MUCKAMORE Abbey hospital is a "high-risk setting" where vulnerable patients have a one in four chance of being "harmed", an expert heading up a confidential abuse probe has concluded.
The shocking revelation was relayed to families who have loved ones at the Co Antrim facility following a year-long review which also found a "culture of silence" - that led to a litany of abuse allegations going unreported for months.
If it were not for the discovery of CCTV footage dating back 18 months ago in a Psychiatric Intensive Care Ward (PICU) - which was not supposed to be in operation at the time - many of the allegations would never have come to light, senior directors at the Belfast health trust have revealed.
The hospital close to Antrim town is Northern Ireland's regional facility for adults with learning disabilities and has been at the centre of a trust probe and external NHS investigation since last August, alongside an ongoing police investigation examining more than 70 incidents of "ill treatment" of patients.
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Thirteen staff, the majority of whom are nurses, are currently on "precautionary suspension".
Detailed notes taken by a relative at a briefing between trust officials, independent investigators and families last month expose the full scale of the scandal, with the trust's top nursing chief admitting her sense of "shame".
"I would reiterate as a nurse I have never used the word 'ashamed' about my own profession - until this time," Brenda Creaney, the trust's director of nursing, told relatives.
In equally stark language, the trust's director of adult social care services, Marie Heaney, also spoke of the sense of shock that has swept through the organisation since disturbing CCTV images of staff apparently abusing patients first emerged last year.
She confirmed to distressed families there was a "significant delay" in reporting the allegations of abuse when they were first identified last August.
When they were finally reported by Muckamore management, their version of events was much less severe than what was uncovered in the archive footage. The hospital's senior managers have since been "relocated" across the trust.
"I think it's fair to say that we were extremely shocked, disappointed and ashamed when the events unfolded. Certainly the written report (of the abuse allegations) we got bore no relation to the CCTV images that the team we appointed subsequently saw...It did send shockwaves throughout the Belfast trust and the wider system," Ms Heaney admitted to relatives.
The social care director described the behaviour as "completely unacceptable" and that the trust "must take full responsibility".
She revealed the CCTV footage from the PICU ward, where the most seriously ill patients were nursed, exposed a "very high number" of similar incidents caused by a "significant amount of staff".
"Staffing is always a challenge...but why did this happen in Muckamore Abbey hospital where there is a concentration of highly qualified and skilled staff?'', she said.
Ms Heaney told families there must have been a 'culture' where that conduct was acceptable, particularly in the Psychiatric Intensive Care Unit.
She also disclosed that CCTV images from other parts of the hospital did not reveal similar behaviour.
Relatives heard there were severe nursing shortages at the hospital, high sickness rates and a massive reliance on agency staff - with the equivalent of 50 bank or agency nurses filling in per week, a situation that was "impossible" to sustain.
It was a hospital with "no focus" and no planned activities for its vulnerable patients which led to them becoming "incredibly bored" - that regime has now been being overhauled with walks, music therapy and hydrotherapy in swimming pools planned.
Another director told relatives that while staffing problems were a serious issue and may have been a contributory factor to the abuse allegations, there was no explanation for the "culture of silence that went on in Muckamore".
The Irish News first revealed the allegations and unprecedented level of nursing suspensions in late July.
Recordings show patients allegedly struck by staff while there were also claims of 'unauthorised seclusion' and adults 'being left in the dark' without supervision.
There are almost 90,000 hours of 'saved' archive CCTV footage - relating to a period between March and September last year - which a team of experts have combed through.
The reason the allegations were discovered was because the cameras had been installed a few years ago in relation to a separate investigation but weren't due to go live until last September, relatives heard.
The separate high-level independent NHS review was ordered last September and is almost complete. It will never be made public but families of patients affected have been told they will "hopefully" receive a copy "shortly" by its lead author, Margaret Flynn.
Ms Flynn, who headed up the review into the Winterbourne View abuse scandal in Bristol which led to six care workers being jailed for abuse in 2102, described the Muckamore case files of patients who had allegedly been harmed as a "hard, hard read".
Detailed interviews with family members were also carried out and Ms Flynn said she heard at first hand how "incredibly hurt, betrayed and guilty" relatives felt.
Of particular concern to Ms Flynn and her team was the use of "unmonitored" and lengthy periods of "seclusion" - in which patients are placed in isolation to manage difficult behaviour.
Ms Flynn referred to three patients who were kept in seclusion "for most of their life" in 2015 - which she equated to being kept in prison. She said it must have been "hugely distressing" for them.
Records showed a total of 21 patients were subject to 859 periods of seclusion three years ago, with 90 per cent of those involving three patients. Two years later, 15 patients experienced 616 periods of seclusion - involving two of the same patients.
"We are talking about people being placed in what is perceived to be somewhere safe...seclusion is not effective treatment...it does not work in the long term," Ms Flynn added.
The expert team also discovered more than 4,000 'adverse incidents' were recorded at Muckamore between November 2015 and November 2017. Of this total, more than 1,000 were 'patient on patient harm' .
"Patients have a one in four chance of being harmed when they come into Muckamore hospital. That is too high, that is far too high...I've no doubt you do not want that for your relatives," she said during the meeting.
Ms Flynn added: "Our overarching observation is Muckamore Abbey hospital is a 'high-risk setting' - there are high risks for patients who are placed at MAH.
"We think of hospitals as healing environments, we think of hospitals as places where we stay for a limited period and then we are discharged - this is not the experience of patients at Muckamore Abbey hospital."
Belfast Trust has been contacted about the information relayed to relatives but declined to comment.
In July the Belfast Trust apologised "unreservedly" to patients and their families at Muckamore following the suspension of more than a dozen staff amid allegations of ill-treatment.
