Recurring concern

Unreliable CCTV detection and tracking of people at risk

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First reported 19 Oct 2015•Latest report 6 Sep 2021

Definition

What this concern includes

Includes CCTV-based controls specifically intended to detect, track or alert staff or other responsible responders to people at risk or safety-critical behaviour, including alerting to odd or concerning behaviour, monitoring high-risk areas, identifying potential self-harm risks, and accessing or using relevant footage when it is needed for intervention.

Not included

  • Excludes the existing concern concerning CCTV monitoring of access to high-risk locations where the assertion is limited to coverage or monitoring of approaches and entrances rather than detection or tracking of people at risk.
  • Excludes generic CCTV coverage, recording, storage or retrieval deficiencies where no person-at-risk detection, tracking or safety-alert function is identified.
  • Excludes CCTV used solely for retrospective investigation, crime evidence or property protection when no timely safety-detection or intervention function is asserted.
  • Excludes failures of staff training, communication or supervision unless they directly make the dedicated CCTV detection, tracking or alerting control unreliable.
Reports
5

Distinct published reports

Individual concerns
5

A report can raise multiple concerns

Date range
2015–2021

First to latest report issue date

Stated actions
5

Described in published responses

Reports over time

Reports over time

Reports about this concern issued each year.

* 2026 is projected from reports observed to 7 Sep 2026.

Most frequent recipients

Most frequent recipients

Reports about this concern sent to each recipient.

Care UK1
Department of Health and Social Care1
Dorset Healthcare University NHS Foundation Trust1
Durham County Council1
Home Office1
Recipient name withheld1
Sussex Partnership NHS Foundation Trust1
The Darlington Farmers Auction Mart Company Limited1
Transport for London1

Concerns and responses across reports

Only concerns grouped under this recurring concern are included. Select any concern, action or position to view the source wording.

  1. County Durham and Darlington

    AI-generated summary

    Joseph William DENT · Prevention of Future Deaths report

    This summary was generated using AI from the published report. Please read the original report for the complete account.

    Report summary

    Joseph William DENT was seen parking a car near Newton Cap Viaduct in the early hours of 20 June 2021, and his body was found near the base of the bridge shortly after 08:00. The investigation found that he died from multiple injuries after falling from the bridge, with an open conclusion because it was unclear how he came to fall. Concerns included pedestrian access to the bridge parapet and the area below, the lack of effective climbing prevention, the absence of monitored CCTV and lighting or other detection measures, and the bridge’s reported association with suicide by jumping.

    Read the report on judiciary.uk

    Source evidence

    How this individual concern was interpreted

    PFD Monitor created a concise, searchable interpretation from the report wording shown below.

    PFD Monitor interpretation

    Absence of monitored CCTV, lighting or other means of detecting people at immediate risk

    Wider context from the report

    “All concerns relate to the bridge, which carries a road and two footpaths up to around 30m (100ft) above the River Wear (1) the bridge’s parapet and railing is accessible to pedestrians on the bridge; (2) the bridge is frequently discussed on social media as suitable location for suicide by jumping; (3) there is absence of monitored CCTV and lighting or other means of detecting those at immediate risk; and (4) there is a risk of death to persons falling AND to those near the foot of the bridge at any time when persons fall Detective Sergeant ████████ gave evidence that: (a) there is pedestrian access to either side of the bridge; (b) the bridge lacks effective measures to prevent persons climbing over the parapet; (c) the bridge is “a well-known area for suicide” (and is openly discussed as such on social media); and that (d) police frequently (possibly as much as daily) have to attend the location in response to concerns about persons falling from the bridge. Photographs reveal that the area around the foot of the bridge, where falling objects or persons may land, is accessible to pedestrians. My records indicate that there have been four other deaths of persons falling from this bridge in the past five years; the conclusions in all of their inquests were suicide. ”

    Source location

    Joseph William DENT · Prevention of Future Deaths report
    Page 1 · concerns

    Open source report

    Source evidence

    How this respondent action was interpreted

    PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

    PFD Monitor interpretation

    Consider implementing lighting and CCTV at the viaduct through feasibility and planning processes.

    Verbatim wording from the response

    “• Consideration of the potential to implement lighting and CCTV on the viaduct (subject to a Feasibility Study and Planning Application).”

    Source location

    2021-0297-Response-from-Durham-County-Council_Published
    Page 2 · response
    Published 9 September 2021

    Open published response

    Source evidence

    How this respondent action was interpreted

    PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

    PFD Monitor interpretation

    Assess whether lighting and CCTV can be implemented at an earlier stage as part of the viaduct prevention work.

    Verbatim wording from the response

    “The assessment process will also include any potential for lighting and CCTV to be implemented at an earlier stage (yet to be confirmed), which addresses concerns raised in the Regulation 28 report. A Suicide Prevention Reference Group has been initiated to project manage this work and govern the representation of residents and people using the viaduct and the paths below. This group met for the first time on 11th October 2021. Full updates from this group on progress of this work can be given to your Office on a regular basis.”

    Source location

    2021-0297-Response-from-Durham-County-Council_Published
    Page 3 · response
    Published 9 September 2021

    Open published response
  2. Inner West London

    AI-generated summary

    Alfonso Sinclair · Prevention of Future Deaths report

    This summary was generated using AI from the published report. Please read the original report for the complete account.

    Report summary

    Alfonso Sinclair entered the Victoria Line tunnel at Warren Street station on 31 August 2018 and was struck and killed by a train approximately 19.5 minutes later. The principal concerns were that staff did not identify or track his unusual behaviour on CCTV, that there were no alarms at the platform-end barriers, and that staff working systems and CCTV monitoring could be improved to help prevent similar deaths.

    Read the report on judiciary.uk

    Source evidence

    How this individual concern was interpreted

    PFD Monitor created a concise, searchable interpretation from the report wording shown below.

    PFD Monitor interpretation

    Lack of a system for staff to alert and track individuals of concern on CCTV

    Wider context from the report

    “1. That there is no apparent system for staff to alert odd behaviour and then track an individual of concern on CCTV. ”

    Source location

    Alfonso Sinclair · Prevention of Future Deaths report
    Page 2 · concerns

    Open source report

    Source evidence

    How this respondent action was interpreted

    PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

    PFD Monitor interpretation

    Continue evaluating camera-based detection technologies and equipment that could alert staff to dangerous or potentially suicidal behaviour.

    Verbatim wording from the response

    “It is not possible for us to continuously monitor every single one of our roughly thirteen thousand cameras that are positioned around our stations. We therefore continue to assess and evaluate new and evolving camera-based detection technologies that can alert staff to certain behavioural traits and actions that could pre-empt an act of self harm or people unintentionally putting themselves in danger of being struck by a passing train.”

    Source location

    2019-0141-Response-by-Transport-for-London
    Page 4 · response
    Published 14 June 2019

    Open published response

    Source evidence

    How this respondent position was interpreted

    PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

    PFD Monitor interpretation

    Existing CCTV arrangements are considered appropriate for local congestion management, incident support and incident review rather than continuous real-time tracking.

    Verbatim wording from the response

    “Moving on to the second part of this concern, CCTV cameras are in place in all LU stations but it is worth noting that their primary purpose is not to track the movement or actions of individuals in real time. Station operations rooms are not continuously staffed and CCTV camera views are not continuously monitored. Where station staff are alerted to unusual behaviours, the images from the CCTV can be viewed locally in the station operations room or remotely in the London Underground Control Centre (LUCC).”

    Source location

    2019-0141-Response-by-Transport-for-London
    Page 2 · response
    Published 14 June 2019

    Open published response

    Source evidence

    How this respondent position was interpreted

    PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

    PFD Monitor interpretation

    Continuous CCTV monitoring is not possible, and behavioural detection technologies are considered too immature for reliable London Underground operation.

    Verbatim wording from the response

    “It is not possible for us to continuously monitor every single one of our roughly thirteen thousand cameras that are positioned around our stations. We therefore continue to assess and evaluate new and evolving camera-based detection technologies that can alert staff to certain behavioural traits and actions that could pre-empt an act of self harm or people unintentionally putting themselves in danger of being struck by a passing train.”

    Source location

    2019-0141-Response-by-Transport-for-London
    Page 4 · response
    Published 14 June 2019

    Open published response
  3. Exeter and Greater Devon

    AI-generated summary

    Stephen Mark SHAYLOR · Prevention of Future Deaths report

    This summary was generated using AI from the published report. Please read the original report for the complete account.

    Report summary

    Stephen Mark SHAYLOR was found hanging in his cell at HMP Exeter in the early hours of 1 January 2014 and was pronounced dead at 03:35. He was on a drug stabilisation regime and subject to healthcare night welfare checks. Concerns included the inadequacy of checks conducted through cell-door hatches, the absence of continuous CCTV monitoring, and the failure to carry out the 02:00 check.

    Read the report on judiciary.uk

    Source evidence

    How this individual concern was interpreted

    PFD Monitor created a concise, searchable interpretation from the report wording shown below.

    PFD Monitor interpretation

    Reliance on continuous CCTV monitoring to detect prisoner self-harm

    Wider context from the report

    “(3) Night welfare checks and observations on an ACCT document are at best intermittent and rely on continuous CCTV monitoring could spot a prisoner self-harming. ”

    Source location

    Stephen Mark SHAYLOR · Prevention of Future Deaths report
    Page 2 · concerns

    Open source report
  4. East Sussex

    AI-generated summary

    Sabrina Michelle Walsh · Prevention of Future Deaths report

    This summary was generated using AI from the published report. Please read the original report for the complete account.

    Report summary

    Sabrina Michelle Walsh was detained under the Mental Health Act at Woodlands Acute Care and was found hanging with a ligature around her neck. The inquest concluded that she deliberately attached the ligature, but the evidence did not fully explain whether she intended a fatal outcome; this was contributed to by neglect. Concerns included the lack of formal risk assessment, inadequate observations and the absence of CCTV in corridors and communal areas.

    Read the report on judiciary.uk

    Source evidence

    How this individual concern was interpreted

    PFD Monitor created a concise, searchable interpretation from the report wording shown below.

    PFD Monitor interpretation

    Lack of CCTV in corridors and communal areas for locating vulnerable patients

    Wider context from the report

    “The lack of CCTV in corridors and communal areas at Woodlands Acute Care, St Leonards on Sea, which would enhance location of vulnerable patients where observations do not immediately locate them. Valuable minutes would be saved in locating vulnerable patients if CCTV was installed. ”

    Source location

    Sabrina Michelle Walsh · Prevention of Future Deaths report
    Page 1 · concerns

    Open source report

    Source evidence

    How this respondent action was interpreted

    PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

    PFD Monitor interpretation

    Install CCTV in the entrance areas of all 12 Acute Inpatient and PICU wards, including Woodlands.

    Verbatim wording from the response

    “As a result of the information we now have available to us, I confirm that the Trust is in the process of implementing the installation of CCTV in the entrance areas of all our Acute Inpatient/PICU wards, which is a total of 12 sites, including Woodlands.”

    Source location

    2017-0449-Response-by-Sussex-NHS-Trust
    Page 1 · response
    Published 14 July 2017

    Open published response

    Source evidence

    How this respondent position was interpreted

    PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

    PFD Monitor interpretation

    Intrusive CCTV in everyday communal living areas is not advisable; CCTV should be limited to entrances and main access pathways.

    Verbatim wording from the response

    “The national steer from NHS England (which I’m aware is being forwarded directly to you), now states that CCTV would be advisable in the areas where people enter the unit and the main pathways in. However, it would not be advisable to have intrusive cameras in everyday areas such as common living areas shared by patients.”

    Source location

    2017-0449-Response-by-Sussex-NHS-Trust
    Page 1 · response
    Published 14 July 2017

    Open published response

    Source evidence

    How this respondent position was interpreted

    PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

    PFD Monitor interpretation

    Current CCTV guidance for non-secure mental health units is considered proportionate, so intrusive cameras in common areas are not advised.

    Verbatim wording from the response

    “Professor Kendall’s advice for non-secure units such as Woodlands Acute Care is that CCTV would be advisable in the areas where people enter the unit such as the entrance and the main pathways in. However, it would not be advisable to have intrusive cameras in everyday areas such as common living areas shared by patients. CCTV should not be placed in bedrooms or shower areas.”

    Source location

    2017-0449-Response-by-NHS-England
    Page 2 · response
    Published 14 July 2017

    Open published response

    Source evidence

    How this respondent position was interpreted

    PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

    PFD Monitor interpretation

    Care providers, rather than CQC, decide whether to use surveillance; CQC does not require providers to install CCTV.

    Verbatim wording from the response

    “to use surveillance is for care providers to make in conjunction with the people who use the service... This document does not give guidance on whether or not you use surveillance and CQC does not require providers to do so.” It also states that: “We would be concerned by an over-reliance on surveillance to deliver key elements of care, and it can never be a substitute for trained and well supported staff.””

    Source location

    2017-0449-Response-by-NHS-England
    Page 2 · response
    Published 14 July 2017

    Open published response
  5. County Durham and Darlington

    AI-generated summary

    Kyle David Michael Hull · Prevention of Future Deaths report

    This summary was generated using AI from the published report. Please read the original report for the complete account.

    Report summary

    Kyle David Michael Hull, a 15-year-old teenager, suffered fatal injuries after falling through a fragile roof at the Auction Mart. Concerns were raised about limited CCTV coverage and whether more extensive CCTV and monitoring could help identify risks and enable earlier intervention, particularly around dangerous and fragile roofs.

    Read the report on judiciary.uk

    Source evidence

    How this individual concern was interpreted

    PFD Monitor created a concise, searchable interpretation from the report wording shown below.

    PFD Monitor interpretation

    Failure of CCTV monitoring to alert relevant parties to risks and identify particularly high-risk areas

    Wider context from the report

    “Evidence was given about limited CCTV coverage and access thereto via a Council system. This may not be adequate and consideration ought to be given as to whether a more extensive CCTV installation and monitoring thereof may be able to alert the Company and/or others to potential risks of people harming themselves and/or damaging the property and early intervention might be helpful and further, such CCTV may be able to better identify particularly high risk areas, especially dangerous and fragile roofs. ”

    Source location

    Kyle David Michael Hull · Prevention of Future Deaths report
    Page 1 · concerns

    Open source report

    Source evidence

    How this respondent action was interpreted

    PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

    PFD Monitor interpretation

    Seek financing and make a final board decision on installing a night-vision, motion-detecting CCTV system linked to management’s mobile phones.

    Verbatim wording from the response

    “Since the inquest we have had two CCTV firms out to measure the site, both have taken time in what type of CCTV would be needed, the number of CCTV’s, maximising the area of coverage as the design of the mart makes it extremely hard to cover every corner. The conclusion was that CCTV’s with night vision, movement detection and linkage to the internet where the images can be streamed to Mobile phones of company management.”

    Source location

    2015-0379-response
    Page 1 · response
    Published 19 October 2015

    Open published response
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Data last updated 7 September 2026