Hidden cameras in care homes: can they help or hinder British social care?
Edmund Stubbs, 12 February 2015
Today the Care Quality Commission (CQC) published an advisory pamphlet on clandestine surveillance in care homes by means of hidden cameras or sound recording equipment. Following the BBC’s ‘Panorama’ programme of April 2014 where hidden cameras were carried by Panorama reporters who had managed to get themselves appointed as care assistants, and the diffusion of footage recorded by patients families, it is only to be be expected that such secret monitoring will increase.
The CQC’s pamphlet advises on certain issues, such as patient consent, the privacy of other residents and staff, and the public availability of footage. However, beyond this legal aspect, it ought surely to be be considered that hidden cameras could inadvertently have other consequences than the safeguarding of individual patients which has been the primary motivation for their use.
In many areas of life, quality control is effectuated by spot checks, where inspectors may turn up, unannounced, at any time, or not declare their presence at all. This procedure is intended to improve standards in a cost effective manner as services must treat any day as a potential day of inspection. In the same way the possibility of the presence of secret cameras could have the potential to ensure staff always act in a professional manner and make providers more responsive patients families’ concerns. Companies could easily have their reputation irresibly damaged by any instances of unprofessional care being submitted to regulators or posted on the internet.
However, it is all too easy to forget that care staff often have a very difficult job to do and are often required to rely on their personal discretion and experience. For example, if a patient suffering from dementia is in such a mood as to make it inappropriate for staff to undertake a certain task, or if a patient is in a great deal of pain, they may decide it is better to postpone that task even, in the case of non-essential services, to another day in order to reduce a patient’s distress or suffering.
The system-wide problem of chronic understaffing also must be acknowledged, where staff might be forced to prioritise urgent tasks over those less so, simply to keep patients safe. In the case of visiting carers, understaffing might mean that they are not able to spend enough time with each home bound patient to fully meet their non-urgent needs. All these instances could appear negligent if recorded and viewed out of context. Thus, a culture of ‘spy cam evidence’ could scapegoat conscientious staff members under pressure for what is in reality a systemic problem.
Often, the same patients and staff interact with each other every day, ideally they develop relaxed and informal relationships. Both parties can find these interactions extremely rewarding. The prospect of secret monitoring might easily create a formal, tense atmosphere of ‘by the book’ care, sacrificing normal and beneficial human interaction.
At the end of the day what counts is good human resource management. Nowadays, many care staff are employed on ‘zero hours’ contracts. Visiting carers are often not paid for their travel time between patients, effectively meaning they are paid far less than the minimum wage. If staff were paid fairly for their work, valued by their employers and given sufficient time to do their job properly, more well-motivated and conscientious people would choose to stay to make their careers in the care sector rather than, as now is often the case, care often being regarded as a ‘temporary’ job to be undertaken by people who don’t really want to be there, those indeed most likely to be committing the offences revealed by covert surveillance.
Local government funding for social care has been seriously cut in recent years. What the care sector needs is more resources to adequately reward and thereby retain hard working committed staff. This is the only credible way to improve care at the system level, with ‘big brother’ watching likely to demoralise committed and caring staff.
Edmund Stubbs, Healthcare Researcher