CONTROVERSIAL seclusion and "potential financial abuse" of vulnerable patients were discovered over the past three months in inspections of a hospital at the centre of a massive abuse probe.
Confidential minutes seen by The Irish News lay bare the ongoing "low and unsafe" nurse staffing levels at Muckamore Abbey Hospital and warn of the "psychological disconnect" between ward staff and management on the Co Antrim site.
The Regulation and Quailty Improvement Authority (RQIA) state the situation had "become so precarious as to be critical" - with reliance on agency workers having the potential to "impact on patient safety and the safety of staff themselves".
Muckamore employees are also experiencing "psychological trauma", according to inspectors, with some allowing themselves to be hit by patients - such is the level of concern in the wake of a scandal that has led to the suspension of 20 of their colleagues.
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"The inspection team was clear that staff across the site were fearful. Inspectors found a number of examples where staff had allowed themselves to be be hit by patients because they feared the consequences of using the legitimate intervention techniques in which they had been trained," the minutes state.
"The use of CCTV on site has also contributed to that fear, with many staff unable to articulate to RQIA their understanding of how and why CCTV was used."
The high-level leak reveals what was said during two heated meetings on March 1 and April 17 between RQIA chiefs and Belfast trust management following two "unannounced" inspections by the regulator in February and last month.
Despite assurances from trust bosses that major improvements have been made, the RQIA inspectors found all wards were in "a cycle of crisis management" which was "impacting on the quality of care".
Read More: Department of Health says public inquiry into Muckamore scandal 'not in public interest'
Scathing criticism of failings in the physical and dental assessments of patients - some of whom are non-verbal and cannot express if they are suffering from physical pain or toothache - is also made, with warnings for this to be urgently addressed.
The development comes almost a year since the story first broke about harrowing physical abuse and mental cruelty of adults with severe learning disabilities in the regional facility's Psychiatric Intensive Care Unit (PICU).
Specialist teams of detectives are investigating 300 incidents of alleged abuse captured on CCTV cameras which staff didn't know were turned on. Footage relating to suspected wrongdoing in other wards is also being assessed.
RQIA inspectors conclude they have "significant concerns" following their detailed inspections since February and "robust" action was required.
Read More: Parent at centre of Muckamore probe hits out at department
The north's health watchdog also discovered that the 'seclusion' or isolation of patients to manage difficult behaviours was continuing in rooms which "did not meet the requirements for this purpose".
The 2019 inspection notes:
"RQIA had been advised that between 21 January and 24 February there were 102 episodes of seclusion in the hospital. 73 of these had been in respect of one patient - 68 in line with the patient's agreed care plan."
Other concerns highlighted by the RQIA team centred on patients' money -
- Four patients had finances over the threshold of £23,500 and trust bosses were legally required to refer them to a State body, the Office of Care and Protection, to ensure their money is properly managed while they are ill. This didn't happen
- 'Potential financial abuse' of a patient's assets was also suspected and should have probed as a "safeguarding" matter. Inspectors said this should be treated with "urgency"
- No "overarching financial governing system in place" for 13 patients' finances. Records "incomplete" with "large gaps" for expenditure in another case with no receipts
Further warnings relate to the "observation" of patients - which were not properly carried out due to low staff numbers - and the impact of the closure of the six-bedded PICU ward, which cares for the sickest patients and has been shut since Christmas
The minutes conclude with a RQIA chief stating that the watchdog believes there is a "sense of crisis on site where staff are 'firefighting' rather working in a planned way".
"The (inspection) team agreed that there was a not a structural but psychological disconnect between ward staff and management on the site," it adds.
The Irish News asked the Belfast trust last night to respond to the serious findings of the RQIA inspections, specifically concerns around staffing, seclusion and suspected financial abuse.
A spokesman said they "actively addressing the matters".
'We will continue to work collaboratively as a priority to improve the lived experiences of people with intellectual disabilities and their families," he added.
"We have systems and processes in place which assure that care today in Muckamore Abbey Hospital is safe. We are actively participating - with other Trusts, the Health and Social Care Board and the Department of Health - in the regional plan to realise the permanent secretary's vision that no-one should call Muckamore Abbey Hospital their home."
