- From a time well before the Inquiry hearings began, the parents were firmly of the view that CCTV would protect babies on the neonatal unit. It would be a visible and clear deterrent to those who intended harm to babies. In the course of her evidence, Mother C made the point that in-cot cameras would be particularly useful, so that parents (or others) who wanted to observe the babies could do so from a different location.1 It would also act as a deterrent to anyone who intended harm to a baby.
- On behalf of Family Group 1, Mr Skelton KC and his team submitted that all neonatal units should have individual cameras in each cot/incubator. This would enable real-time monitoring of actions by staff and allow parents to monitor their babies when they were not present at the hospital. They asserted it would also have a significant deterrent effect.2
- On behalf of Family Groups 2 and 3, Mr Baker KC maintained that the provision of CCTV within the unit would:
“provide greater security to the vulnerable patients who are cared for there. In cases where deliberate harm is suspected its presence would either confirm the occurrence of crimes or exonerate the individual accused of them. It would act as a deterrent to an individual intent on causing harm to vulnerable patients, whether that individual was a healthcare worker or another individual present on the unit. At the very least, it would make the act of causing harm to babies considerably more difficult.”3
This group added: “Families would say that CCTV covering each cot/incubator but not the wider spaces within the NNU [neonatal unit] would limit the risk of intrusion into private or intimate moments.”4
- Mr Harvey considered that CCTV would have a deterrent effect but would not completely remove the risk. Ms Hodkinson thought it could have a deterrent effect and it could help Trusts better monitor activity on neonatal units.
- The Countess recognised that CCTV can be important to help parents feel reassured about their babies’ safety, particularly when parents cannot readily access the ward, although acknowledged that there may be some privacy issues. Live cot or incubator cameras could help advance that aim. They expressed their support for any recommendations intended to provide for better contact and engagement between parents and their child while they are on the neonatal unit.5
- The RCPCH was neutral on the CCTV proposal, although described it as “surveillance” and submitted that “the key question was whether the increased level of protection justifies the breach of a child’s right to privacy”.6 The RCPCH did not deal with the question of in-cot cameras.
- CQC did not deal with in-cot cameras. As to CCTV, it “considers whether or not it is appropriate for hospitals to deploy CCTV to be a fact-specific question that falls to be addressed by each Trust in light of the specific circumstances at that Trust. In cases where CCTV is appropriate, the CQC has issued guidance to support its lawful use.”7 In my view, it would be unfortunate were there disparities in approach between different Trusts and I can see no justification for different approaches in different places.
- Having raised privacy issues about CCTV in respect of breastfeeding and close contact with babies, Sir Stephen Powis informed the Inquiry that a different form of CCTV, such as in-cot cameras, was being explored and pilots were due to take place, and that this may be a more appropriate way forward.8 Before those pilots took place, NHS England performed a U-turn. Their final position was: “[H]aving sought the views of neonatal experts and reviewed the published scientific literature on the issue, our view was that a pilot of cot cams would not be appropriate taking into account other priorities to improve neonatal services and the findings of the scientific research on this topic to date.”9
- The change of position is disappointing and puzzling. On behalf of NHS England, Mr Jason Beer KC explained that the scientific literature relied on by NHS England was a pilot at University College London Hospitals, in addition to learning from abroad of which no details were provided. Mr Beer KC explained the outcomes of the pilot to the Inquiry. He stated that there was not an identifiable gain in patient safety by having in-cot cameras, by which he meant that there was no change to the outcomes for babies when the cameras were there. I infer that the cameras did no harm.10 I also infer that there was no question of anyone being seen trying to harm babies. He summarised that, whilst families felt reassured and it gave them a feeling of greater safety, the cameras led to an increased workload because parents believed that they could see issues on the cameras that required a clinical response. I suggested to Mr Beer KC that, had the parent been present next to the cot and seen something they were concerned about, they would be entitled to raise the issue with staff. Mr Beer KC, rightly, did not seek to persuade me that there was any difference between the two situations. Parents do worry about their babies. Part of the job of the nursing and medical staff is to reassure them. I acknowledge that, if absent parents are in a position to raise a concern about something that would otherwise have gone unnoticed, it will make more work for nurses and doctors. There are two ways of dealing with that: the first is not to allow cameras. The second is to expect nurses and doctors to respond to the concerns of parents. Where a mother or father in a neonatal unit expresses concern about their baby, a nurse attends. I do not accept that, because a parent expresses concern as a result of something seen on a baby monitor, it is less worthy of attention.
- The number of babies for which nurses are responsible is not changed by the fact that baby monitors are in place. They are all being looked after. Very tiny babies are often linked to monitors of various kinds, such as oxygen monitors. When the alarm sounds, someone has to attend. It may be said that those alarms make work for nurses and doctors (and sometimes unnecessary work), but no one suggests the answer is to get rid of the monitors.
- Nurses manage parents’ concerns as a matter of course. The risk of something being missed is reduced if the baby is being observed more often.
- NHS England also asserted that there were significant training, supervision and resource demands because of the in-cot cameras. There is nothing technically complex about a baby camera/video monitor. Parents use them at home all the time. Training, if any, would be minimal. If it really was thought necessary, short rules could be drafted to govern the use of monitors by parents and staff.
- In submitting that there was no difference in outcome for the babies when in-cot cameras were in place, NHS England overlooked the deterrent effect of the monitors. I accept that attacks by healthcare professionals on babies are very very rare. In-cot cameras will make them rarer. NHS England cannot operate on the basis that harm is unthinkable. It is not. The total cost for approximately 3,500 monitors – to cover all neonatal cots – is minimal in the scheme of NHS expenditure. It is easily justified by the fact that it will certainly reassure parents and will act as a deterrent.
- Finally, there is no suggestion that the presence of the camera would pose any risk to the baby.
Conclusion
- I do not think that fixed CCTV cameras would add sufficient extra deterrent to outweigh the privacy concerns and the practical problem of who is to watch the footage, where it is to be stored and for how long. I am sure that all cots and incubators in all neonatal units should be fitted with in-cot cameras with livestreaming video, so that parents may observe the baby remotely at any time. The funding for this should be centrally managed and ring-fenced, to ensure consistency and implementation across all neonatal units at speed. I have no doubt that parents of very young babies will find this reassuring. That will be its principal effect. It is inescapable and important that it will also be a deterrent to those rare people who seek to harm babies. Everyone will get used to it.
Endnotes
2 Written Closing Submissions on Behalf of Family Group 1 4 March 2025 89/paras 274-275
3 Written Closing Submissions on Behalf of Family Groups 2 and 3 7 March 2025 140/para 610
4 Written Closing Submissions on Behalf of Family Groups 2 and 3 7 March 2025 141/para 613
5 Written Closing Submissions on Behalf of the Countess of Chester Hospital NHS Foundation Trust 4 March 2025 86/paras 319-321
6 Written Closing Submissions on Behalf of the Royal College of Paediatrics and Child Health 26 February 2025 56/para 120
7 Written Closing Submissions on Behalf of the Care Quality Commission 4 March 2025 27/para 56
10 There was a trial of the AngelEye CameraSystem in a Level 3 neonatal unit in the UK in 2020, which found that the impact of webcams on nursing workload in the neonatal unit was low per camera-related task and the benefits for parents were recognised. More recently, in a clinical study in 2026, a research team has also trialled a calibrated RGB, depth and infra-red camera system at Addenbrooke’s Hospital neonatal unit, which picks up medical information as well as live video stream for parents. The use of webcam technology is prevalent in neonatal intensive care units in the United States. This all proves that in-cot cameras with live video streams for parents are possible.