Stop Oxevision

On Wednesday 22nd January 2025, BBC News shared coverage of our campaign online and on national and local television and radio channels. The article featured three members of our campaign group, and has brought greater attention to some of the pressing concerns regarding the use of Oxevision and other video-surveillance devices in psychiatric hospitals. The news coverage also featured statements from the Royal College of Psychiatrists (RcPsych) and the charity Rethink Mental Illness, calling for the use of Oxevision to be paused. Following months of silence on the issue from both organisations, including in response to Stop Oxevision’s requests, we were surprised by this new stance. 

Whilst we agree with these calls for the rollout and use of Oxevision to be halted, we first wish to express disappointment that neither institution (nor others such as The Royal College of Nursing, CQC, NHS England or other mental health charities such as Mind) have previously used their platforms and associated power to make such calls previously, instead leaving the work of campaigning and advocacy to patients and survivors. We do not consider this acceptable nor sustainable, and urge institutions to take greater responsibility in taking steps to address harmful and abusive practices within psychiatric services.

A lack of clear position statements from RCPsych and Rethink Mental Illness

These calls came as news to us. Neither organisation had publicly made such statements, despite 18 months of our campaign, and years of patient-led campaigning. Though Rethink has previously spoken on their concerns around Oxevision – in a statement published on November 20th, 2023, they acknowledged the issues about Oxevision raised by patients, and agreed that Oxevision (and other surveillance) is a form of restrictive practice and must only be used with the consent of patients – they have also stated that if a patient is deemed to lack ‘capacity’, it may be appropriate to use the technology in their ‘Best Interests’. In an update in April 2024, Rethink call for “more independent, co-produced research that thoroughly evaluates the impact of monitoring systems, including the full range of potential harms, to ensure the use of this technology is in no way detrimental to the therapeutic relationship between people in services and their caregivers”. This, arguably, contradicts their prior argument. Surely, a technology cannot be seen as being in an individual’s best interests when it has not yet been established as safe or unsafe. In either case, Rethink’s call for Oxevision to be stopped is new. 

Similarly, the Royal College of Psychiatrists are yet to issue any position statement regarding Oxevision, beyond comments to media outlets. We have been informed through private communication that RCPsych have been working on a statement, however, nothing has been published.

Research: the answer to the problem, or a problem itself?

In a comment to the BBC, a spokesperson for the Royal College of Psychiatrists stated: “before any further rollout of video monitoring technology is considered, we believe there needs to be significant research undertaken that is independently accredited and co-produced with patients, their carers and families”. This language is strikingly similar to Rethink’s, both speaking to a tendency to make hypothetical calls for ‘more research’ as a solution to a pressing issue – serving to delay decisive action. Calling for hypothetical research, whilst taking no steps to action their call, also serves to deflect and diffuse responsibility, failing to recognise their own position as an influential institution capable of enacting meaningful change. 

Research – even that which purports to be “independently accredited and co-produced” – is not an inherent force for good. This was starkly evidenced when a study using Oxevision to collect and analyse video footage of patients without their consent was approved by the NHS Health Research Authority. We are aware of more research currently in progress that aims to examine ‘patient safety incidents’, using data from Oxevision in a similar way. However, we have found it difficult to gain information about this study, having been refused details about the nature of the research. This raises unaddressed questions about the transparency, integrity and ethicality of any further research about the technology.

Ultimately, no research should ever be given greater weight than the safety, autonomy, and mental health of patients, which may never be fully quantifiable by research. The substantial concerns regarding Oxevision – including a series of patient deaths in which technology may have played a role – should be evidence enough to halt the use of the technology immediately, without the delay of lengthy research processes. 

‘Guidelines’, ‘principles’ or the law?

In their response to the BBC, NHS England said it has “instructed mental health trusts to review its use of camera surveillance and will update its guidance in the coming months”. As with calls for more research, we do not feel reassured that updated guidelines are a sufficient solution. Firstly, poor practice is rife in psychiatric services and abuses often occur where protocols, policies and laws are disregarded, inconsistent, and/or poorly enforced. We have heard reports of Oxevision being used in ways which are not sanctioned by Trust policies and have concerns about the potential for it to be used as a tool for sexual predation by staff. ‘Guidelines’ will be insufficient to address the risks of the technology being misused. 

Repeated calls for further guidance about the use of technology overlooks the key guiding principles already in existence: the law. In their letter to NHS mental health trusts on the 7th September 2023, NHS England urged trusts to ensure that “the use of such systems should be carefully considered on a case by case, patient-by-patient basis to ensure that any decision to use such systems has a legitimate aim and is both lawful and fair”. Their calls to ensure practice is lawful implies genuine doubt about the legality of the previous or current processes. Despite their letter outlining the actions they said would be completed by March 2024, NHS England have failed to provide any further update. 

Since the BBC coverage, two written questions have been submitted to the government regarding Oxevision by Labour MP Satvir Kaur and Lord Scriven. Responses returned on 29th January 2025, refer to research commissioned by the Mental Health Policy Research Unit, however fail to mention that this identified that there was a lack of evidence to support the use of surveillance in mental health units. The responses also reference NHS England’s ongoing work to develop guidelines, yet no further commitment was made to address the concerns raised. This echoes our fears that, whilst the guidelines do not go far enough to protect patients from harm under Oxevision and similar technologies, the existence of this work can be used to justify delaying decisive action. Guidelines ultimately risk supporting and legitimising the use of Oxevision. The development of guidelines infers that there is no choice but to use the technology, ruling out the possibility that the use of this restrictive practice can be avoided altogether. 

Accountability for mistakes

RCPsych and Rethink’s statements fail to acknowledge the countless patients who have been harmed by mental health services and been subject to unlawful treatment over the past decade. Without the recognition of these harms is omission mistake – that yet another ‘innovation’ has been allowed to be rolled out without proper checks and balances – there is little to prevent this reoccurring, and no accountability taken by the organisations who claim to serve individuals with lived experience of mental ill-health, distress or trauma.

Oxevision was first introduced in Broadmoor hospital in 2014, but it was not until 2023, following our campaign efforts, that some trusts began to change their policies to seek consent from patients for the use of the technology. This leaves a significant period of time – during which Oxevision was awarded funding, support and endorsement from the NHS Innovation Accelerator to support its widespread adoption across the country – when Oxevision was in operation across the country, unbeknown to those it recorded.

Our campaign to improve patient care in the future is dependent on acknowledging the mistakes of the past. Where it is now clear that Oxevision may have been used unlawfully and lacks any robust, independent evidence to support its use, we must hold those who are responsible for facilitating its widespread rollout to account for the harms of these actions. 

We therefore call on RCPsych, Rethink, and other stakeholders to take a stronger stance on the rollout of Oxevision; to unequivocally commit to protecting patients currently vulnerable to the harm and distress associated with video surveillance technologies, and to use their power and influencing expertise to seek justice for those who have been harmed by the failings we are campaigning to rectify.