Loss of Faith in Care System
A woman whose daughter experienced abuse and neglect at two separate care facilities has expressed a loss of confidence in the care system.
After Alicia Fox was discharged from Muckamore Abbey Hospital, her mother Catherine hoped for a fresh start. However, this optimism was short-lived when Alicia was moved into residential care and encountered similar neglect and abuse.
Muckamore Abbey Hospital, a facility for adults with severe mental health needs and challenging behaviour, is currently the focus of the UK's largest criminal adult safeguarding and abuse investigation within the NHS.
A public inquiry into the events began in 2022, with its final report, findings, and recommendations anticipated in June. Concurrently, criminal proceedings against staff members are ongoing.
Alicia's Journey Through Care
Alicia was admitted to Muckamore Abbey Hospital in County Antrim at age 25. Upon her discharge, the family was informed she would transition to supported living accommodation; however, she was instead placed in residential care.
Catherine stated that lessons from the Muckamore experience had not been applied. Alicia, who once attended college and had friends, now at 36 resides in a different facility with limited independence and choice, effectively becoming institutionalised for a second time.
"My daughter once went to college and had friends, at 36 she now lives in a different facility with little independence or choice and has become institutionalised for the second time, have lessons not been learnt from Muckamore," Catherine said.
At River House, a residential home in Belfast, Alicia faced further neglect and unsupervised care. Catherine, along with two other families whose adult children had been patients at Muckamore, expressed shock at these conditions.
Catherine described the situation as cruel and stated that Alicia had been failed twice.
Complaints regarding patient care were submitted by families and some staff members at River House. Alicia's records at the new care home indicate she was subject to 42 separate adult safeguarding referrals, all related to neglect.
Complaints and Safeguarding Referrals
Among the complaints raised were issues of neglect and inadequate supervision.
Serious Adverse Incident Review
Following these complaints, the Belfast Health and Social Care Trust reported the abuse allegations to the Department of Health in 2021, initiating a serious adverse incident (SAI) review. An SAI is defined as any event or circumstance that caused or could have caused unintended or unexpected harm, loss, or damage.
The review, which took nearly four years to complete, concluded that Alicia and two others experienced neglect and safety concerns at River House.
Although Catherine was assured she would be involved in the review process, this did not occur. When the review was finally issued in May 2025, Catherine stated it failed to address the safeguarding concerns it was meant to investigate, and families were not given the opportunity to respond to critical findings.
"Families had been left without answers as to why repeated safeguarding referrals occurred, why opportunities for learning were missed, and why there had still been no meaningful accountability for failures in their loved ones' care," Catherine said.
Feeling let down, families initiated judicial review proceedings to challenge the lawfulness of the SAI review and to ensure a proper investigation.
Days before the High Court hearing, the Belfast Trust conceded that the SAI review was unlawful, acknowledging unreasonable delays and failure to engage properly with families.
The High Court subsequently quashed the SAI review and report in full. The Trust has committed to conducting a fresh investigation through a new, independent panel.
According to Phoenix Law, representing Catherine, the process should have been completed within 12 weeks but instead took four years.
In a statement, the Belfast Trust said it had invited families from River House to meetings and offered a direct apology.
Legal Representation and Impact
Victoria Haddock, a solicitor at Phoenix Law, expressed concern that legal action was necessary to secure a lawful review of serious incidents involving vulnerable adults, especially given the increased scrutiny following the Muckamore Abbey Hospital Inquiry.
"The outcome achieved is significant as the previous case law limited the ability of families and patients to challenge the legality of SAI reviews through the courts," Haddock said.
"This case signals a shift by demonstrating that SAI reviews are not beyond legal scrutiny and can be successfully challenged.
"This case sends a clear message that families cannot be shut out from investigations into the care of their loved ones."
In a statement, the Belfast Trust acknowledged the lengthy process and noted the appointment of a family engagement lead. It stated ongoing efforts with River House since 2021 to improve facilities and safeguarding as part of a comprehensive action plan and confirmed continued engagement with the Fox family regarding their concerns.
Consequences of Muckamore Investigations
The investigations at Muckamore have resulted in 19 staff dismissals, nine final warnings, 11 formal warnings, one verbal warning, 37 staff departures, 52 cases awaiting legal proceedings, and 65 staff known to the Nursing and Midwifery Council.
