PUBLIC BOARD MEETING 19 November CM/11/14/08. Agenda item and Paper Number. Andrea Sutcliffe/Paul Bate Rachael Dodgson

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1 MEETING: Agenda item and Paper Number Agenda Title Sponsor Author PUBLIC BOARD MEETING 19 November CM/11/14/08 Covert and Overt surveillance Andrea Sutcliffe/Paul Bate Rachael Dodgson PURPOSE OF PAPER: The Board is asked to: Note how we have addressed the issues and points made at the October Board meeting and further developed the information for the public and providers on covert and overt surveillance. Agree that we publish the attached information for both providers and the public that sets out the issues to consider in relation to the use of covert and overt surveillance Note that work on the circumstances in which CQC might use its own covert surveillance powers is outside the scope of this paper, and a separate programme of work is being planned around this. 1. Summary 1.1 The purpose of this paper is to bring to the Board for approval the information documents for the public and providers on the use of covert and overt surveillance. 1.2 At the Board meeting in October we presented a slide set to the Board that set out the proposed content and principles that would apply to these information documents. The board also discussed covert and overt surveillance in July. 1.2 In October the Board had a useful debate about the principles we had set out and gave some helpful views and steer on tone and content. We have set out how we have addressed the points raised. We have also shared the information documents with a few key stakeholders to seek their views, and our legal colleagues within CQC. 2. Discussion and Implications Context and background 2.1 We expect providers to provide care that is safe, effective, responsive and compassionate. This is crucial if services are to provide high quality care. 2.2 Providers need to ensure they have a workforce that is well trained, well supervised and well supported. They must ensure they recruit people with the right values and approach to caring. They need to create a culture whereby Page 1 of 5

2 people can challenge one another in instances of poor practice and issues can be raised and addressed. They must lead the service well. 2.3 We know that some people who use services, their families, carers and friends can have high levels of anxiety about the quality of care provided. Sometimes these anxieties can lead them to think about installing hidden cameras (particularly in the light of high profile examples of the use of covert surveillance exposing abuse such as Winterbourne View, Ash Court and the Old Deanery.) 2.4 Whilst evidence suggests that covert surveillance is mostly used in social care settings, it may also be used in other sorts of services. For example Winterbourne View was a hospital. Overt surveillance is used frequently in some settings, for example in waiting areas and corridors in hospitals, and surgery is often recorded for training and education purposes. 2.5 When members of the public consider using a hidden camera because they are anxious about the quality of care some will decide for themselves that this is the course of action to take. Others will want to find out more information before going ahead. One of the places people will look to for that information is CQC (we know this as numerous people already contact us to ask our advice). 2.6 CQC is on the side of people who use services, and as part of that we should do what we can to support people with health and social care issues. In this case part of that support is about providing information about using covert surveillance to help people reach a decision. That information should also make clear to people that CQC will act on evidence of poor care. 2.7 We want people to talk to us if they are concerned about poor quality care. Whilst CQC does not have the power to resolve individual complaints we do use the intelligence from people who raise concerns or make complaints to assess the risk to quality and safety, and in many cases will inspect a service as a direct response. We encourage people to refer their concerns to CQC and will continue to do so, being aware that sometimes those concerns might take the form of surveillance footage. 2.8 When we have evidence about poor quality care we will take swift action to secure improvements. For example, our State of Care report highlighted an appalling care service we found in East Anglia. We served 4 warning notices immediately and worked with commissioners to make sure the service improved. We cite another example in our State of Care report where a whistleblower had raised concerns with us, we undertook an inspection and served a warning notice. Care did not improve and we cancelled the registration of the service. 2.9 Providers are also actively considering whether they should use surveillance (for example HC-One have recently consulted on the use of surveillance). For many providers they will be considering the use of overt rather than covert surveillance. Again, providers want to know what the CQC view is on the use of surveillance, and are looking to us to provide information to help them take decisions and make sure they take account of the relevant issues. Page 2 of 5

3 Addressing the points raised by the Board 2.10 At the last Board discussion several points were made about the principles and proposed content of the information documents. This part of the paper sets out how we have addressed those points. Comment 1. The position taken sounds like we are sitting on the fence 2. We need to keep the information for the public practical and simple. 3. We need to be clear that generally the public install covert cameras because they are concerned and anxious about care and set out what else they can do if they are worried about care. 4. We need to be clear what we will do with any surveillance information provided to us 5. Is there adequate research on this issue? How we have addressed this We have made the information clearer, for example we don t say we neither discourage nor encourage. We have made the information for the public very short and only included legal issues that are absolutely necessary. Once the Board has approved the content the information will be further worked on to ensure the language used is accessible to the general public. We have made this clear in the document and included information about who else people can go to if they are worried (including of course CQC). We have set this out in the information for both the public and providers. We also have more detailed information for our staff on what they should do if they receive any surveillance footage. We will make this guidance available on our website so providers and the public are clear and we are transparent about our internal processes. We commissioned a literature review from SCIE and that concludes there is little research and evidence about the use of covert and overt surveillance in health and social care settings. We will publish the literature review at the same time as the information documents. The literature review is an appendix to this paper. 6. We need guidance for staff We already have guidance on assistive technology for staff which includes information about surveillance. We have information for our staff (both NCSC and inspectors) on what to do with any surveillance evidence we receive. Page 3 of 5

4 7. It should include something about routine filming in surgery for record keeping in hospitals The provider information does talk about the occasions that surveillance may be used more routinely and includes this specific point. 8. References to Parliamentary and Health Service Ombudsman and Local Government Ombudsman confusing for families 8. Is the information sufficiently helpful regarding detail i.e. the key legislative guidance for providers in particular 9. Should we say if you have any concerns do contact us and we will inspect straight away as a commitment? We have removed these references and instead refer to CQC, the local authority and the police The provider information includes lots of detail on the legislation as it applies to them. The public information is focused on the questions they are most likely to have. We are clear in the information that we will follow up on issues people share with us. We should not commit to inspecting straight away as this might not always be appropriate. 3. Conclusion and Next Steps 3.1 The helpful discussion and steer from the last Board meeting has helped us to draft the final versions of the information documents which are being shared with the Board today for approval. 3.2 The intention is that these documents prove helpful to people in making decisions about using surveillance. 3.3 If the Board are content to agree the information documents we will ensure that they are finalised quickly with help from colleagues in engagement in terms of ensuring they are accessible to the public and clear to providers. 3.4 We will aim to publish both documents by the end of November. Appendices Appendix 1 Information for the Public Appendix 2 Information for providers Appendix 3 Literature review Background Papers Chief Executives Report 30 th July 2014 Board paper 15 th of October Page 4 of 5

5 Name Rachael Dodgson Title: Head of Adult Social Care Policy Date 7/11/2014 The following people have been involved in the preparation of this paper Simon Richardson Information Rights Manager Dave James Policy Manager April Cole Policy Officer Page 5 of 5