RCN position on the use of body worn cameras
Body worn cameras are small, mobile devices, usually worn on the outside of clothing, which allow the wearer to record audio and video footage during interactions. The use of body worn cameras has been steadily increasing in health and care settings across the UK as a measure to prevent incidents of violence and aggression occurring. Incidents of violence and aggression can lead to varying degrees of physical and psychological harm occurring.
Statistics from the RCN Employment Survey (2021), NHS England Employment Survey 2021, Northern Ireland's Health Trusts, and returns from the Health Boards in Scotland and Wales show incidences of violence and aggression against nursing staff remain high. In addition, violent and aggressive incidents are the third biggest cause of injuries reported under RIDDOR (Reporting of Injuries, Diseases and Dangerous Occurrences Regulations) from the health and social care sector (HSE 2023).
The RCN acknowledges the views of the nursing workforce on the use of body worn cameras in health and care settings can be emotive, conflicted, and diverse, with concerns around ethics, trust, and the potential impact on ward culture. The RCN further recognises the limited availability of published evidence on the effectiveness and acceptability of body worn cameras in healthcare settings.
The RCN has considered the findings from studies/pilots into the use of body worn cameras, which are taking or have taken place recently. This includes Ambulance Trusts in England, The Northern Ireland Ambulance Service HSC Trust, The Southern Health and Social Care Trust Mental Health In-Patient Unit (Northern Ireland) and a project led by researchers at the Institute of Psychiatry, Psychology & Neuroscience, King’s College London, the Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, and clinicians at South London and Maudsley NHS Foundation Trust.
The latter is the largest study to date of NHS staff and patient attitudes to the use of body worn cameras and explores the ethical and therapeutic considerations of their use in NHS healthcare settings. The researchers expect the study to inform policy and practice on the use of body worn cameras and identify further research needs. The study reported in the Spring of 2023.
Overall, the findings from the all the studies demonstrated participants felt psychologically safer and supported when body worn cameras were being worn and were more likely to have a positive view of body worn cameras following trials of their use. In the Kings College study, patients viewed the use of body worn cameras as a safeguarding tool, however some patients felt hesitant speaking to staff when the cameras were being worn and others expressed concern about being recorded.
Analysis from the ambulance trusts showed the majority of violent and aggressive incidents involved alcohol and/or drugs, mostly occurring in private dwellings and not linked with normal night-time economy.
The actual number of incidents may not significantly decrease, when body worn cameras are used, however the severity of incidents tended to be less and in some mental health settings a significant reduction in restrictive interventions was seen. Factors such as understaffing, inadequate training, and a general lack of resources were considered to be amongst the root causes of violent and aggressive behaviour.
Regulation 4 of the Safety Reps and Safety Committee Regulations requires health and social care and independent employers (for example private providers of services for those with learning difficulties) to consult with their employees and or their representatives (e.g., RCN Reps) when the introduction of new technology is being considered. Consultation and union support is key to helping employees understand the reasons for implementation and allay fears as to why body worn cameras are being introduced. For example, one key learning point from the trial in the ambulance service was to reassure staff that they were not being personally monitored.
Before immediately turning to the use of body worn cameras, the RCN believes employers should address the systemic and underlying causes of violence and aggression in the workplace by carrying out a suitable and sufficient risk assessment, in line with health and safety legislation and Regulation 4 of the Safety Reps and Safety Committee Regulations.
Identified control measures should be implemented to reduce the risk of violent and aggressive incidents as far as it is reasonable to do so. This includes ensuring safe staffing levels (with the relevant skill mix) are in place and implementing evidence-based methods of violence reduction and management, including suitable training in de-escalation techniques, and having clear lines of communication in place.
Where a suitable and sufficient risk assessment has identified the use of body worn cameras as a control measure, the RCN’s position is to support that decision. However, any system which introduces the wearing of body worn cameras must ensure legal and ethical compliance requirements are met. This includes the provision of suitable and sufficient information, instruction, and training.
Employers also need to consider the practical implications around the wearing of body worn cameras, such as supplying an attachment strap or similar, ensuring additional risks, such as a ligature, are not introduced.
There are no specific laws or regulations covering the use of body worn cameras, however, a code of practice has been produced by the Surveillance Camera Commissioner and the Information Commissioner, which employing organisations should refer to before implementing any system involving the use of body worn cameras. The code of practice aligns with existing legislation such as the Data Protection Act 2018, the Protection of Freedoms Act 2012, the Regulation of Investigatory Powers Act 2000, and the Human Rights Act 1998.
In summary, where a risk assessment indicates that body worn cameras should be used as a control measure by health and social care employers, the following principles should be applied:
- The use of body worn cameras must be for a specified purpose, with a legitimate aim and necessary to meet an identified pressing need.
- The effect on individuals and their privacy must be taken into consideration with regular reviews to ensure the use of body worn cameras remains justified.
- The employing organisation must be transparent regarding the use of body worn cameras including publishing a contact point for access to information and complaints.
- There must be clear responsibility and accountability for all body worn camera system activities including images and information collected, held, and used.
- Clear rules, policies and procedures must be in place before a body worn camera system is put into operation, and these must be communicated to all who need to comply with them. This includes filming where a child/young person may be the subject or in the vicinity, and consideration of consent and/or the capacity to consent.
- No more images and information should be stored than that which is strictly required for the stated purpose, and such images and information should be deleted once their purposes have been discharged (for example after 1 month).
- Access to retained images and information should be restricted and there must be clearly defined rules on who can gain access and for what purpose such access is granted; the disclosure of images and information should only take place when it is necessary for such a purpose or for law enforcement purposes.
- Operators of a body worn camera system should consider any approved operational, technical and competency standards relevant to the system and its purpose and work to meet and maintain those standards.
- Body worn camera images and information should be subject to appropriate security measures to safeguard against unauthorised access and use.
- There should be effective review and audit mechanism in place to ensure legal requirements, policies and standards are complied with in practice, and regular reports should be published.
Where a body worn camera system has been introduced, feedback from users should be actively encouraged and acted upon. This includes checking understanding of how and when they should be activated, the use of data/images and welcoming suggestions for improvement.
- RCN position on work related violence in health and social care
- RCN violence in the workplace advice guide
- RCN prioritising personal safety advice guide
- Department of Health Northern Ireland, Body Worn Video Public Consultation Phase 2: https://www.health-ni.gov.uk/consultations/body-worn-video-public-consultation-phase-2, accessed 18 January 2023
- GOV.UK, Draft updated surveillance camera code of practice (accessible version): https://www.gov.uk/government/consultations/surveillance-camera-code-of-practice/draft-updated-surveillance-camera-code-of-practice-accessible-version
- Health and Safety Executive Great Britain: https://www.hse.gov.uk/healthservices/violence/index.htm, accessed 23 January 2023
- Kings College London: https://www.kcl.ac.uk/research/body-worn-cameras-on-inpatient-mental-health-wards, accessed 18 January 2023
- NHS England, NHS roll out of body cams to boost ambulance crews safety (June 2021)
- NHS England Employment Survey 2021: https://www.nhsstaffsurveys.com/results/national-results/
- RCN Employment Survey 2021: https://www.rcn.org.uk/Professional-Development/publications/employment-survey-2021-uk-pub-010-075
- Southern Health and Social Care Trust: https://southerntrust.hscni.net/trust-trials-body-worn-cameras-to-protect-patients-and-staff/, July 2022
- The Northern Ireland Ambulance Service Health and Social Care Trust, Body Worn Camera Consultation Phase 2: https://nias.hscni.net/body-worn-video-public-consultation-phase-2/, 13 May 2022
- Wilson, K., Foye, U., Thomas, E., Chadwick, M., Dodhia, S., Allen, J., Lynn, J., Brennan, G., Simpson, A. (Accepted: 6th February 2023; Published 15th Feb 2023) Exploring the use of body-worn cameras in acute mental health wards: A qualitative interview study with mental health patients and staff. International Journal of Nursing Studies, 140: https://doi.org/10.1016/j.ijnurstu.2023.104456
- Wilson, K; Eaton, J; Foye, U; Ellis, M; Thomas, E; & Simpson, A. (2021) What evidence supports the use of Body Worn Cameras in mental health inpatient wards? A systematic review and narrative synthesis of the effects of Body Worn Cameras in public sector services. International Journal of Mental Health Nursing. https://doi.org/10.1111/inm.12954