On 7th February 2025 NHS England (NHSE) published new principles on the use of digital technologies in mental health inpatient settings. They are, at least in part, NHSE’s answer to rising concerns about surveillance technologies such as Oxevision – which are often for-profit – being used in psychiatric settings.
This long-overdue publication is vague and disappointing. The principles do not halt the roll-out of unethical, poorly evidenced and potentially unlawful technologies. Instead, they are a weak appeal from NHSE for individual NHS Trusts to ensure the use of these technologies is legal and ethical, without obliging them to do so.
About the principles
The principles are a response to service user concern and grassroots campaigning around the use of Oxevision, a for-profit surveillance technology being used in psychiatric inpatient settings. This campaigning has been widespread, spearheaded primarily by survivor-led collective Stop Oxevision, who have worked to highlight the scale of use and misuse of this technology across the UK.
Despite being developed in response to Oxevision specifically, the principles fail to name it explicitly.
Rather than acting as guidance, the principles serve to outline, in great detail, the potential risks of surveillance technologies. This includes listing all the ways use could breach data protection and human rights laws, decrease safety, and undermine the culture of care standards for inpatient care.
The recommendations made are both vague and light-touch; such as asking Trusts to brush up on the law, to keep clear records of why decisions were made to use technologies, to conduct impact assessments, and to “co-produce” the procurement and implementation of digital technologies.
The problems with surveillance technologies
The concerns about Oxevision and other surveillance technologies are well-known and widespread; they may breach a persons’ human rights, undermine NHS England’s own culture of care standards, be based on no or biased evidence, and are being called into question as a potential contributor to the deaths of psychiatric inpatients in the Lampard Inquiry.
Additionally, independent research into the perspectives of patients, carers, and staff demonstrate the ways in which these technologies serve to undermine trust and safety, rather than building it.
The problem is not that NHSE does not recognise these issues. Many of them are stated in the introduction to the principles. In fact, the principles begin with NHS England’s own research which concluded that there is no evidence-base to support their use.
What’s wrong with the principles?
In July 2023, Stop Oxevision, supported by NSUN, began a campaign to ask NHS England to commission an independent review into Oxevision’s legality and evidence base. We fear that these principles, along with NHS England’s own research, will be deemed sufficient to meet those demands.
The problems with the principles are numerous, but their key failings are:
- They are unenforceable. There is no obligation for NHS Trusts to follow them, or consequences if they do not.
- It places the burden for ensuring care is legal on service users. When stating the legal obligations of NHS Trusts, NHSE highlights that failures may result in litigation and challenge from patients. It should not be the responsibility of patients to ensure their care is legal.
- It undermines its own values. Despite emphasising the value of co-production, the principles do not state who they were made by, in consultation with whom, and whether people with lived experience were involved (and how). They attempt to advocate for co-production, but without seeming to have done any.
What do we want instead?
- NHS England should immediately halt the use of all for-profit surveillance technologies.
- NHS England must develop a set of robust and enforceable safeguards, which do not encourage but instead require NHS Trusts to ensure that the use of these technologies is lawful.
- NHS England should ensure that these new safeguards are meaningfully co-produced with patients and service users.
NSUN stands in solidarity with all who are affected by and concerned about creeping privatisation and surveillance in psychiatric care. In particular, we stand with our friends at Stop Oxevision, who have written their own response to the release of the principles.