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Listening to and hearing people and family’s experiences is the first line of defence when safeguarding vulnerable people

This article was originally published in the newsletter

 

In the aftermath of the Muckamore Inquiry, Meadbhba Monaghan, Chief Executive of Patient Client Council, says listening is the first line of defence when safeguarding vulnerable people.

The findings of this public inquiry are truly appalling. Extremely vulnerable individuals with mental health problems and learning disabilities, many of whom were non-verbal, were subjected to shocking abuse and neglect. Their families had entrusted their care to Muckamore Abbey Hospital, the Belfast Trust and our Health and Social Care system - that trust was inexcusably abused. Families have acted with extreme dignity, determination and love to ensure the experiences of their loved ones have finally been acknowledged and the abuse they suffered has been fully uncovered.

It is clear from the Inquiry’s findings that a core reason for the failure to act over the years was because individuals, organisations and their governance systems did not hear or listen to the voices and concerns of patients and families, and that these were not given sufficient weight.  The report recognises that ‘patients and families are experts by experience and are sometimes better placed than staff or health experts to comment’. The Inquiry heard powerful testimony that individuals and families tried to raise concerns but were not listened to. That there were multiple, persistent and well-documented warning signs but that there was a failure of organisations and the system to ‘join the dots’ and to be connected to itself.

Listening to and hearing people and family’s experiences should be the first line of defence when safeguarding vulnerable people. This Inquiry demonstrates that having your voice heard by the right people, in the face of power imbalances and complex systems and structures, can be extremely difficult. Any individual or family that has concerns that something is not right with the care their loved ones are receiving, should be provided with access to independent support and expertise to ensure they are listened to and their rights are respected. This support and expertise is described as advocacy and in such circumstances should be delivered by trained individuals to recognised standards.

With permission, advocates can act on families’ and individual’s behalf to engage with professionals and officials to ensure their voice is heard, their issues are resolved or their concerns are appropriately escalated and dealt with.

Advocacy services were in place in Muckamore Abbey Hospital, however, they were not well known or integrated, they were not effective and they were not respected by, or regarded as integral to, the Health and Social Care system. Most crucially they were not appropriately independent of the Belfast Trust to provide a robust challenge and assurance function, being directly contracted by them. This situation is unfortunately replicated across Northern Ireland today. There is a patchwork of advocacy services, very few of which are genuinely independent and the public has limited knowledge of them, how to access them or what to expect when they do.

The PCC has a statutory duty to independently represent the interests of the public in Health and Social Care. We also have a duty to assist members of the public making or intending to make a complaint relating to health and social care. One way in which we deliver against this duty, is by providing an independent advocacy service to members of the public in health and social care in Northern Ireland. As a small regional organisation with limited resource, we currently support the public in approximately 10% of HSC issues and complaints across Northern Ireland.

PCC are generalists, which means we support people right across the breadth of health and social care.  Of the 3,600 contacts by the public with PCC last year, our team of 18 practitioners on any given day might have supported someone with a concern about maternity services, whilst the next might have been on how to access social care support. Other organisations focus on issue-based advocacy (for example support for older people, carers or learning disability) and therefore are often in place to provide specialist support. In short, whilst more PCC independent advocacy services would be welcome and are necessary, we are only part of the answer.

Recommendation 20 of the Inquiry Report says: ‘Properly trained independent advocates should be made available to service users and families to support effective communications with staff, and for raising concerns and complaints.’  It is clear to us that advocacy services across health and social care must be independent, regionally commissioned to agreed standards, and valued within the Health and Social Care system. This will go a long way to determining their effectiveness. This was echoed by families in their closing submission to the Inquiry. 

Ensuring the voice of the public cannot be ignored is fundamental, as all parts of the system collectively consider how we respond to the tragic circumstances which gave rise to this Inquiry. Given PCC’s statutory functions, we will continue to lead in this area to ensure the public’s voices are heard.

If you have a concern about the care you or a loved one has received the PCC can help. Contact us by:



Tags: PCC NEWS PCC BLOG MAHI By PCC at 07/06/2026

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