Stop Oxevision

An NHS Trust has had to pay out to a patient after she complained to the Ombudsman about the use of Oxevision during her time as an inpatient. This is not unique – all Trusts are at risk of having to pay out

We have written to NHSE outlining how we believe that now is the time for them to call for the complete cessation of the use of Oxevision across the NHS. 

If you would like support or advice regarding complaints processes or escalations, please get in touch at stopoxevision@gmail.com.

On the 27th March 2026, the Parliamentary and Health Service Ombudsman (PHSO) ruled that Essex Partnership University NHS Trust had made failings in relation to its use of Oxevision during the admission of ‘Miss B’ between 2021-2022. The report outlines failings in relation to the use of Oxevision without Miss B’s consent and not turning it off despite her requests; the lack of information provided about the technology; and additional failings in the Trust’s processing and response to Miss B’s original complaints. With her consent to share, the report from the PHSO is available here.

The PHSO ruled that EPUT’s current policy is not in line with the guidance of NHS England or the GMC – even though this was reportedly revised in order to adhere to the NHS England digital principles, causing disruption to the Lampard Inquiry hearings last May. 

However, the way EPUT has used Oxevision previously, and in their current policy, is no different to how Oxevision has been used across the country – aligned with the way the manufacturer, Oxehealth/LIO, have promoted it. Therefore, this ruling has important implications nationally and could present significant issues for the other Trusts who have historically and continue to use this technology. 

We have written to NHS England to highlight these concerns and to suggest that, whilst they have published national ‘principles’ this action has been insufficient to address the issues inherent to the use of surveillance in patient bedrooms. Our letter, which you can read here, highlights concerns about the lack of national oversight and enforcement; the lack of clarity in the NHS Digital Principles; and raises concerns about the inappropriate involvement of external private companies in the operations of NHS services. 

In our letter, we also asked NHS England to write to the National Mental Health and Learning Disability Directors Forum regarding ‘national guidelines’ developed with Oxehealth/LIO which promoted the use of Oxevision in ways that did not align with NHSE’s ‘digital principles’. Since our letter to NHS England, this ‘national guidance’ has now been deleted. 

We are yet to receive a full response from NHS England to our letter and have been advised that they will provide this in due course. However, in an email on 16th April, two NHS England directors said: 

“Our position (as set out in the Principles for the Use of Digital Technologies) remains unchanged in that due to the need for personalised decision making, including seeking patient consent, digital technology (including VBMS) must never be used as a ‘blanket approach’ to care applied to all patients on a particular ward or in a particular department.

As I am sure you are aware, the subsequent CQC guidance for inspectors is also clear that VBMS should not be used for surveillance. This means that providers must not use these technologies to continually monitor people to keep them safe from abuse, neglect, or other criminal activity.”

In this article, we first provide an overview of the guidance regarding ‘vision based monitoring systems’ from NHS England and CQC. We will then outline the ruling from the PHSO in relation to Miss B’s complaint, and finally we will outline a summary of how 20 NHS Trusts in England are using Oxevision. 

NHS digital principles 

Following our initial letter, and growing concerns nationally, in September 2023 NHS England wrote to all NHS Trusts stating that “it is our view that Vision-based monitoring systems should never be implemented in a blanket way and that any decisions to use VBMS in patient bedrooms should be made in a person-centred way” (bold in original). The letter continues, “we are, therefore, asking all services to please review, clinically and ethically, current VBMS practice within your organisation to ensure your use of these technologies aligns with the principles of least restrictive, compassionate, therapeutic and personalised care”. NHS England initially committed to providing more substantive guidance by March 2024. However, it was not until February 2025 that NHS England published its ‘Principles for using digital technologies in mental health inpatient treatment and care’. 

Following publication of the Principles, Stop Oxevision reiterated the concerns we had expressed repeatedly throughout stages of development. These had not been addressed in the final publication. We expressed concerns that the Principles failed to provide sufficient clarity; risked presenting fundamental legal requirements as optional; and lacked any commitment to enforce or monitor adherence to the Principles. We described the Principles as “vague and unenforceable” and highlighted the fact that “the choice to present the document as a set of ‘principles’ renders it ambiguous and unenforceable. They have no regulatory power, and there is no clarity over who is responsible for their use.” 

We outlined that “framing Human Rights as a ‘principle’ positions Human Rights law as something healthcare providers should aim to achieve but is ultimately unenforceable – rather than something that should already be fundamental to all actions in mental health wards”. As we noted, “it should go without saying that Trusts must follow the law in all aspects of healthcare, but the very fact that these ‘principles’ were made highlights that trusts fail to do so. In this instance clarity, closing loopholes, enforcement and holding individuals to account is paramount – these principles risk doing the precise opposite.” (bold in original). Our response to NHS England’s Principles concluded: 

“The new ‘principles’ fail to address fundamental legal and ethical issues with Oxevision and similar technologies. Without direct, decisive action that has real-world implications, private and for-profit technologies will continue to cause harm. In the absence of transparency and accountability, claims of ‘co-production’, ‘human rights approaches to care’, and ‘high-quality evidence’ will remain inauthentic and unenforceable… 

…We call upon NHS England to take a clearer position on Oxevision and similar technologies, and to commit to the development of enforceable regulation around their usage. Stop Oxevision will continue to push for a stronger and more decisive approach, to protect patients’ rights and defend mental healthcare from creeping privatisation.”

Over a year on from the publication of these principles, and almost three years after our initial letter, we are forced to have to repeat these demands. 

It unfortunately comes as no surprise that when Trusts were contacted in 2023 with a suggestion to ‘review’ their policies but with no indication that this would be monitored or enforced, that Trusts were slow to take action, before making only superficial changes to policies. It is also unfortunately unsurprising that the ambiguous ‘principles’ outlined in 2025 have been unsuccessful in preventing Trusts using Oxevision in a blanket way, without patient consent, despite ever mounting, evidence-based concerns about the safety, legality and evidence base (or lack thereof) of the technology. 

CQC’s very brief ‘Brief Guide’

In August 2025, two years after we first made contact with them, the Care Quality Commission (CQC) published two webpages related to concerns about the use of Oxevision and other surveillance technologies in psychiatric hospitals. The first is a report entitled ‘Exploring evidence regarding vision-based monitoring in inpatient mental health units’. Shortly afterwards CQC published a ‘Brief Guide’ which outlines what CQC Mental Health Act inspectors review when inspecting services in relation to ‘vision based monitoring systems’ (VBMS). 

The CQC guidance outlines that Trusts must not use vision based monitoring systems to replace in-person staff support; they must have appropriate data protection policies and seek legal advice where necessary; and they must have relevant policies to address the risk of unintended use of the technologies. The CQC also outlines that there should be individual care plans and risk assessments for each patient in relation to the use of digital technologies in their treatment, indicating that the blanket way in which services have implemented Oxevision previously would not be supported by CQC inspectors.

However, the Brief Guide offered by CQC follows NHS England’s lead in issuing what appears to be a watered-down version of pre-existing legal and legislative frameworks, making general references to the principles of the Mental Health Act without offering anything in the way of clarity. It is not clear whether these are aimed at inspectors or service providers, but the framing of the document results in an emphasis on a health providers’ aim to ‘pass’ inspections, rather than any duty to provide lawful, safe person-centred care to patients. Given trusts often go years between CQC inspections, this convoluted framing of the law, appears to position the rights of mental health patients as ‘optional’, ‘occasional’, and ‘ad hoc’. 

Miss B’s complaint 

On the 27th March 2026, the PHSO produced a final report in relation to the investigation of a complaint raised by ‘Miss B’. Miss B was admitted to Essex Partnership University NHS Trust (EPUT) inpatient wards between 2021-2022, and had Oxevision used on her against her will. Miss B’s formal complaint – which has taken years of follow up and escalation to reach this conclusion – details how Oxevision was used without her consent and that she was inaccurately told that there was no option for the camera to be turned off. 

The PHSO report outlines Miss B’s complaint: 

“Miss B says the use of Oxevision violated her right to privacy and made her feel vulnerable, frightened and at risk of abuse. She says staff could not reassure her about its use which meant she had a lot of unresolved concerns. She says this added to her anxiety and paranoia and led to a deterioration in her mental and physical health…

…Miss B says staff’s reliance on Oxevision made her feel that they were not caring for

her. She says staff left her alone to struggle at night and this made her feel vulnerable and frightened…

…Miss B has told us having Oxevision in her room made her feel vulnerable and at risk of abuse, and she had concerns staff could misuse the images. She feels this impacted her mental and physical health and she changed her behaviours to try and protect herself from the technology”. (pg.2)

The PHSO considered the General Medical Council’s (GMC) professional standards for ‘making and using visual and audio recordings of Patients’. On this basis the report finds that “in-line with the GMC guidance, we therefore consider the Trust should have sought Miss B’s consent for the use of Oxevision.” (page 5). They reiterate that the updated GMC guidance in 2024 maintained that recordings must not be made “against a patient’s wishes, or where a recording may cause the patient harm” (pg.7). 

The PHSO report subsequently considers the Trust’s policy – both in 2021 during Miss B’s admission and its latest version from May 2025 – concluding that: 

“It is our view the Trust’s current SOP departs from the GMC and NHS England guidance because it says when a patient with capacity declines consent for Oxevision, this is ultimately a decision for the nurse in charge or a doctor and requires MDT approval. This means that under the Trust’s SOP, it may refuse to turn off Oxevision for a patient with capacity who does not consent to it. We consider that this is not in line with the guidance… 

…The SOP says this decision is determined by whether it is ‘clinically safe’ to turn off the monitoring. However, the SOP maintains that the use of Oxevision is to complement and not replace its observation policy. It is therefore unclear why the Trust considered there may be cases where it would not be safe to turn off Oxevision, and why it cannot rely on an appropriate level of in person observations to maintain patient safety when a patient does not consent to Oxevision…

…On review of the Trust’s 2025 SOP, we do not consider this meets with the relevant national guidance. We therefore do not consider the Trust has acted to fully address what went wrong, or to prevent this from happening again. This remains an impact to Miss B. We have therefore set out our recommendations at the end of our report to address this.” (pg.7)

The report issues a recommendation that the Trust change their SOP to meet the requirements of the GMC guidance and NHS England’s principles. 

The report also outlines: 

“Miss B complains staff over-relied on watching the Oxevision monitors and did not complete in-person observations in-line with her care plan. She has said she started to notice the staffs’ reliance on Oxevision from January 2022 when her mental health team put her onto lower-level observations. She says there were times at night she was struggling and in tears and staff should have been checking her every 15 minutes but she did not see anyone for hours”. (pg.9)

The report makes a recommendation for the Trust to issue a sum of £925 in recognition of the impact of the trust use of Oxevision on Miss B. 

This complaint ruling illustrates the serious breaches of patient’s rights as associated with the use of Oxevision without patient consent. The NHS England digital principles have supported the PHSO in outlining a ruling that use of Oxevision without Miss B’s consent was a failing and in making a further ruling that the Trust’s current policy continues to not adhere to these principles.

However, it is imperative to note that the policy in question – EPUT’s 2025 Oxevision SOP – was specifically reported as having been changed in order to adhere to NHS England’s principles. The EPUT Oxevision SOP is not unique. Our review of Oxevision policies across the country highlighted that 90% (18/20) of Trusts appear to still be permitting the use of Oxevision for periods of time without patient consent.

This is not unique – all Trusts are at risk of having to pay out 

As NHS England made no commitments to follow up on how Trusts were using Oxevision or to enforce these recommendations. Instead we have been forced to conduct our own follow up review. We have submitted hundreds of Freedom of Information requests to NHS Trusts across the UK. We attached the full report in our letter to NHS England, you can view this here.

When Stop Oxevision began in 2023, all but one of the Trusts using Oxevision were using an ‘implicit consent’ model where Oxevision was used as part of standard treatment for all patients; even where objections were raised the cameras would not be turned off. Indeed, Cumbria, Northumberland, Tyne and Wear NHS Trust opted not to have an option to even turn off the cameras until October 2024. Therefore, the way EPUT uses Oxevision is not an issue unique to them. 

In Miss B’s case, the PHSO has established a position that Oxevision should not be used without consent. In addition, whilst the PHSO did not uphold Miss B’s complaint that Oxevision was over-relied on in place of in-person observations, the extensive consideration of this matter reflects the position that patients should be supported in person and that video surveillance systems (including Oxevision, CCTV and other systems) should not be used in place of in-person support. On this basis, not a single one of the 20 NHS mental health Trusts still using Oxevision appears to adhere to this position, despite many of these having been supposedly amended since the publication of the NHS England Digital Principles, claiming the Trust’s use of Oxevision is now in line with these. 

In 2026, we have identified that of the 20 trusts still using Oxevision, 18 appear to have a model where Oxevision is permitted to be used for periods of time without patient consent. Nine policies explicitly outline that Oxevision is turned on in all patient bedrooms upon admission – consent is not sought. If a patient expresses an objection, the camera will remain on until a MDT has been held (usually policies state that this will be within 72 hours). The camera would then only be turned off on the basis of an MDT decision appropriate. Two Trusts have a model where patients are supposedly asked to ‘opt-in’ to the use of Oxevision on admission. A further two have a similar model, whilst purporting that this is an ‘opt-in’, informed consent model, but still suggesting the camera could be turned on against someone’s wishes as the direction of staff, prior to a formal MDT and best interests discussion being held. One Trust (West London NHS Trust) appears to be continuing to use the same policy dated 2021/2022 where patient consent is not sought and there appears to be no option for the camera to be turned off despite patient objections. A further six Trust policies were so unclear we have not been able to determine what their policy for seeking patient consent is, however it appears that Oxevision is used on a blanket basis in all these cases. 

It is vital to emphasise that we do not consider Oxevision to be compatible with lawful, safe, evidence-based or trauma informed care irrespective of ‘consent’. We note issues of ‘consent’ not being truly informed on the basis that patients are continuously misinformed regarding what Oxevision is and how their data is shared and processed. Additionally, even with Trusts that supposedly have a consent process, their audits outline that this is frequently not followed. This includes data protection breaches such as cameras being erroneously activated remotely or software updates that have resulted in cameras being turned on without patient or staff knowledge. 

In addition, nine NHS Trusts policies explicitly outline that Oxevision is permitted to be used in place of in-person observations (in the cases of other trusts this remains the standard usage even if not endorsed in the official policy). A further four policies are unclear but appear to endorse usage in this way. 

Most Trust policies outline that Oxevision may be used in a patient’s ‘Best Interests’ if they are considered to not have capacity to provide informed consent. However there is no clarity regarding how a video surveillance system, a recognised restrictive practice, would ever be considered the ‘least restrictive’, proportionate approach.

Our review also identified that none of the Trusts who were not using Oxevision, or had not indicated plans to install this in 2023 are now using it in 2026. Nine Trusts have now uninstalled Oxevision or cancelled plans to implement the technology. However in 2025, eight of the Trusts that were using Oxevision in 2023 have installed and/or activated additional camera monitors, or indicated plans to further install this, despite our persistent campaigning, mounting national concerns, ongoing investigations, prevention of future deaths reports and contact from NHS England. Six of the Trusts who have expanded their use of Oxevision in the last year continue to operate a policy where Oxevision is turned on as a blanket policy for all patients. Therefore, not only have these trusts not addressed matters of consent within their policies but they have actively sought to further expand the use of a blanket restrictive practice despite contact from NHS England. 

To summarise – a year on from the publication of the NHS Digital Principles, Oxevision continues to be used across Trusts. In the example of EPUT, the trust reportedly made changes to their policy following the publication of the Principles however, they have later been found to still not be adhering to the guidance. We see this issue as the inevitable outcome of the limitations in NHS England’s implementation of such principles. We believe that NHS England’s hesitancy to set out a clear position or utilise its leadership position to address widespread Human Rights breaches in relation to this technology – which NHS England have been aware of for years – has played a contributory role in the ongoing poor, unsafe and unacceptable practice patients continue to face. 

The inappropriate involvement of external companies 

In our letter to NHS England, we also highlighted concerns about the recommendations being made by Oxehealth as well as an organisation called the National Mental Health and Learning Disability Nurse Directors Forum. We asked NHS England to write to the National Mental Health and Learning Disability Nurse Directors Forum to ask them to retract their guidance. Since our initial letter, this webpage has now been deleted. 

Following the publication of the NHS England digital principles, Oxehealth / LIO wrote to NHS trusts with a document stating: 

“Oxehealth, whose technology has been co-developed with NHS patients, carers, clinicians and researchers/academics for over a decade, warmly welcomes the publication of these principles. They align closely with the purpose of Oxehealth, the approach already taken by many NHS Trusts that have implemented the platform, and the published guidance from the National Mental Health and Learning Disability Nurse Directors Forum. This document explains how the Oxehealth platform supports these principles and offers a framework for providers seeking to link their approach to demonstrate Alignment.” 

It is our view that this document allowed Trusts to circumnavigate the Digital Principles and sought to ensure trusts would not consider these for themselves or question whether their use of Oxevision was compatible with guidance. They consistently refer to the guidance from the National Mental Health and Learning Disability Nurse Directors Forum throughout the document. It is notable that the majority of trusts have now moved to using a model ‘recommended’ in this document in which Oxevision is used with ‘implicit consent’ and that if a patient objects it will remain switched on for 72 hours until an MDT meeting is held and clinicians determine a decision – indeed this is similar to the model EPUT followed in their latest iteration of the policy which the PHSO has ruled must be changed. 

The National Mental Health and Learning Disability Nurse Directors Forum is a “network for Senior Executives working in the Mental Health and Learning Disability Sectors”. It is not a governmental or statutory authority, and its activities are not subject to regulation. In 2022, following campaigning from patients under Camden and Islington mental health trust and national media coverage, the Mental Health Nurses Forum published “national guidance” about the use of Oxevision. The report was developed in ‘collaboration’ with staff members from Oxehealth/LIO as well as NHS Trusts. It included just one patient representative and one carer. There does not appear to have been robust consideration of legal issues or involvement of experts in mental health and Human Rights law. The document claims to have followed “recommendations […] based on recent literature, implementation best practice and feedback from service users, carers, and staff in mental health organisations from across the country” (pg.8).

It discusses the matter of consent at length, yet without providing a clear legal position, stating that: 

“Regarding consent, it remains challenging for the staff and patient groups to recommend an approach for healthcare providers to adopt. The Working Group had a lot of discussions within the Group and outside the Group with a range of stakeholders. Whilst several arguments have been raised around human rights and ethical issues, there are equal arguments on the use of VBPMS to support saving lives and establishing this as a standard way of delivering a safe service.”

We assert that consent is not complex or challenging and that it is not appropriate or lawful to film individuals in their bedrooms and share video footage with an external company, especially without consent. Nevertheless, the document goes on to suggest “two options for how to implement an informed consent regime for healthcare providing organisations to consider” (pg.16). One of these includes an “implicit consent” model in which Oxevision (or other ‘vision based monitoring systems’) is used as part of standard treatment for all patients. This document includes the flow chart which is repeated across a number of the NHS trust current Oxevision policies stating that Oxevision cameras may be kept on for 72 hours until an MDT meeting is held and a decision is made supposedly in a patient’s ‘Best Interests’. 

This recommendation is not in line with the GMC guidance, NHS England principles or the PHSO ruling. Nevertheless, Oxehealth claimed to trusts that the use of Oxevision was compatible with the principle of “consent and capacity” on the basis that:

“National best practice guidance on use of the Oxehealth platform by the National Mental Health and Learning Disability Nurse Directors Forum includes a clear set of questions and considerations to support providers in formulating their approach to consent. […] The Oxehealth platform is configured to support [NHS Trust’s] consent model. As with the provision of any digital technology in mental health care, providers should ensure that their SOP includes a section on how consent is managed in practice locally.”

However, Oxehealth had previously marketed that consent was not needed for the use of Oxevision, stating “if the system is being used in the normal course of treatment, we [Oxehealth/LIO] do not believe there is a need to obtain consent and many customers do not seek consent” (slide 3).  

Additionally, our review highlighted that a number of Trust policies include a flow chart produced by Oxehealth/LIO (page 13) outlining how Oxevision can be used to conduct patient observations remotely through the video camera. The report claims that this “modified observation protocol is as safe as conventional methods”. We strongly contest this claim and have outlined significant methodological issues with the study these egregious claims are based on.

Stop Oxevision are extremely concerned that external parties are becoming involved with NHS healthcare provision and recommending practice that is not lawful, safe or in line with NHS guidance. Indeed we consider that guidance from the external company – who work closely with their providers in developing standard operating procedures – has contributed to the ongoing use of Oxevision without patient’s consent and as a replacement of in person support. Oxehealth – who use patient video in order to develop their algorithms and conduct further research and development – stand to gain financially and reputationally from wider use of Oxevision. 

This is, of course, part of a wider context. Oxevision serves as a stark example of how the increased involvement of private companies in the ‘collaborative’ implementation of ‘innovations’ in the NHS is not sustainable, ethical, or indeed in line with the NHS’ core principle of accountability. It begs the question as to whether the NHS can be held appropriately accountable for the implementation and use of technologies when these are evaluated through documents and guidance made ‘collaboratively’ with companies who stand to financially benefit from their implementation and use.

This only becomes more clear when Trusts contracts with Oxehealth are considered. They state that:

“7.4  […] Partner shall send to Oxehealth for its prior written approval, the text and layout of all proposed Presentations or other similar material relating to Oxehealth or the Oxehealth System. In the event that Oxehealth does not approve such material, it shall give written notice of such non-approval to Partner within 10 days of receipt by Oxehealth of the material. Partner shall not use any material in the Presentations or other similar documentation relating to Oxehealth or the Oxehealth System that has not been approved by Oxehealth.” (pg. 11, our emphasis). 

NHS England’s failure to ensure independent, properly enforceable, and appropriately informed decision-making and regulation has only added to these issues, and could even be said to have enabled a private company inappropriate influence over NHS services to the detriment of provision of safe, lawful and patient-centred care.

We believe that now is the time for NHSE to call for the complete cessation of the use of Oxevision across the NHS. 

Stop Oxevision will continue to campaign until Oxevision has been removed from all bedrooms and seclusion rooms. We hope more patients like Miss B get the compensation they deserve. If you would like support or advice regarding complaints processes or escalations, please get in touch at stopoxevision@gmail.com. We will continue to update regarding NHS England’s response to our letter.