More ED staff are wearing body cameras for safety. Are they working?

Reveal Media

By Daniel Pye

In response to a surge in abuse directed at medical staff, more trusts are using body cameras in emergency departments and mental health wards. Doctors.net.uk examines what that means for doctors and patients – and for tackling the underlying causes of violence.

It was after a patient pulled a knife in the emergency department at Manchester Royal Hospital that Dr Daniel Kristiansen decided to start wearing a body camera.

For him, it was the final straw. “The rates of violence and aggression across all the trusts I have worked at feel to be increasing and increasing and increasing weekly,” he told Doctors.net.uk. “If I cast back to 2015 when I qualified, it felt like quite a rare occasion compared to now.”

Weeks after he started wearing the camera, he saw a patient punching the walls and making “really vile, horrible physical threats towards my consultant”. The senior doctor had barricaded himself behind a door for his own safety.

The use of body cameras is part of increasingly urgent efforts to address the surge in violence against healthcare workers in recent years

Kristiansen captured the event on camera, including the patient kicking the door, and the consultant falling to the floor. The whole thing was “very scary and upsetting” he recalls. This exact kind of footage is sometimes used to help bring charges, and then as evidence in court.

While police and security teams have been wearing body cameras for nearly two decades, more recently they are being worn by doctors and other medical staff in emergency departments (ED) and mental health units. Their use is part of increasingly urgent efforts to address the surge in violence against healthcare workers in recent years.

The rationale is simple enough: the cameras themselves can deter escalation to violence, and clearly documenting abuse when it happens can make prosecution more straightforward.

Yet even among those who embrace their use, there are concerns – both about potential impact on the patient relationship, and also whether taking these measures represents a kind of resignation to addressing the symptoms, not the root cause, of the surge in abuse.

How did we get here?

Last year, almost one in seven NHS staff experienced at least one incident of physical violence by a patient or member of the public. It was the highest level of violence against staff in three years – and most likely a drastic underestimate. Between 25-50% of all incidents go unreported, according to a 2023 study of workplace violence in UK healthcare published in Frontiers of Public Health.

Triggers include long wait times to see a doctor or receive medication, a shortage of staff, exposure to pain, high-stress levels and feelings of anger, frustration and unmet patient needs, the research shows.

These pain points are becoming more frequent amid a huge increase in the number of patients attending ED and a simultaneous retention crisis in the NHS. The 2023 analysis found there were 133,000 healthcare vacancies in England and warned the impact of increasing violence against workers “could be catastrophic” for retaining staff.

In the latest NHS staff survey, just 58% said they would recommend their workplace.

Going on camera

The UK is somewhat of a global pioneer when it comes to body cameras to protect public-sector workers. They were first piloted in 2005 by the Devon and Cornwall Police, which found that their use decreased bad behaviour and provided strong evidence against criminals.

This success led to a nationwide rollout among law enforcement two years later. Today, more than 70% of police officers routinely wear body cameras on duty. 

NHS England took heed. After more than 3,500 ambulance staff were physically assaulted by the public in 2020 – a 30% increase compared to five years prior – they provided thousands of crews with body cameras.

Several emergency departments and mental health inpatient units have since followed suit, and are making use of body cameras in trials. It is hard to quantify exactly how many, as unlike the ambulance service rollout this is being led by trusts rather than NHS England.

Yet what is known is that some, such as Kristiansen’s employer Manchester University NHS Foundation Trust (MFT), have already moved beyond pilots and are now using body cameras routinely in some areas.

Lynsey Maton, head of nursing at the urgent and emergency care centre in Rotherham NHS Foundation Trust, says violence and aggression are “absolutely” the reasons cameras were introduced there two years ago. “It’s something we shouldn’t have to come to work for. We don’t have to tolerate it, and it does help with police prosecutions.”

Since he started wearing his camera two years ago, Dr Kristiansen has felt the need to turn it on more than 50 times

Currently, the cameras are worn mainly by nurses and sometimes healthcare assistants, says Professor Alan Simpson at the Centre for Mental Health Nursing Research at King’s College London.

He has studied the use of surveillance tools including body cameras in mental healthcare settings and says there is a creep in their use by trusts desperate to find solutions.

He does not know of any psychiatrists who wear one. Kristiansen says he is the first doctor to wear one at his hospital, as far as he knows.

Promoting safety

In general, the cameras worn by NHS staff tend to be small, Simpson says, unlike the bulky ones police use that have a longer charge and bigger battery. They can be attached to clothing via a magnet, lanyard, sew-in mount or crocodile clip. 

Helen Metcalfe, an advanced clinical practitioner who works in the emergency department at Salford Royal, wears the Calla camera made by the company Reveal. It weighs about 50 grams.

Kristiansen says that since he started wearing his, two years ago, he has felt the need to turn it on to either viewing mode – or full recording – more than 50 times.

In the aftermath of the knife incident, the security team at his hospital advised him to complete physical interventions training and a course in positive behavioural support, which was required to get the cameras.

This required two days of training which he says many doctors, even those interested in the cameras, don’t want to invest the time needed to complete it.

“I pursued getting on that training with a view to getting that camera,” he says.

When to record

The use of body cameras is highly regulated. Exact policies on their use may vary from trust to trust, but many already have guidelines in place for security teams that can be adapted to the medical staff. In all instances, though, medical staff should only wear a camera with their trust’s knowledge and consent.

Unlike the police, who have the cameras running all the time, Simpson says those used in healthcare are usually only turned on when there is a concern over behaviour. They are also deliberately designed to promote de-escalation by showing the perpetrator what the camera view is via the forward-facing screen.

The MFT policy is to only turn it on when a warning has been given and an offence is being committed or likely to be committed, but Kristiansen says he personally uses a higher threshold than the official trust policy.

In a mental health setting there are examples of cameras being used to document when a psychiatric patient is declining medication and the team knows they will have to restrain them – in order to show that staff have followed the right procedure, Simpson says.

There have also been cases of patients asking staff members to turn them on when they wished to make a complaint so they know it will be documented.

As to what happens to the footage, the person recording will usually not be able to view it. By default, systems are in place to ensure that videos are securely uploaded and only reviewed by security.

Kristiansen says he does not own the footage – it goes straight to a senior member of the security team.

Metcalfe says that, at Salford Royal, staff return their cameras to a central docking station at the end of shift, and footage can be uploaded either via the station or through a USB cable and goes direct to security.

Calla Camera. Reveal Media

Official guidelines

When Doctors.net.uk asked about guidelines for ethical use of the cameras, the General Medical Council (GMC) pointed us to a section of its professional standards pertaining to visual and audio recordings of patients, which states that any benefits of filming “must be balanced” against patients’ rights to privacy and dignity.

Regarding whether a national framework for body camera use is forthcoming, a spokesperson for NHS England gave this statement: “We will continue to support Trusts who implement measures designed to better protect their staff and we urge anyone affected by acts of violence to report incidents to their employer and the police.

“Any violence against staff is completely unacceptable and the NHS remains fully committed to tackling violence and abuse against staff with various programmes of work under way, including through a new violence prevention and reduction standard to help staff feel safer at work.”

Evaluating the impact

As more data comes in about their use in healthcare settings, a consistent takeaway is that body cameras may improve staff safety not by reducing the total number of incidents, but the severity of them. This has psychological benefits for staff and also leaves them feeling physically safer.

In general, when used appropriately, most patients don’t seem to mind the cameras: in a survey of 400 patients and relatives exposed to body cameras during a trial at Royal Derby Hospital, just 11 people (3%) voiced any concerns at all.

But to really evaluate their impact – and whether they are actually improving safety, helping to retain staff and reducing costs – we still need more and higher quality evidence, Simpson says.

That was the main conclusion of a 2024 review of research he and colleagues conducted which evaluated the use of different forms of surveillance, including CCTV and body cameras, within in-patient mental health settings.

Simpson has also studied the use of body cameras specifically at two inpatient mental health wards. That study, published in May 2024, found the cameras have limited impact on the number or severity of incidents.

In terms of perceptions among staff and patients, there was a mix. “For the nurses in particular there are concerns that cameras can create an additional barrier between them and the individual,” Simpson says. But he also found that the cameras do make staff and other patients feel safer.

In any case, he and co-authors cautioned that success at one hospital site doesn’t guarantee the approach will work at another.

Patient trust

Kristiansen acknowledges that there are instances when turning the camera on might aggravate the situation and break the doctor-patient relationship.

A violent patient with possible background vulnerabilities may need to be held in the Emergency Department until they can be referred on for a mental health assessment, for instance.

Those instances are relatively uncommon though, he adds, and acknowledges that, even then, if a patient became “really violent and aggressive I would still turn it on”.

He expresses some discomfort about police wearing body cameras in a clinical setting, however. “With stabbings and very severe incidents, often the police will still have their body-worn camera on, and they will come into the clinical bay while we’re resuscitating or starting to see the patient and have it recording all staff.

“That’s very tricky and it can feel that that’s destroying the ability to properly assess patients.”

The root of the problem

Whatever their current benefits and drawbacks, body cameras are far from a single solution to the growing issue of violence against medical staff. Within hospitals and other healthcare settings, panic alarms, protected areas for staff rest and other measures can all make a difference.

Simpson and Kristiansen also say that staff need to be trained in de-escalation, identifying patterns of behaviour and understanding triggers. In a mental health care setting in particular, these skills are crucial for staff to do their jobs effectively, Simpson says.

Kristiansen, Maton and Metcalfe all acknowledge that wearing a camera for safety isn’t something they should have to do. The systemic issues that have brought us to this moment – including skyrocketing demand for healthcare services, an ageing population with more complex needs, struggles with staff retention and more – start outside of the hospital walls.

But within those walls, Kristiansen says he has no regrets about wearing a body camera. Already the footage he has recorded has been used in two criminal investigations.  

In his experience, during consultations patients are often inquisitive about the camera. 

When he explains what it is for, the response is seldom outrage that he is wearing it, but shock and sadness that a doctor feels the need to.

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