Vision based patient monitoring system (VBPMS) policy

1 Document summary

This policy sets out the trust’s approach and expected standards for the use of video based monitoring systems (VBMS). A video based monitoring systems is an assistive technology designed to support, but not replace, direct in‑person clinical observation, which remains the standard and expected practice for monitoring patients within inpatient services.

Video based monitoring systems may be used to enhance patient safety by enabling non‑contact monitoring of selected physiological parameters, such as pulse and breathing rate, alongside limited information relating to patient location, activity, or behaviour. The system may also provide contextual video information, which may be blurred and available either in real time or for retrospective review.

The use of video based monitoring systems does not replace high‑quality nursing care, therapeutic engagement, professional curiosity, or clinical judgement. Colleagues must continue to prioritise regular, meaningful, in‑person observations and interactions as the primary means of assessment and care delivery. A video based monitoring system should only ever be used to complement, augment, or provide additional assurance alongside direct observation.

Video based monitoring systems must be prescribed and implemented in a person‑centred manner, supported by clear and ongoing communication with patients, explicit consent prior to activation, regular multidisciplinary team (MDT) review, collaborative care planning, and consistent in‑person therapeutic engagement by the clinical team.

2 Introduction

The trust is utilising video based monitoring systems to enhance the delivery of safe and effective care by introducing solutions to proactively manage and prevent incidents.

The trust has considered the national recommendations, guidance and best practice on safe use of video based monitoring systems in the development of this policy.

This policy details the processes to be followed when using video based monitoring systems. The use of the system will align to and complement traditional working practices and relevant trust policies.

The video based monitoring systems does not replace positive and therapeutic engagement with patients and the visible presence of colleagues within inpatient settings. Colleagues must remain responsible for the patient and clinical judgement must always be used.

The purpose of this document is to provide colleagues with clear guidance on video based monitoring systems, to help plan, review and optimise treatment for patients whilst making the best use of resources.

The trust currently delivers video based monitoring systems via LIO which uses an optical sensor (camera and infrared illumination in a secure housing on the wall) supporting colleagues to:

take cardio-respiratory measurements remotely

access cardio-respiratory trends from the last 24 hours to understand if a resting patient’s physical health may be deteriorating
receive real time alerts to high-risk activity
view objective patient activity reports to support clinical decision-making

The technology is not closed-circuit television (CCTV) and colleagues should not attempt to use it for surveillance purposes. Colleagues should refer to the trust security policy for further information on closed-circuit television.

3 Procedure

3.1 General guidance and principles of use

Any decision to use LIO must be made on a case-by-case basis, using a person-centred approach. Explicit consent must be obtained before the system is activated.

The use of LIO must be based on a legitimate, proportionate, lawful and fair purpose. It must not be applied as a blanket intervention for all patients.

While LIO can offer valuable support in promoting sleep hygiene and reducing unnecessary disturbance during the night, it is important to emphasise that LIO should never replace in person observations. LIO use overnight should be determined collaboratively through ongoing discussion with the patient, the multidisciplinary team and as part of a personalised care plan, which may also incorporate positive behaviour support (PBS).

Where a decision is made to use or not use LIO, the discussion with the patient and, where appropriate, relevant others (such as family members, carers, attorneys and deputies under the Mental Capacity Act with the appropriate powers or members of the multidisciplinary team), along with the intended aims, must be clearly documented in the electronic patient record (EPR).

The nurse in charge is responsible for ensuring that LIO is accessed and used only by colleagues who have completed the appropriate training.

The nurse in charge is responsible for the allocation of observations ensuring that these are distributed evenly and according to competence. Wherever possible a colleague should not be expected to undertake observations for longer than 1 hour at a time. See the trust’s supportive therapeutic observation policy for further guidance.

When undertaking an observation using LIO, colleagues must ensure that the patient’s privacy and dignity are respected and always maintained. There may be circumstances where it is not appropriate to continue an observation, including where:

the patient is undressed or partially undressed
the patient is engaging in sexual activity, including masturbation
the patient is privately practising their religious or spiritual beliefs

In such circumstances, the observation must be immediately discontinued where no risk is evident and reattempted later.

LIO must not be used while a patient is using the en suite bathroom. The room tile will clearly indicate room status. Colleagues must only access the vital signs workflow when the room tile is green and displays either “in room” or “in bed”.

When an alert is received or a check is initiated, colleagues will view a live image of the patient for a maximum of 15 seconds. Alert images are blurred.

All incidents identified or observed through LIO must be reported:

in Radar under patient details, “Did a digital system alert you to the incident?”
in the electronic patient record (EPR) on the intervention or de-escalation template in the reducing restrictive interventions (RRI) node

The system does not generate alerts for vital signs, including high or low pulse or breathing rates, nor for the cessation of vital signs.

3.2 LIO functionality

LIO has three core functions to support therapeutic observation and physical health monitoring, with access controlled through user authentication to ensure only authorised colleagues can use the system:

observations
vital signs
alerts

On admission and where appropriate thereafter, colleagues, with support of the multidisciplinary team must consider the potential clinical benefits of LIO and whether it should be offered or used to support the individual patient.

Colleagues must consider how LIO can complement core practice in line with relevant observational policies. The electronic patient record (EPR) must clearly reflect all decisions relating to the use of LIO.

A flowchart outlining how to perform an observation is available in appendix A.

User authentication is built into LIO to ensure that only authorised and appropriately trained colleagues can access the system, view patient information or manage observations.

Access is controlled through secure user credentials and trust-approved devices, helping to protect patient privacy and maintain accountability for system use.

The following requirements apply to all colleagues using LIO:

secure device access: LIO must only be accessed through trust-approved devices, including nursing station screens and encrypted portable tablets
individual log-in: colleagues must use their own secure credentials when accessing LIO; shared accounts must not be used
signing out: colleagues must sign out of LIO when they have finished using the system or when leaving a device unattended
automatic sign-out: for security, LIO will automatically sign users out after 15 minutes of inactivity or when the maximum session duration of 60 minutes is reached
role-based access: access permissions must reflect the colleague’s role and clinical need, with access limited to the functions and areas required for safe patient care
audit trail: LIO records user access and activity to support clinical accountability, information governance and investigation of inappropriate access where required
system administration: system configuration and infrastructure-level changes must only be undertaken by authorised LIO support engineers following appropriate verification and approval

Colleagues can view this video to support logging in for the first time. If you’re having trouble signing in, please report this via the trust information technology (IT) portal (staff access only).

3.2.1 Observations

In person observation is the trust’s standard and expected practice. Where in person observations are not undertaken, there must always be a clear, recorded clinical rationale explaining why in person observation was not required in that specific instance and why LIO was selected instead.

LIO may be used as a supportive measure alongside in person observation, particularly where either:

entering the patient’s bedroom is likely to increase agitation, escalation, or distress
a room‑entry alert indicates that another patient may have entered the bedroom

LIO enables colleagues to observe patients without physically entering the bedroom and may provide visual reassurance that a patient is awake and alert, or asleep with visible signs of breathing, alongside pulse and respiration readings where available.

Any reliance on LIO in place of, or in support of, in person observations must be proportionate, time‑limited and clinically justified. Where there is any uncertainty including but not limited to situations where a patient is concealed under bedding, has changed position, visibility is restricted, there is a known or suspected self‑harm risk, or concerns arise regarding physical health, colleagues must undertake an immediate in person review.

LIO must not be relied upon in circumstances where a patient’s body, face, or breathing is obscured (for example, under blankets or bedding), or where there is any risk of concealed self‑harm, suffocation, or strangulation. In such situations, in person observation is mandatory to safeguard the patient’s wellbeing.

3.2.2 Physical health observations (vital signs)

LIO records basic physical health observations, specifically pulse and respiration rate. Where additional observations are required (for example, blood pressure or oxygen saturation), these must be completed in line with relevant trust procedures.

When physical health observations are taken via LIO, colleagues will view a live image of the patient for a maximum of 15 seconds.

Where a patient requires regular physical observations, pulse and respiration must be taken manually alongside other required observations. A combination of LIO and manual readings should not be used.

LIO cannot measure pulse or respiration accurately when a patient is moving. If the patient is moving, colleagues should record the patient’s position and reattempt the reading once the patient is still.

Colleagues may make up to two attempts to obtain a respiration rate via LIO. If unsuccessful, they must physically locate the patient and complete a manual assessment.

Any concerns regarding a patient’s physical health must be escalated in line with the trust’s physical health policy. Where a pulse or respiration reading is abnormal, colleagues should manually confirm the reading before escalation, unless there are clear visual signs of deterioration.

Although LIO vital signs functionality is a certified medical device, patients must always be assessed in person if there are concerns regarding accuracy or clinical presentation.

Emergency intervention must not be delayed checking LIO. Clinical judgement must be used to determine the most appropriate and timely response.

3.2.3 Alerts

LIO provides alerts and notifications relating to a patient’s location and movement within their room. Here is a list of available alerts and notifications:

leaving bed: alerting colleagues when a patient is attempting to leave the bed
out of bed: alerting colleagues when a patient is out of bed
in bathroom: notifying colleagues when a patient enters the bathroom
out of room: notifying colleagues when a patient has left their bedroom
multiple people: indicates that another patient may have entered the bedroom
replay last alert: allows colleagues to view a blurred clip showing up to five minutes before and after the most recent alert; this supports review of the circumstances of the alert and helps inform appropriate action, only the most recent alert is available for review within a 24-hour period.

When an alert is triggered, colleagues will initially view a blurred image to determine whether a physical check is required to maintain patient safety.

Alerts may be temporarily paused for up to 30 minutes while colleagues are providing direct personal care.

3.3 Seclusion

LIO is intended to enhance the visual and physical observations required under the secluded or segregated policy. It does not replace the requirement for constant observation but provides additional information to support patient safety and more frequent physical health monitoring without unnecessary entry into the seclusion room, where this may increase risk or distress.

LIO must not be paused in a seclusion environment, as it provides additional support for patients already subject to constant observation.

A mobile LIO tablet is available within seclusion areas and must be activated upon admission of a patient to seclusion, enabling monitoring in line with this policy.

3.4 Falls

LIO may support falls prevention and management by:

alerting colleagues when a patient is attempting to leave the bed (leaving bed alert)
alerting colleagues when a patient is out of bed (out of bed alert)
notifying colleagues when a patient enters the bathroom
enabling retrospective review of footage following a fall to identify potential contributing factors and inform preventative measures

3.5 Changes to room layout

LIO can automatically detect minor bed movements, such as those made during cleaning, or when a bed is raised or lowered.

However, LIO cannot automatically detect significant changes to bed position, for example if a bed is moved to a different location within the room or rotated by 90 degrees. Such changes may affect the accuracy of “in bed” room status indicators and related alerts, particularly leaving bed and out of bed alerts.

Where a bed has been moved significantly from its original position, colleagues must notify LIO as soon as possible. This should be done either by using the Feedback function within the application or by contacting the LIO support line, available 24 hours a day, 7 days a week, on 0800 030 6781, to enable appropriate system adjustments.

LIO must also be informed of any significant changes to room layout or furniture, such as the movement of wardrobes or other large items, to ensure that the optical sensor remains unobstructed and functions accurately.

3.6 Patient information, capacity and consent

3.6.1 Providing information to patients

On admission and at appropriate intervals thereafter, colleagues must provide patients with clear and accessible information about the use of LIO. Explicit consent must be obtained before the system is activated.

Colleagues must explain:

the purpose of LIO and how it supports safe and effective care
what the system monitors, including activity, pulse and respiration rates
the circumstances in which privacy may be compromised during observations
what data is captured, how it will be used and how long it will be retained
how patients may request deletion of data where applicable

Patients must be given the opportunity to ask questions and raise concerns. Colleagues must respond appropriately or escalate concerns where required.

Discussions must be supported by written information, including the LIO patient leaflet. Colleagues should also use resources available on the LIO intranet page (staff access only) to support explanations.

Information must be provided in formats suitable for the patient’s communication needs and in accordance with the accessible information standard (AIS).

LIO signage must be clearly displayed in relevant public areas. Families, carers and visitors should be informed about the use of the system at the earliest appropriate opportunity.

3.6.2 Legal basis and consent requirements

In line with NHS England’s Principles for Using Digital Technologies in Mental Health Inpatient Treatment and Care, any decision to use video based monitoring systems (VBMS) and collect or store data generated by the system must be based on:

the patient’s consent
consent from a person lawfully acting on the patient’s behalf; or
a lawful best-interest decision where the patient lacks capacity to consent to its use

Consent must be informed, personalised and regularly reviewed. It must not be applied as a blanket approach across wards or services.

Patients must be informed that they may withdraw consent at any time.

If a patient withdraws consent to the use of video based monitoring systems, monitoring and future data collection must cease unless a lawful best-interest decision or other legal authority applies.

3.6.3 Data protection and lawful processing

For data protection purposes, the trust does not rely on UK General Data Protection Regulation (GDPR) consent as the lawful basis for processing video based monitoring systems data.

Personal data generated by video based monitoring systems is processed under:

UK General Data Protection Regulation Article 6(1)(e): public task or exercise of official authority
UK General Data Protection Regulation Article 9(2)(h): provision of health or social care or treatment, and management of health or social care systems and services

Withdrawal of consent does not retrospectively change the trust’s lawful basis for processing data already collected.

Previously collected data remains part of the health record and may be retained and used for:

direct care
patient safety
safeguarding
incident review
audit
legal or regulatory obligations

Information about how the trust processes personal data is available in the trust privacy notice or from the data protection officer (DPO) or Information Governance team.

For the purposes of consent discussions, patient data includes any information relating to the patient’s health and care generated through video based monitoring systems. This may include demographic, administrative and medical information in numerical, textual, image, video or audio formats.

3.6.4 Clinical decision-making

Video based monitoring systems may be proposed where it represents the most appropriate, effective and least restrictive option to support patient safety and care.

The admitting nurse, in consultation with the multidisciplinary team, must consider the clinical appropriateness of LIO for each patient. This decision must balance:

patient safety
clinical need
risk management
patient preferences
alternative monitoring or therapeutic options

Senior clinical advice should be sought where necessary, including through out-of-hours on-call arrangements.

If LIO is considered clinically appropriate, but the patient does not consent, the system must not be used unless concerns arise regarding the patient’s decision-making capacity. In such circumstances, the multidisciplinary team must consider alternative monitoring and support arrangements.

3.6.5 Capacity and best-interest decisions

Where a patient’s capacity to consent is uncertain, a capacity assessment specific to the use of LIO must be undertaken.

If the patient is assessed as lacking capacity, the multidisciplinary team must make a best-interest decision in accordance with the trust’s Mental Capacity Act policy. This applies to both informal and detained patients.

Best-interest decisions must authorise only the least restrictive use of LIO necessary to meet the patient’s identified care and safety needs.

3.6.6 Documentation

The patient’s decision, including any conditions or preferences relating to the operation of LIO, must be documented in the electronic patient record (EPR).

The record must include:

the information provided to the patient
the clinical rationale for video based monitoring systems use
how the data will be used
when the next review will occur
how the patient can withdraw consent

Where video based monitoring systems use is agreed, colleagues must discuss with the patient how any privacy compromises should be managed if they occur (for example, whether the patient wishes to be informed afterwards or reminded that monitoring is active). These preferences must be recorded in the patient’s management plan.

All decisions relating to the initiation, continuation, refusal or withdrawal of LIO -including best-interest decisions and withdrawals of consent must be documented in the electronic patient record to ensure multidisciplinary team oversight and inform ongoing care.

3.6.7 Review and oversight

Decisions relating to the initiation, continuation, refusal or withdrawal of LIO must be reviewed by:

the responsible clinician (RC)
the consultant in charge or approved clinician (AC)
the consultant on call (if relevant)
the multidisciplinary team

This review must occur within 24 hours. As these decisions are not typically emergencies, reviews should normally take place during daytime multidisciplinary team hours.

Decisions must be reviewed weekly, or sooner if the patient’s presentation or wishes change.

3.6.8 Advocacy

Patients must be supported to access independent advocacy services where appropriate:

Rotherham: Cloverleaf
Doncaster: VoiceAbility
North Lincolnshire: POhWER

Further guidance to support discussions with patients is provided in appendix B, and a decision-making flowchart is available in appendix C.

3.6.9 Operational requirements

If LIO is switched off in an individual room, it must be manually reactivated if monitoring is later required.

A LIO health check must be completed for each admission to confirm the system is operational when consent or a best-interest decision authorises its use.

3.7 Requesting and approving clear video data

The LIO system can provide short segments of clear video data (CVD) to support the investigation of patient safety incidents.

Video footage is available in either:

clear format (available only within 24 hours of recording)
anonymised (blurred) format, depending on the timing of the request

Clear clear video data must be requested as soon as possible, as video data is held within a rolling 24-hour buffer. Once this limit is reached, data is permanently deleted and cannot be retrieved.

Where trust authorisation is provided, LIO will deliver requested video footage within:

72 hours for requests made Monday to Thursday
96 hours for requests made Friday to Sunday

While reviewing footage, colleagues may identify additional concerns requiring further investigation. Any such findings must be managed in line with trust governance processes.

3.7.1 Requesting clear video data

All requests for clear video data must be submitted by a registered healthcare professional (HCP) using the trust’s step-by-step guide (staff access only). Requests should be authorised within 28 days, and the patient should be informed when footage is requested and received. The process must ensure that only relevant parties access the footage and that all actions are documented in the electronic patient record (EPR). Any concerns about privacy or data protection should be escalated to Information Governance.

3.7.2 Storing clear video data

Footage viewed in Egress must be assessed for long-term storage based on its relevance to serious incidents or formal investigations. Storage must comply with the NHS Records Management Code of Practice and only footage required for ongoing investigation or legal purposes should be retained. All storage decisions should be documented and access to stored footage must be restricted to authorised colleagues.

3.7.3 Out-of-hours access

Where there is an urgent clinical need to view footage outside normal working hours, the nurse in charge must seek approval from the on-call manager. Footage should be viewed directly via the Egress portal, with standard processes followed thereafter for storage, retention, and deletion.

3.7.4 Data protection and colleague support

Any data protection concerns, or requests to use video footage outside its original purpose, must be discussed with the trust’s data protection officer.

The lead investigator must consider the emotional impact on colleagues viewing footage and ensure appropriate support and debriefing arrangements are in place.

3.8 Data retention and management of information requests, complaints and legal disclosure

Footage stored on the trust’s secure video folder (R:\Secure Video) must be retained in line with NHS Record Code of Practice. Retention timescales may vary depending on the original reason for storage.

Patients who wish to access their personal data via a subject access request (SAR) will be supported through the trust’s established processes. Detailed guidance on individual rights and subject access request procedures is set out in the trust’s individual rights policy. The trust has established processes for subject access requests (SARs), disclosures. More information is available on the public website under information governance.

Requests for access to video based monitoring systems data-including video footage; must be managed in line with the trust’s data protection procedures. This ensures compliance with UK General Data Protection Regulation, maintains patient confidentiality and supports transparency in responding to complaints or legal matters. Colleagues must be aware that any request for video based monitoring systems data may require review by information governance and the data protection officer prior to release.

3.9 Oversight of LIO

The partnership board meets quarterly and provides the trust and LIO with the opportunity to discuss overall use of the system, developments and highlight any issues that need to be resolved.

The digital community of practice meets monthly and provides an opportunity for clinicians and front-end users of the system to reflect on practice, raise issues for discussion and action directly with LIO, it also provides an opportunity for LIO to share developments directly with trust colleagues.

3.10 Business continuity plan

If for any reason there is a technical failure or malfunction of LIO, then colleagues must revert to the manual taking and recording of observations and ensure that the appropriate supporting clinical policies and any local working instructions or agreements are followed.

All faults should be reported to LIO. Any connection issues need to be reported to both LIO and trust IT service desk.

Please also refer to your local business continuity plan.

3.11 Escalations

Concerns regarding LIO functionality should be escalated to the ward manager and LIO.

Concerns regarding consent, privacy and information governance should be escalated to the mental capacity lead and head of information governance respectively.

Concerns regarding safety should be raised with line managers and the Patient Safety Leadership team (PSLT) or via freedom to speak up (staff access only).

4 Responsibilities

4.1 Data protection officer

Data protection officer is responsible for ensuring the organisation processes, the personal data of its colleagues, customers, providers or any other individuals (also referred to as data subjects) in compliance with the applicable data protection rules.

4.2 Chief nursing information officer

The chief nursing information officer and clinical safety officer is responsible for ensuring that assistive tools are clinically appropriate and adhere to clinical safety guidelines.

4.3 Patient Safety Leadership team

The Patient Safety Leadership team are responsible for oversight of the LIO contract, developments to the system and authorising release of secure data.

4.4 Senior managers

Senior managers of the trust are responsible for ensuring that assistive tools are appropriately deployed and used in their clinical areas alongside authorising release of secure data.

4.5 Ward managers

Ward managers are responsible for ensuring assistive tools are used appropriately within their ward environments including monitoring colleagues training and compliance and requesting developments to the system and secure data for patient safety incidents.

4.6 Line manager

Line managers are responsible for ensuring that colleagues who report to them complete the required LIO training and maintain compliance with the annual refresher requirement. They must ensure completion is accurately recorded in Health Roster.

Where LIO training is required, the line manager must manually add the relevant skill to the individual’s roster profile.

Training records must accurately show the completion date and agreed renewal interval. LIO training must be reviewed and refreshed annually.

As Health Roster does not generate automated refresher notifications for staff skills, line managers must monitor compliance, identify when refresher training is due and ensure colleagues complete it within the required timescales. Once refresher training has been completed, managers must update the individual’s roster profile to maintain an accurate compliance record. Where training needs or concerns are identified, line managers should support colleagues to complete refresher training and seek additional advice from the clinical safety officer where required.

4.7 Nurse in charge

The nurse in charge is responsible for ensuring appropriately trained colleagues are allocated to use the system during each shift.

5 Training

Training for LIO is delivered through the NHS Learning Hub linked to electronic staff record (ESR).

Guidance on accessing the training (staff access only) can be found on the intranet.

Prior to using the system, trust colleagues must complete and pass the online training package annually.

Completion and annual refresher training must be recorded in Health Roster by the colleague’s line manager to maintain an accurate compliance record.

Currently NHS Professional colleagues are unable to access the LIO training and therefore must not use the product. The trust is exploring options to facilitate this training in the near future.

It is important that colleagues using the system provide regular feedback (sent via the monitor) to support troubleshooting.

Additional technical support will be provided by LIO via:

Phone

08000 306 781

Customer service phone line for urgent technical issues
Email

 support@LIO.com

Most technical issues will be resolved remotely. Where onsite support is required from LIO, attendance will be between 24 and 72 hours provided access can be facilitated.

6 Monitoring arrangements

Ward managers are responsible for monitoring compliance with this policy, associated management plans and Mental Capacity Act (MCA) assessments. This will be achieved through:

local documentation audits
review of RePortal reports

Matrons will provide senior oversight by:

reviewing RePortal data
monitoring outcomes of ward-level audits
escalating concerns or non-compliance in line with trust governance processes

LIO will provide monthly usage reports, which will be shared with care groups via the Patient Safety Oversight Group and escalated to the Quality and Safety Group where necessary to support oversight, including the identification of themes, trends and learning opportunities.

In addition, a monthly local LIO audit must be completed by ward management teams using the trust’s electronic audit system. Audit results will be submitted to care groups for review and assurance and overseen by the reducing restrictive interventions lead learning opportunities should be discussed in ward manager meetings and actions managed by the multi-professional leadership team on each ward.

7 Related documents

LIO
Incident management policy
Privacy notice
Information Governance team
Mental Capacity Act (2005) policy
Resuscitation manual
Security policy
Supportive therapeutic observation policy
Patient falls manual (prevention and management)
Physical health policy
NHS Record Code of Practice
Freedom to speak up (staff access only)
Consent to care and treatment policy
Healthcare record keeping policy
National Mental Health and learning disability nurse director’s forum. 2022. Vision based patient monitoring systems (VBMS) in mental health wards.
Principles for Using Digital Technologies in Mental Health Inpatient Treatment and Care

8 Appendices

8.1 Appendix A assisted observations process flowchart

Flowchart overview

Click on “Take Observation”.
Check video for patient presence:
- not present, check patient:
  - check patient in person
  - record patient location
Check video for reasons for patient concern:
- concerned, check patient:
  - check patient in person
  - record patient location
Not concerned, is patient still?
- No: record patient location.
Yes patient is still, is breathing rate available?
- Yes: record patient position, and breathing rate.
- No: if breathing rate not observed, process may be repeated once before checking patient in person is required, go back to step 1 and repeat process.

8.2 Appendix B colleague guidance: consent for using the video based monitoring system (VBMS)

Applies to: inpatient mental health services using video based monitoring systems.

Purpose: help colleague obtain and manage consent when proposing, starting, reviewing or stopping video based monitoring systems.

8.2.1 Key principle

Patients should consent to the use of video based monitoring systems technology before monitoring begins whenever they have capacity.

Video based monitoring systems must always be used in line with:

least restrictive care
human rights
person-centred practice

Video based monitoring system must not be used as blanket monitoring across a ward.

8.2.2 Legal position (simple explanation)

Consent here is clinical or ethical consent to use the technology.

Video based monitoring system data itself is processed under NHS legal duties:

UK General Data Protection Regulation Article 6(1)(e): public task
UK General Data Protection Regulation Article 9(2)(h): health and social care

This means:

patients can withdraw consent to monitoring
but existing recordings remain part of the clinical record

8.2.3 Before activating video based monitoring system

You must explain:

why video based monitoring system is being proposed (safety or least restrictive option)
what it monitors
when and how it will operate
what types of data it captures, for example:
- images
- video
- observations
- demographic information
how the data will be stored and used
how often it will be reviewed
how the patient can withdraw consent

Provide information in accessible information standard (AIS) formats if needed.

8.2.3.1 Record in the electronic patient record (EPR)

The consent discussion.
The decision (consent or refusal).
Rationale for using video based monitoring systems.
Review date.
How consent can be withdrawn.

8.2.4 Capacity and best interests

If the patient aged 16 and over has capacity; obtain their consent before activating video based monitoring systems.

If capacity is unclear; Complete a Mental Capacity Act (MCA) decision-specific assessment.

If the patient lacks capacity, video based monitoring systems may be used only if it is in their best interests.

Where possible:

involve the person, family or advocates
seek agreement from a lawful proxy, for example, Health and Welfare Lasting Power of Attorney (LPA)

Document the best interest’s decision clearly.

8.2.4.1 Fluctuating capacity

Reassess; if the patient regains capacity, seek their consent to continue video based monitoring.

8.2.5 Children and young people

For those under 16, assess whether the young person is competent to consent:

if competent, obtain their consent
if not, obtain consent from someone with parental responsibility

8.2.6 If consent is withdrawn

If a patient with capacity (or lawful proxy) withdraws consent:

deactivate video based monitoring systems promptly
agree alternative safety measures (for example, observation levels)
explain clearly:
- withdrawal stops future monitoring
- previously captured data will not be deleted

Existing recordings remain part of the clinical record and may be used for:

patient care and safety
incident review
safeguarding
duty of candour
audit and legal requirements

8.2.7 Review requirements

Video based monitoring systems use must be reviewed:

at least during the agreed multidisciplinary team review schedule (for example, weekly)
whenever the patient’s condition or wishes change

Document all reviews in the electronic patient record (EPR).

8.2.8 Colleague quick checklist

Before activating video based monitoring systems:

explained purpose and safety benefits
confirmed it is the least restrictive option
explained what data is captured and how it is used
provided privacy information
used accessible information standard formats if needed
recorded consent, refusal or best interests decision
documented review schedule

If consent is withdrawn:

switched video based monitoring systems off
agreed alternative safety plan
explained why existing recordings remain part of the clinical record

8.2.9 Example script

Starting video based monitoring systems:

“We’re proposing a monitoring tool to help support your safety in the least restrictive way. It may capture brief blurred images and vital sign trends. I’ll explain what it records, how it’s stored, and who can access it. You can choose whether to agree, and we will review it regularly.”