and effectiveness of the technology.
What inspectors and Mental Health Act reviewers look at
Inspectors looking at the use of these technologies will use these key questions/quality statements as a starting point:
- Safe: Safe environments at the service level
- Well-led: Governance, management and sustainability at the trust level
If necessary, other key questions and quality statements can then be considered. The way providers use this technology may provide evidence for several quality statements, including Safeguarding and Learning, improvement and innovation.
Mental Health Act reviewers looking at the use of these technologies will use chapter 8 of the Mental Health Act Code of Practice as a starting reference. They will then consider other chapters or paragraphs if applicable.
Inspectors and Mental Health Act reviewers will also look at the following:
- Where these technologies are used for people who are detained under the Mental Health Act (MHA), the provider should be following the principles of the MHA Code of Practice and considering patients’ views. In other cases, providers should be considering people’s consent or a best interests assessment for the use of this technology in line with statutory requirements.
- Staff should understand the intended and appropriate use of these technologies by both the manufacturer and the provider, and be aware of any unintended or inappropriate use. They should have received training in their use.
- The provider should have relevant policies and procedures for safeguarding people’s personal safety, privacy, and dignity rights against misuse of the technologies. This should include how their personal data is used, stored, and accessed in line with statutory requirements.
- Staff should use the technologies in a person-centred way that balances people’s privacy and dignity rights with any individual safeguarding and risk management support needs. There should be an individual care plan and/or risk assessment for each person regarding use of the technologies to support them.
- The technologies should not be used with the objective of reducing staffing numbers. Staff should be able to show that people’s in-person care and support needs are being met safely and effectively.
- Providers should ensure equity in access to this type of technology for people. This will include making any reasonable adjustments.
Our position on the use of digital contactless patient monitoring technologies by mental health in-patient services
- When we look at services and providers that use these technologies, we should incorporate this guidance in ways that are aligned to our assessment, monitoring and enforcement processes and associated standards.
- These technologies should not be used for covert surveillance purposes. Surveillance should not be carried out in a way that is designed to make people unaware that surveillance is (or may be) taking place. This guidance must not be interpreted as CQC tasking or authorising covert surveillance activity.
- Patients and staff must be made aware that these technologies are being used. For example, this could be by displaying signs to indicate the locations of the cameras, including on the cameras themselves if appropriate.
- Providers should make sure that signs are clear, visible and readable. They must also include details of the person in charge of the surveillance. This should include who to contact about the scheme, including information such as their website, phone number and/or email.
- These technologies are a therapeutic tool and should not be used as a form of CCTV to help keep people safe from abuse, neglect, or other criminal activity – except in exceptional circumstances. For example, corroborating allegations of staff-patient abuse that may have been captured by the video function of these devices. See our guidance on using surveillance in your care service.
- Providers must also be aware that any recordings they make of people amount to information about them. Collecting information about people is regulated by the Information Commissioner's Office (ICO). We recommend providers get legal advice to help them decide whether to use surveillance and to make sure they comply with the law.
Regulations and standards
The Regulated Activities Regulations 2014 for each key question/quality statement are in our assessment framework .
The regulations that could apply in this case, depending on the concern, are:
- Regulation 9: Person-centred care
- Regulation 10: Dignity and respect
- Regulation 11: Need for consent
- Regulation 12: Safe care and treatment
- Regulation 13: Safeguarding service users from abuse and improper treatment
- Regulation 15: Premises and equipment
- Regulation 17: Good governance
- Regulation 18: Staffing
- Regulation 19: Fit and proper persons employed
We do not regulate medical devices within digital contactless patient monitoring technologies. The Medicines and Healthcare products Regulatory Agency (MHRA) regulates the medical devices market. The MHRA performs market surveillance of medical devices and can take decisions over the marketing and supply of devices in the UK.
Information about how inspectors and Mental Health Act reviewers should approach assessing use of technologies that incorporate a medical device is included in the scope of this guidance document.
Good practice guidance and resources
In response to concerns about the use of vision-based monitoring systems, NHS England published a set of principles.
Clinicians can use the principles to help decide whether the use of digital technology is appropriate, effective and the least restrictive method of care and treatment. They are based on a human-rights approach about the use of all digital healthcare technology in NHS mental health inpatient settings in England.
Good practice resources referenced by NHS England include: