Do remote monitoring systems compromise patients' rights?

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By Emma Wilkinson

Infrared cameras used on mental health wards allow medical staff to track vital signs and sleep patterns from a distance, but there are concerns about consent – and patients’ best interests. Emma Wilkinson looks at the debate.

A complaint about the use of remote monitoring in an NHS mental health trust creating additional anxiety for an unwell patient has been partially upheld by the health ombudsman due to lack of consent. This decision comes at a time when roughly half of trusts providing psychiatric care are thought to use remote monitoring tools.

What is remote digital monitoring?

The latest complaint relates to Oxevision, which is a non-contact system that can measure a patient’s pulse, breathing rate, movement and sleep through a wall mounted infra-red camera unit. These cameras are placed in single occupancy rooms on inpatient mental health wards and can also provide activity and location-based alerts.

A consent leaflet provided by Cumbria, Northumberland and Tyne and Wear NHS Foundation Trust explains that the camera is placed above the bed, cannot see into the bathroom and does not record sound.

In addition to staff being able to monitor physiological signs remotely, the system can alert a staff computer if a patient has been in the toilet for a long time or if they leave the room.

When staff are observing the pulse and breathing rate of a patient they can access a 15 second image.

The system is being widely used, but some patients have reported that this kind of monitoring is adding to their sense of paranoia and making them more unwell.

A campaign group, Stop Oxevision, wants to see the end of video surveillance technologies in psychiatric hospitals and has raised concerns about informed consent for patients.

What did the ombudsman find?

The BBC has reported on a complaint to the ombudsman from a former mental health inpatient at Essex Partnership University NHS Foundation Trust (EPUT) who said the use of "frightening" cameras and sensors in patients' bedrooms made her even more unwell.

Referred to in the report as Miss B, the patient who was admitted in 2021 said the feeling of constantly being watched was distressing and she was given contradictory information about whether she was being recorded.

Miss B said staff did not ask for her consent to be remotely monitored, there was no information on the ward about it, and when she asked staff to turn the system off in her room, her request was refused.

Rebecca Hilsenrath KC, chief executive at the Parliamentary and Health Service Ombudsman, said EPUT "failed to seek Miss B's consent for the use of Oxevision, or to properly explain the system and how it would be used to observe her”, according to coverage of the report by the BBC.

“The use of technology can greatly improve health outcomes, but its use must follow national guidelines. In this case that did not happen,” she added.

“At a time when [Miss B] was already distressed, this lack of transparency exacerbated her anxiety and undermined her trust.”

In response EPUT apologised to Miss B and said it was making changes to how consent was obtained for contactless monitoring and would ensure “they were fully in line with national guidance”.

Who else has raised concerns?

The Royal College of Psychiatrists has said that digital technology has a large contribution to make to improving care for people with mental illness.

Digital monitoring technology varies from CCTV to systems which electronically track vital signs and may have a positive role to play as part of this agenda, they note.

But it is important that these technologies are not used in a blanket way, they stress.

“We believe there needs to be significant research undertaken that is independently accredited and co-produced with patients, their carers and families.

“In any event, safeguards will need to be put in place which prevent this technology from being used inappropriately and ensure patient consent is secured, where appropriate.

“This technology should only ever be used for its potential clinical benefits and not due to staff shortages.”

The mental health charity Rethink have also asked for more independent, co-produced research that thoroughly evaluates the impact of monitoring systems.

Use of Oxevision at EPUT has been raised at the ongoing Lampard Inquiry, which is looking into more than 2,000 mental health-related deaths in Essex over a 24-year period.

What is the current national guidance?

This is not a new issue and concerns been raised for some years about remote monitoring with some patients reporting feeling so frightened of being watched that they chose to sleep in the bathroom or corridor instead.

Campaigners say its use can be retraumatising for those who have fears around surveillance and abuse and hospitals are not always asking for consent. They want to see the use of systems like Oxevision and other video monitoring systems suspended.

In response, NHS England commissioned a rapid evidence review of vision-based monitoring systems and alongside people with lived experience, clinicians, and stakeholders developed national guidance that was published in February 2025.

It sets out eight principles to “help clinicians consider whether use of a digital technology is the most appropriate, effective and least restrictive method of caring for or treating a patient in inpatient mental health settings”. They also set out expectations around data protection and staff training.

The principles should be applied across all NHS mental health inpatient service types including those for learning disability and autistic people, children and young people and older adults; as well as specialised mental health inpatient services, such as mother and baby units and secure services.

The guidelines include that any use of digital technology must be in accordance with the Human Rights Act (1998) with competing rights in terms of privacy, dignity, and autonomy and safety carefully balanced and documented.

And where a person has capacity to consent, it should always be sought and regularly reviewed.

Echoing the phrase used by the Royal College of Psychiatrists, the guidance states that digital technology must never be used as a “blanket approach” to care applied to all patients on a particular ward or in a particular department.

Where a person is deemed unable to consent as part of a mental capacity assessment, but the digital technology is considered the “most appropriate, effective and proportionate method to provide care or maintain a patient’s safety, informed consent should be sought from a person with parental responsibility, power of attorney or a court appointed health and welfare deputy, the guidance states.

Use of such technology must also enable therapeutic and personalised care and providers must have a way to regularly assess the impact and benefit on patient outcomes, according to the guidelines.

Services have also been told they need to adopt a process for assessing the evidence base of any digital technology prior to procurement and implementation.

In response to the ombudsman report, NHS England said they have “instructed all mental health trusts to review their use of visual monitoring systems to ensure it is always humane and compassion.

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