Compulsory CCTV cameras in care settings and better funding for regulators are among the demands being made at the conclusion of an inquiry into abuse in a Northern Irish hospital.
The Muckamore Abbey Hospital Inquiry, which is looking into the circumstances surrounding more than two decades of patient abuse at the County Antrim learning disability hospital, is currently hearing closing statements.
“But for the discovery of CCTV in 2017, none of us in the room would be here”
Mark Robinson
Abuse at the hospital, run by Belfast Health and Social Care (HSC) Trust, was discovered in 2017 when CCTV footage was shown to the father of a patient after he claimed his son had been assaulted.
Following this revelation, a tide of further allegations of abuse dating back decades was discovered.
A police investigation is running alongside the inquiry and so far, 16 people – including some nurses from the hospital – have been charged, with more potentially on the horizon.
The Police Service of Northern Ireland (PSNI) has to date submitted 68 files to the Public Prosecution Service for consideration.
The Muckamore inquiry is looking into events that occurred at the hospital between 2 December 1999 and 14 June 2021. Other events outside this scope have also been considered, though.
This week, legal representatives of the inquiry’s core participants have been delivering their closing statements.
Once this finishes, the inquiry panel will retire to form its final report, which will include recommendations to the government, health and social care leaders and others concerned with the protection of adults with learning disabilities.
Yesterday, representatives for the PSNI, the Regulation and Quality Improvement Authority (RQIA) and the Northern Ireland Department of Health (DOH) gave their final thoughts to the inquiry.
Mark Robinson KC, counsel for the PSNI, spoke about the important role CCTV monitoring played in the unveiling of abuse at Muckamore.
“But for the discovery of CCTV in 2017, none of us in the room would be here,” he said.
“We say that the presence of CCTV affords the most vulnerable additional protection and ensures they have a voice in the criminal justice process.”
The PSNI, he said, backs calls from families of Muckamore victims for mandatory CCTV in care settings.
He communicated the organisation’s disappointment that this was absent from the draft Adult Protection Bill currently being considered by Northern Irish lawmakers.
“Without that CCTV, there would be no police investigation, no prosecutions and no public awareness of the issues uncovered in Muckamore Abbey Hospital,” Mr Robinson said.
“The circumstances giving rise to abuse may indeed [have continued] to this very day. That’s been said before, but we say it loses nothing in repetition.”
Mr Robinson hit out at claims that staff suspensions from the hospital as a result of police investigations into those workers may have put patients at risk due to shortages of personnel.
The alternative, of allowing staff members suspected of crimes to have continued access to patients, would have in fact compromised patient safety, he said.
He also pushed back at a suggestion that the criminal investigation had “taken precedence” over patient welfare.
Mr Robinson also spoke of the ongoing “resource crisis” at his police force, but that despite this it had still allocated a lot of time and money to the investigation and inquiry.
Since the 2017 revelations, he told the inquiry, the PSNI had hired 12 dedicated adult safeguarding officers and implemented additional training to help officers “recognise and respond” to adult safeguarding concerns.
“PSNI is a learning organisation,” he finished. “We welcome any recommendations which will assist the police in improving the provision of care to adult safeguarding issues and those most vulnerable in society.”
Barrister Michael Neeson gave closing statements on behalf of the Northern Ireland health and social care provider regulator RQIA.
Mr Neeson said that, having heard evidence during the inquiry, the regulator remained convinced that it acted promptly and as it should when concerns came to light – but that it was working under intense budgetary pressures that limited its capabilities.
The lawyer conceded that RQIA inspections give only a “snapshot” of a service and submitted that merely inspecting a setting does not itself prevent abuse.
He said the RQIA, when it did become aware of allegations of abuse, acted “promptly”, and “committed a significant amount of its limited resource” to ensuring improvements happened.
He outlined the developments to inspection methodology the RQIA had undertaken in recent years, and how it continued to do this in response to the Muckamore case.
“RQIA invites the inquiry to conclude that RQIA is a learning and reflective organisation,” he said.
Mr Neeson said that the RQIA recognised the need to be a more visible presence for families of patients at services like Muckamore, airing regret that some did not hear from the regulator for a long time after the abuse allegations became public.
“We unreservedly apologise”
Andrew McGuinness
However, he said the RQIA remained limited, both in terms of resources and the scope of its powers.
“As [the inquiry] nears closure, and patients start being resettled, RQIA recognises the need to adapt to the evolving care model in Northern Ireland,” he said.
“It is proper to observe that there is insufficient capacity or resource available to RQIA to fulfil the requirements of its regulatory role across the varied environments in which people are now being supported.”
He further said that the organisation lacked some of the enforcement powers available to the Care Quality Commission (CQC) in England and Wales, and that RQIA would “welcome” work to “modernise” health and social care regulation in Northern Ireland.
Andrew McGuinness KC spoke on behalf of the Northern Irish DOH.
“We are sorry,” Mr McGuiness said early on in his closing statement.
“The DOH has ultimate responsibility for the health and social care system. Where [it] has failed patients and families at Muckamore, and it’s undoubtably failed them, we unreservedly apologise.”
He said that the senior departmental witnesses from the DOH had “reiterated” their apologies to the families during their witness statements to the inquiry.
Mr McGuiness pointed to the apology of Dr Michael McBride, DOH chief medical officer and former Belfast HSC Trust chief executive, who had described the events at Muckamore as a “fundamental breach of trust” and an “abuse of power”.
The DOH representative also quoted ex-national chief nursing officer (CNO) Professor Charlotte McArdle as having told the inquiry that she apologised as the “most senior nurse” dealing with the situation.
He said, however, that the DOH recognised that apologies without actions were meaningless, and said the organisatino had already identified “improvements” that could be made.
He outlined how, in his view, the department had responded to the 2017 revelations, in particular the work Professor McArdle did to stabilise the nursing workforce at Muckamore in the years after.
“Following the 2017 revelations the DOH engaged with the Belfast trust on operational staffing issues in an unprecedented way,” said Mr McGuiness.
“The chief social work officer and CNO were discussing staffing almost daily… the impact of staff suspensions and staffing pressures was a live issue for the DOH and a standing item [in a report released after].”
Mr McGuiness, in response to calls by other inquiry participants for mandatory CCTV in care settings, outlined why it would likely not feature in the upcoming Adult Protection Bill: “The DOH recognises the value of CCTV in the identification of abuse at Muckamore.
“Its use is not being discouraged, and the use of video is governed by regulatory guidance. The issue of CCTV has been significant consideration over the last few years.
“Advice has been taken… [which suggested] it’s not possible to legislate mandatory CCTV in what is, after all, someone’s home.”
He said, however, that the DOH would look to bring in “regulations” governing the use of CCTV in care settings and that the bill may include this.
The inquiry continues.
Read more about Muckamore
