Section one Context setting.145 CQC published its final report on restraint, seclusion and segregation on 22 October 2020.146 In Northern Ireland, data for 2018–19 shows 1,106 total compulsory admissions under the Mental Health (NI) Order 1986 for mental illness. This was an increase of 12% since 2014. Of the detained patients, 518 (47%) were female. Additionally, there were 35 compulsory admissions under the Order for people with a learning disability, a decrease of 40% since 2014.147 RQIA raised concerns about the management of adult safeguarding incidents, serious adverse incidents and near misses which impacted on the safe delivery of care and treatment for patients who were detained across mental health and learning disability inpatient facilities inspected in Northern Ireland. RQIA was concerned about: increased pressures across mental health services impacting on patient safety and care and treatment in inpatient facilities; significant staffing shortages; frequent over-occupancy on wards across inpatient facilities; reduced capacity to receive new admissions; inappropriate admissions to psychiatric intensive care units; and increased environmental risks to patient safety. These concerns resulted in RQIA taking escalation action with three of the five health and social care trusts. Three of the five trusts in Northern Ireland have inpatient facilities which require environmental improvements, with RQIA identifying potential risks associated with old hospital wards such as a high number of ligature points. In August 2019, RQIA took enforcement action against the Belfast Health and Social Care Trust in respect to serious concerns about staffing, safeguarding and the management of patients’ finances and property (Article 116 Mental Health (NI) Order 1986) in Muckamore Abbey Hospital. The hospital provides inpatient assessment and treatment facilities for people with severe learning disabilities and mental health needs.148 The action followed reports of abuse of patients and the suspension of 20 nurses in 2018, with police investigations ongoing.149 In particular, CCTV footage from the hospital revealed approximately 1,500 crimes against patients in the hospital’s psychiatric intensive care unit over a six-month period in 2017 to 2018. A February 2019 review into the treatment of patients by Dr Margaret Flynn said there were ‘catastrophic failings’ in the hospital.150 Throughout 2019–2020, RQIA completed a series of inspections of the hospital and supported the Trust to address the improvements required to comply with the actions as set out in the Improvement Notices. At the beginning of 2020, significant improvements had been made and all three Improvement Notices were removed. 145 CQC, May 2019, Review of restraint, prolonged seclusion and segregation for people with a mental health problem, a learning disability or autism Interim report, https://www.cqc.org.uk/sites/default/files/20191118_rssinterimreport_full.pdf [accessed 16/12/2020] 146 CQC, October 2020, Out of sight – who cares? A review of restraint, seclusion and segregation for autistic people and people with a learning disability and/or mental health condition, https://www.cqc.org.uk/sites/default/files/20201023_ rssreview_report.pdf [accessed 01/12/2020] 147 Department of Health, August 2019, Mental health and learning disability inpatients 2018/19, https://www.health-ni.gov. uk/publications/mental-health-and-learning-disability-inpatients-201819 [accessed 24/08/2020] 148 BBC News, September 2020, Muckamore Abbey Hospital: Timeline of abuse allegations, available: https://www.bbc.co.uk/ news/uk-northern-ireland-49498971 [accessed 16/09/2020] 149 BBC News, August 2019, Muckamore Abbey: RQIA takes action after abuse claims, https://www.bbc.co.uk/news/uknorthern-ireland-49372659 [accessed 24/08/2020] 150 Belfast Trust, February 2019, Summary of Muckamore Abbey Hospital – A Way to Go, https://belfasttrust.hscni.net/wpfd_ file/summary-of-mah-safeguarding-review/ [accessed 16/09/2020] 47