Muckamore Abbey Hospital (MAH) is located just outside Antrim town and is managed by the Belfast Trust to provide regional in-patient services for the learning disabled population of three Health and Social Care (HSC) Trusts, the Belfast, South-Eastern and Northern Trusts. The Hospital provides inpatient, assessment and treatment facilities for people with severe learning disabilities and mental health needs, forensic needs or challenging behaviour.
There are presently 6 wards in the hospital, Ardmore for female patients, Cranfield 1 and 2 for male patients, Sixmile Assessment and Sixmile Treatment wards which are mainly forensic patients, and Erne ward for male and female patients with complex needs.
Historically MAH also provided assessment and treatment services for some Southern and Western HSC Trust patients with forensic needs, although this has significantly reduced since the major resettlement of long stay patients over the past number of years. Generally Southern and Western Trust patients are now admitted to Dorsey Ward at Bluestone Unit, Craigavon Area Hospital, and Lakeview Ward at Gransha Hospital respectively.
MAH has a lengthy history, opening in 1949, and services provided by the hospital have undergone significant changes in focus over the years, reflecting evolving policy imperatives for people with a learning disability since its establishment. Previous services provided at the hospital included provision of training, socialisation, occupation and recreation, supervised employment and long-term accommodation.
Since 1992 the overarching policy direction has been the resettlement of long-stay residential patients with learning disability from facilities such as MAH to community living facilities. In 1995, a decision was taken by the then Department of Health and Social Services to resettle all long-stay patients from the three learning disability hospitals in Northern Ireland to community accommodation.
The Bamford Review was initiated in 2002, and a key message emerging from the review was an emphasis on a shift from hospital to community –based services. ‘Equal Lives’, which was published in 2005, was the second report from the Bamford Review and set out the Review’s vision for services for people with a learning disability. This included a target that all people with a learning disability living in a hospital should be resettled in the community by June 2011.
Transforming Your Care (2011) restated the commitment to closing long-stay institutions and completing the resettlement programme by 2015.
The policy direction is therefore clear that no-one should be required to live in long-stay institutions, and people with learning disabilities should be adequately supported to live independently within a community setting, and provided with opportunities and support to enable them to maximise their potential to fully engage in their communities and wider society.
This very clear policy imperative to move accommodation provision away from long stay institutions has been reinforced by a number of high-profile and well-documented service failures in institutional residential settings over recent years.
Nationally, these have included Winterbourne View Hospital near Bristol in 2011, which uncovered criminal abuse by staff of patients and resulted in the closure of Winterbourne and a police investigation which led to 11 criminal convictions.
More recently, similar issues were again identified in 2019 at Whorlton Hall, a high dependency facility for adults with learning disabilities and complex needs in Co. Durham.
Here in Northern Ireland as well, there have been allegations of abuse at residential facilities for people with learning disabilities. In addition to the recent allegations of abuse at MAH which are the subject of a criminal investigation and are also being considered by the MAH Public Inquiry, allegations of abuse also emerged in 2012 at Ralph’s Close, a purpose-built residential care home for 16 adults with severe learning and/or challenging behaviour. A police investigation into these allegations concluded there was no evidence of wilful neglect.
Allegations of abuse of patients in individual incidents have also previously been made against staff at MAH on a number of occasions, which resulted in staff suspensions, and in one case prosecution. In addition, the PSNI carried out an investigation in 2007 into allegations of historic inappropriate behaviour between patients at MAH in the 1960s – 1980s, though no prosecutions arose from these allegations.
Proposal to close MAH
It is difficult to escape the conclusion that the model of care provided at MAH would no longer appear to be the most appropriate or effective way to meet the needs of patients today. The hospital was opened at a time when attitudes to disability, particularly learning disability, were very different to what they are now. While efforts have been made over the years to adapt the services provided at the hospital, these have been hampered by its status and perception as a hospital.
‘A Way to Go’, the report of the Level 3 Serious Adverse Incident investigation into MAH which was published in 2018 noted, ‘It (MAH) is based on an acute-care model that does not work for people with life-long support needs.’ The hospital’s geographical location has also contributed to the perception of a place apart, where people were ‘put away’ and forgotten about.
We believe signalling a clear intention to close the hospital would serve to support and accelerate the direction of travel to deliver on the long standing policy aim set out above – the resettlement of long stay patients into appropriate community facilities and support.
It is important to be clear that any decision to close the hospital will involve a defined timescale for closure, and will be accompanied by a plan, co-produced with current hospital patients and their families, which will clearly set out how the services currently provided on the MAH site will be delivered in agreed alternative settings. Any closure will not take effect until all the current patients have been successfully resettled to agreed alternative accommodation placements in the community.
As a first step to expediting the resettlement of patients who are currently in the hospital, a Regional Resettlement Oversight Board has been established and this is being led by Dr Patricia Donnelly. The aim of the Oversight Board is to bring the learning disability resettlement programme to a successful conclusion for individuals and their families.
Equally, it is important to state that any decision to close the hospital will not affect either of the investigative processes currently underway into events at MAH, and both the criminal investigation and the MAH Public Inquiry will continue according to their planned schedules.
We recognise that any decision to close MAH may be distressing for current and prospective patients at the hospital, and for their families and carers. The HSC system as a whole is working to develop a service that will respond effectively to the continuing need for assessment and treatment through small in-patient units, and modelling a safe community based service that extends home treatment, peripatetic and crisis response. This work will be done in partnership with service users and their carers, as well as local communities. The new Service Model for Learning Disability services will be key to successful delivery of this, and work is continuing to finalise this.
We would prefer responses using Citizen Space, however, if you wish to send an email or hard copy of your response please send it to:
Department of Health
Muckamore Abbey Review Team
Written responses are requested by no later than 24 January 2023.