Patients with learning disabilities at Muckamore Abbey Hospital were kept on wards that were like “prisons” and suffered decades of “inhumane” and “insidious” abuse, an inquiry has heard.
Healthcare staff working at the learning disability hospital in County Antrim subjected some of their most vulnerable patients to physical, sexual, psychological and emotional abuse, lawyers claimed.
“Patients were left exposed to abuse for many years and suffered harm as a result”
Conor Maguire
The Muckamore Abbey Hospital Inquiry, chaired by barrister Tom Kark KC, has been analysing the issue of abuse at the hospital to determine why it happened and the circumstances that allowed it to happen.
It has been looking at the events that occurred between 2 December 1999 and 14 June 2021 but has also considered testimonies that fall outside of this timeframe.
Muckamore Abbey Hospital, run by Belfast Health and Social Care (HSC) Trust, provides inpatient assessment and treatment facilities for adults with severe learning disabilities and mental health needs.
It has been the subject of a long-running police investigation into allegations of abuse of patients by staff members, including nurses.
The total number of people who have been prosecuted so far is 15, including some registered learning disability nurses.
The statutory inquiry into the abuse has been running parallel to the police investigation and is this week hearing its closing statements from core participants.
On Monday, 3 March, it heard testimony from groups representing patients and families affected by the abuse scandal.
Monye Anyadike-Danes KC, instructed by Phoenix Law, represented 46 clients affiliated to campaign groups Action for Muckamore (AFM) and the Society of Parents and Friends of Muckamore Abbey Hospital (SPFM).
Meanwhile, Conor Maguire KC, instructed by O’Reilly Stewart Solicitors, represented 17 clients as part of ‘Group 3’, whose members are not affiliated with any campaign groups.
Mr Maguire told the inquiry that the patients at Muckamore “should have been provided with specialist care in a safe environment”.
He said: “We, as a community, owe a duty of care to these vulnerable people and their families.
“We entrusted our leaders, the government ministers and their permanent secretaries. We entrusted the chief executives and directors of Belfast trust to ensure that duty of care was fulfilled, but it was not.
“Patients were left exposed to abuse for many years and suffered harm as a result.”
He called on the inquiry panel – made up of Mr Kark, former registered nurse and health visitor Dr Elaine Maxwell, and chartered clinical and forensic psychologist Professor Glynis Murphy – to make recommendations so that no vulnerable adult or family “will be faced with the same situation”.
Meanwhile, the inquiry heard from Ms Anyadike-Danes that inpatients at Muckamore were abused “physically, sexually, psychologically, emotionally” and were “neglected, misdiagnosed, inappropriately medicated and had their property interfered with”.
“What needs to be fully and properly understood by all who had a hand in those alleged breaches and failures, or who could and should have prevented them, is the sheer extent of the harm that was done,” she added.
Decades of abuse at Muckamore
Both Mr Maguire and Ms Anyadike-Danes went into detail about the abuse that some of their clients and their families had experienced.
The inquiry heard how perpetrators at this hospital “started with emotional abuse on admission” by denying parents’ permission to accompany loved ones onto the ward and being told they could not visit them.
Once admitted, patients with a learning disability experienced physical, sexual and emotional abuse by staff and other patients, the lawyers told the inquiry.
Ms Anyadike-Danes described how one patient had bruising to his neck where he had been “held down with a foot”, while another had his private parts “bruised so badly that they turned black”.
Patients at the hospital were frequently “left alone” despite being assessed as requiring one-to-one supervision.
Ms Anyadike-Danes said one individual, known to the inquiry as P90, was left alone in a sensory room for two hours while “staff were in a different room talking”.
In that time, he took the cord from his jogging bottoms and caused bruising and bleeding to himself and was found banging his head on the floor.
P90’s family said he often had a strong smell of urine and they had found faeces under his fingernails.
Meanwhile, Mr Maguire shared similar harrowing testimony of patient P28, also referred to as Danny.
“The patients themselves, by virtue of their disabilities, were often without physical voice with the means to communicate”
Conor Maguire
Danny, an adult who had the mental age of an 18-month-old child, was placed on a ward that was “more like a prison”, the inquiry heard.
During his two years on the ward, his medication was mismanaged, his teddies were stolen, he lost significant weight and he became dirty and smelled of strong body odour and urine.
CCTV footage later revealed at least 17 incidents in which Danny was mistreated by staff.
The inquiry further heard how staff at Muckamore Abbey Hospital took part in restraint and seclusion.
Ms Anyadike-Danes said there was an “overreliance on the use of restrictive practices”, which were “regularly used as a form of punishment to instil fear in patients or compliance”.
The hospital had a seclusion room, which was described as dark, small, cold and having no windows.
One witness, P120, previously told the inquiry that his son had been placed in a seclusion room, where he was put in a corner, slapped across the room and had cold water thrown at him.
Another witness, P60, was placed in the room and “locked up, wasn’t fed [and] wasn’t allowed to go to the toilet”.
“You wouldn’t treat an animal like that,” said Ms Anyadike-Danes.
Mr Maguire described the abuse at Muckamore as “insidious” and “inhumane”.
He noted that in some cases staff had pulled loved soft toys from patients “simply to get a rise out of them”.
The inquiry also heard how residents had been subjected to medical neglect, dental neglect and poor nutrition.
One family member previously told the inquiry how their relative had dropped to five stone during his admission, while a mother of an inpatient said her daughter had gone from a size 10 to a size 20.
Patients at the learning disability hospital were also “overmedicated” by staff, the inquiry heard.
Ms Anyadike-Danes argued that this was down to “insufficient” mix and seniority of staff, and that medication was being used as a first response to deal with challenging behaviour.
Meanwhile, staff were also found to have interfered with patient finances and property.
Evidence indicated that staff “regularly misappropriated and stole patients’ belongings” and, in some cases, used their money to buy things like takeaway food or cigarettes.
More on Muckamore Abbey Hospital
Families ‘ignored, sidelined and humiliated’
The inquiry previously heard evidence from senior managers at the hospital that the abuse and neglect was “secret and concealed and therefore almost impossible to detect”.
Ms Anyadike-Danes asked the inquiry to “categorically reject that kind of argument”.
Instead, she argued that the lack of accountability of staff, by managers, the trust, the Department of Health and the Regulation and Quality Improvement Authority (RQIA), allowed serious and widespread abuse to continue.
This was echoed by Mr Maguire, who said there were “lots of warning signs” that abuse was occurring, and the Department of Health and trust leaders should have acted.
He said: “All the while they failed to see the smoke of the many missed opportunities and it wasn’t until the flames of abuse uncovered by CCTV engulfed them that they acted to put out this fire of abuse.”
He added: “The patients themselves, by virtue of their disabilities and vulnerabilities, were often without physical voice or the means to communicate.
“Loving relatives of these abused patients, our clients, when they brought issues to the fore, were frequently ignored, sidelined or humiliated, with devastating consequences for the patient and their families.”
Abuse at Muckamore was uncovered in 2017 after a father of a patient asked to see CCTV following an allegation by his son that he had been assaulted.
It was acknowledged by both lawyers that, had the patient’s father not pushed to see the CCTV, the scale of abuse at the hospital may not have been uncovered.
Mr Maguire said: “CCTV was a gamechanger. We say it was the only effective change that led to the uncovering of widespread abusive practices, and ultimately led to further reports and to this inquiry.”
Factors that allowed abuse to continue
Ms Anyadike-Danes called for the inquiry to make a finding that the failures were “institutional, systemic and substantial”.
She set out nine main “cumulative and overlapping” factors that allowed the abuse to continue for as long as it did.
Meanwhile, Mr Maguire also uncovered many areas of concern that had contributed to the ongoing abuse.
Among the factors identified by both parties included:
Failure of leadership throughout the system
Inadequate funding
Inadequate expertise within the system
Inadequate ratio of staff to patients
Failure to treat learning disability services with the same value as acute services
Failure of accountability mechanisms
Poorly planned resettlement attempts
Lack of communication with parents or other relatives
Poor record keeping and no openness
Importantly, both parties acknowledged that inadequate expertise and staffing contributed to the ongoing abuse.
The inquiry heard how Muckamore Abbey Hospital lacked staff with learning disability experience and had an “approach of using staff with mental health experience instead”.
Ms Anyadike-Danes noted that safe and effective care for people with a learning disability, especially those with complex behaviour and conditions, required individuals trained and qualified in learning disabilities.
Meanwhile, she also identified a failure of leadership and “lack of interest and curiosity” at trust and board level as a reason the abuse went undetected.
She noted that the inquiry had heard evidence from executives and board members “who sought to shift blame for failings to subordinates” and declaring it was their subordinates fault for not telling them when things went wrong.
The regulator also came under fire for not identifying that abuse was taking place.
Ms Anyadike-Danes noted that issues such as inadequate dental care, absence of basic hygiene, theft of personal items and urine-soaked bedsheets “should have been picked up by the RQIA”.
She claimed that failure by the regulator was driven by a range of factors, including inspections being rushed and not actually unannounced, and the regulator having “inexplicable bias so far as they are concerned in favour of the organisations they were charged to inspect”.
Protecting adults with learning disabilities in the future
Both lawyers set out several recommendations that patients, families and carers would like to see from the inquiry’s final report.
Ms Anyadike-Danes called for greater funding allocated to learning disability services in Northern Ireland, which would support an increase in the learning disability workforce.
She said families wanted to see improvement around their involvement in patient care, especially concerning the wellbeing of their loved ones.
The use of CCTV was highlighted in the recommendations, with families urging the inquiry to recommend that CCTV was introduced in all community placements to safeguard vulnerable patients.
Other recommendations included calls for healthcare assistants to be subject to formal regulation, and for Northern Ireland to introduce a new duty of candour for organisations.
Families have also called for a dedicated redress scheme, which can identify the full impact of the abuse and provide compensation, including financial, for personal injury loss and damage.
The Department of Health in Northern Ireland announced last year that it had postponed plans to close Muckamore Abbey Hospital, after failing to find alternative accommodation in the community for all patients.
As such, Ms Anyadike-Danes called for community-based services to be “properly resourced, properly staffed, properly governed and regulated”.
“Muckamore is scheduled to finally close whe the remaining few patients are discharged to their community placements,” she said.
“The focus is therefore now on what happens in the community and the placement carings for those with learning disabilities and mental health issues.”
Mr Maguire echoed this and called for future placements to ensure patients were “safe and well cared for”.
He said this was the responsibility of every person at the “front and centre of their care”, from HCAs, nurses and doctors, to directors and chief executives, all the way to the health minister.
Mr Maguire added: “Only then will our clients feel they are not the problem.
“Only then will they truly feel they and their loved relatives are fully part of our community, at the centre of that community where they should be.
“Anything less, we say, is not good enough.”
The inquiry will hear closing statements until early next week.
