Muckamore Abbey Hospital abuse inquiry is “a watershed moment”, says Health Minister

The Minister of Health for Northern Ireland has said that the long-awaited Muckamore Abbey Hospital Inquiry marks a watershed moment for the health and social care system, particularly in how it cares for the most vulnerable members of our society.

The Inquiry was launched following revelations in 2017 of the abuse of patients by staff at Muckamore Abbey Hospital, the largest hospital in Northern Ireland, which cared for people with learning disabilities and mental health problems.

Mike Nesbitt welcomed the publication of the Inquiry’s final report and said he was committed to ensuring that what happened at Muckamore will never happen again. He said the Government will now consider the report’s details and recommendations before engaging with the sector to understand and implement the lessons learned, helping to ensure we never find ourselves in this position again.

Findings from the Muckamore Inquiry

The Inquiry heard extensive evidence of injuries sustained by patients, particularly bruises, unexplained marks and signs consistent with physical abuse. Some patients were verbal and able to state that they had been assaulted by staff, but such direct evidence was very limited. Families described observing bruising on arms, legs, faces and torsos, including what appeared to be grip marks, finger bruises and injuries appearing in clusters.

• Easy Read version of Inquiry Report

It also heard evidence of physical abuse captured on CCTV, including forceful handling, dragging, pushing and inappropriate restraint.

Other findings included a lack of personal care and hygiene, with descriptions of patients being unkempt, with dirty hair and smelling of body odour and urine. There were complaints about inappropriate clothing or clothing that was soiled with urine or faeces. Teeth and nails were sometimes neglected, particularly toenails, which were sometimes allowed to grow so long as to cause serious discomfort.

In addition, significant weight gain and weight loss were ongoing problems for others. The Inquiry heard of several patients who became obese, with weight gain sometimes dramatic. Weight gain was exacerbated by a lack of activity, and the Inquiry heard that diet and weight were not always actively monitored, even though some patients became obese. Other patients who required assistance with eating lost significant amounts of weight.

Lessons learned by the Muckamore Hospital Inquiry

Mike Nesbitt added: “From the outset I would like to pay tribute to all the patients, families and carers who firstly raised these issues with the Department of Health and then so courageously gave their time to outline and relive their experiences of the hospital and provide evidence to the Inquiry.  This has helped ensure that the Inquiry’s final report has those experiences at its core.

“To those families, patients and carers, I want to extend my sincere apologies on behalf of the entire Health and Social Care (HSC) system for the sustained failures to provide the high-quality care you so rightly expected and deserved, and for the distress and pain that this has caused. I commend you for the dignity that you have shown throughout this process which I know has been extremely difficult and harrowing for you.

“I do not expect that the report will make for comfortable reading for anyone within the Health and Social Care system.  Nor should it.  However, I can assure you that my Department views the safeguarding of those who are most vulnerable in our society as a key priority as demonstrated by the Adult Safeguarding Bill currently going through the Assembly. We are committed to ensuring that what happened at Muckamore will never happen again.”

Recommendations from the Muckamore Inquiry

The Inquiry has made a number of recommendations, including:

• Any service user with a learning disability should have a named person (a key individual) responsible for their care plans and this person should be involved in and record the discussion with the family and the discussion with any relevant MDT and sign off the final decision.
• While patients remain in hospital pending resettlement, there should be a focus on enhancing their independent living skills, tailored to their physical and mental capacity.
• Every person should have an individualised activity schedule, including leisure activities and skill-building activities, and staff should be trained in ‘active support’ so that they can deliver this.
• Properly trained independent advocates should be made available to service users and families to support effective communication with staff and for raising concerns and complaints.
• All documents relevant to the service user’s experience and intended for their information must be made available in Easy Read format.
• All organisations taking responsibility for property and/or finance for people with learning disabilities and autistic people should institute regular checks of adherence to their policies.
• Health and Social Care Trusts should appoint a non-executive director to champion restraint reduction, with a mandate to hold executive directors accountable for delivery.

CCTV and complaints processes

In addition, people with learning disabilities, autistic people, and their families should be provided with clear, written information outlining the available pathways for raising concerns. Complainants must also be regularly updated on the progress of any investigation, including when the process concludes without a specific finding. This applies to Health and Social Care Trusts and private and third-sector care providers.

It also recommended that settings (including community-based settings for those with challenging behaviour) should consider installing CCTV in public areas to protect vulnerable individuals and staff. There should be appropriate consultation with families and service users regarding the installation and use of CCTV in any facility where people with learning disabilities and challenging behaviours reside.

Guidelines should also be agreed upon for providing CCTV systems in residential and day services, where requested, and CCTV viewers should be independent of the setting, i.e., not involved in day-to-day care of the residents.

Legacy will be actions that follow

Jon Sparkes OBE, chief executive at Mencap, said: “The publication of this report follows years of evidence, testimony and determination from families who refused to allow their loved ones’ experiences to be forgotten.

“Mencap recognises the courage shown by individuals, families, and advocates who helped bring these issues to light.  While we continue to analyse the report’s findings in detail, it is clear we must all now focus on implementing its recommendations. People with a learning disability and autistic people have the right to safe, person-led support, dignity, respect and protection from harm. The true legacy of this inquiry will not be measured by the publication of a report but by the actions that follow.

“We call on the Department of Health, Trusts and the wider health and social care system to commit to implementing recommendations in full and to work with people with a learning disability and their families in shaping future services. People’s experiences inside Muckamore must never be forgotten and the harms they experienced must never be repeated.”

Alison Bloomer

Alison Bloomer is Editor of Learning Disability Today.

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