Module 2 of 2 · 45 minutes
Consent, dignity and saying no
By the end of this module you will be able to
- Explain what a person must be told about AI in their care
- Describe the choice people must have
- Apply the Mental Capacity Act to monitoring technology
- Recognise when monitoring threatens privacy and dignity
- Raise a concern about an AI tool
Work through it
1 interactive for this module, built on the WAJD Teach engine. Nothing moves until you ask it to, and every one has a written version if you would rather read it.
Watch: Emma and George talk it through
3 minutes. Captions are on, and the same conversation is written out in full below. The voices are computer generated.
Emma George, we've had acoustic sensors fitted in the bedrooms. They listen for falls at night. Nobody asked the residents. Is that a problem?
George Yes. CQC expects people to be given information about the part AI plays in their care, and to have a choice. With an alternative that doesn't rely on the technology.
Emma What do we have to tell them?
George In ordinary words. What it is, what it does, what it records, who sees it, and that they can say no. At a moment they can take it in. Not buried in an admission pack.
Emma And if they say no?
George Then it has to be a real no. If declining the sensor means a worse service, it wasn't a choice.
Emma Half our residents couldn't make that decision.
George Then the Mental Capacity Act applies, as it does to any decision. Assume capacity. Support the person to decide. An unwise decision isn't a lack of capacity. And if they can't decide, act in their best interests and choose the least restrictive option.
Emma What does least restrictive mean for a sensor?
George It's a real question. Is it needed all night, or for the two hours after medication? Is a camera needed when a pressure mat would do? Monitoring restricts privacy, so less is better where less will do.
Emma One daughter asked us to put a camera in.
George A family member asking isn't consent. Unless she holds a relevant lasting power of attorney or deputyship, it's a best interests decision the service must make and record. And continuous monitoring can be part of what makes someone's arrangements a deprivation of liberty, which needs proper authorisation.
Emma Is all this monitoring a bad thing, then?
George Not at all. There's a useful test. In 2024 care workers and researchers, brought together by Oxford, the Care Workers' Charity and the Digital Care Hub, defined responsible use as supporting and not undermining human rights, independence, choice and control, dignity, equality and wellbeing.
Emma Give me an example either way.
George A sensor that means someone isn't woken every two hours by a torch at the door adds to their dignity. The same sensor, used to justify fewer staff at night with nobody coming when it sounds, takes it away.
Emma We also have an app that reads pain from a face.
George Then know that tools can be less accurate for some people than others. It may have been tested mostly on faces unlike the person in front of you. If what it says doesn't match what you see, trust what you see and report it.
Emma And when should I refuse to use something?
George When it's used without the person knowing. When it stands in for a check a human should make. When its output doesn't match the person you know. Or when nobody's approved it.
Emma Who do I tell?
George Your manager first. Then your whistleblowing route, and you can contact CQC directly. A concern about a tool is a concern about care. Ask of anything new: does this help me be with this person more, or does it stand in for me being there?
The written material
Tell people, and give them a choice
CQC expects people to be given information about the part AI plays in their care, and to have a choice, with an alternative that does not rely on the technology. In ordinary words that means: what it is, what it does, what it records, who sees it, and that they can say no.
Say it plainly and at a moment when the person can take it in, not buried in an admission pack. Families should be told too, where the person wants them involved. And a no has to be a real no: if declining the sensor means a worse service, it was not a choice.
When the person cannot decide
Many people in care services lack the capacity to make a particular decision at a particular time. The Mental Capacity Act 2005 applies to a decision about monitoring as it does to any other. Assume capacity. Support the person to decide. An unwise decision is not a lack of capacity. If they cannot decide, act in their best interests and choose the least restrictive option.
Monitoring is a restriction of privacy, so the least restrictive question is real. Is a sensor needed all night, or for the two hours after medication? Is a camera needed at all when a pressure mat would do? Continuous monitoring can also be part of what makes a person's care arrangements amount to a deprivation of liberty, which needs proper authorisation.
Dignity is the test
In 2024 care workers and researchers convened by the University of Oxford, the Care Workers' Charity and the Digital Care Hub defined responsible use of AI in social care as use that supports and does not undermine human rights, independence, choice and control, dignity, equality and wellbeing. That is a useful test for any tool.
A sensor that means a person is not woken every two hours by a torch at the door can add to their dignity. The same sensor, used to justify fewer staff at night with nobody coming when it sounds, takes it away. A bedroom is a home. Sound and video from it are among the most private information there is.
Tools can also be less accurate for some people than others. A tool that reads pain from a face may have been tested mostly on faces unlike the person in front of you, and CQC expects safe and equitable outcomes. If what the tool says does not match what you see, trust what you see and report it.
When to say no, and how
Say no, or stop and ask, when a tool is being used without the person knowing, when it is being used in place of a check a human should make, when its output does not match the person you know, or when you are asked to use something nobody has approved.
Raise it with your manager first. If that does not work, use your service's whistleblowing route, and you can contact CQC directly. A concern about a tool is a concern about care, and the same protections apply to you for raising it.
Knowledge check
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