Mum lost faith in care system after repeated neglect of daughter

A woman whose daughter was treated at two facilities where patients were subject to abuse and neglect by staff has said she has lost faith in the care system.

When Alicia Fox was discharged from Muckamore Abbey Hospital her mother Catherine was hopeful of a new beginning.

But that happiness was cut short within months when Alicia was moved into residential care - only to find the same neglect and abuse happening again.

Muckamore, an institution for adults with severe mental health needs and challenging behaviour, is at the centre of the UK's largest-ever criminal adult safeguarding and abuse investigation in NHS history.

A public inquiry into what happened began in 2022 and its final report, findings and recommendations are expected to be published in June.

Alongside the inquiry, criminal proceedings involving staff continue.

Alicia was admitted to the hospital in County Antrim when she was 25.

When she was finally discharged her family were told she would be moving into supported living accommodation but she instead ended up in residential care.

Catherine said she felt lessons had not been learned from what happened at Muckamore, where Alicia was a patient from 2015 to 2018.

"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 Alicia's new residential home, River House in Belfast, there was more neglect and unsupervised care.

Catherine and two other families whose adult children were Muckamore patients said they were shocked by this.

Catherine described events as cruel and that Alicia had been failed twice.

Complaints about the patients' care were made by the families and some members of staff at River House.

Alicia's records in her new care home reveal that she was subject to 42 separate adult safeguarding referrals and all relate to neglect.

Among the complaints raised were:

• Assessed levels of supervision not being provided, which led to one service user (not Alicia) swallowing a battery
• Failure to follow care plans
• Unauthorised use of seclusion
• Medication errors
• Failure to document or investigate bruising

Based on those complaints the Belfast Health and Social Care Trust reported the allegations of abuse to the Department of Health in 2021, which triggered a serious adverse incident (SAI) review.

An SAI is any event or circumstance that led or could have led to unintended or unexpected harm, loss, or damage.

That review, which took almost four years to complete, found Alicia and two others had endured neglect and safety issues at River House.

While Catherine had been assured she would have the opportunity to contribute to the review, this did not happen.

When it was finally issued in May 2025 Catherine said it did not examine the safeguarding concerns it was established to investigate and families were not given the opportunity to respond to its critical findings.

Catherine said 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.

Families felt so let down they lodged judicial review proceedings to challenge the lawfulness of the SAI review and ensure a proper investigation took place.

Days before the High Court hearing, the Belfast Trust conceded that the SAI review was unlawful and acknowledged both the unreasonable delay and its failure to properly engage with the family.

The High Court subsequently quashed the SAI review and report in full.

The Trust has now committed to carry out a fresh investigation through a new and independent panel.

According to Phoenix Law, which represented 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 had offered a direct apology.

Victoria Haddock, a solicitor at Phoenix Law, said it was deeply concerning that legal action was required to secure a lawful review into serious incidents involving vulnerable adults, particularly given the heightened scrutiny around adult safeguarding in the wake of 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," she 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 said it acknowledged the process had been lengthy and that it had appointed a family engagement lead.

It said it had been working with River House since 2021 to improve facilities and safeguarding as part of a comprehensive action plan.

It added that it continued to work with the Fox family over their concerns.

The investigations at Muckamore have led to 19 staff being dismissed, nine have received final warnings, 11 received formal warnings, one verbal warning has been issued, 37 members of staff have left their jobs, 52 cases are still awaiting legal process and 65 members of staff are known to the Nursing and Midwifery Council.