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Following revelations in 2017 of the abuse of patients by staff at Muckamore Abbey Hospital, the Minister for Health in Northern Ireland ordered a public inquiry be held into that abuse and related matters. The Inquiry, chaired by Tom Kark KC, and heard from 235 witnesses, including a number of service users, and over 90 relatives of service users. It found that patients had been abused and systematically bullied by staff members at Muckamore Abbey Hospital whose job it was to look after them. The report includes 106 recommendations. The Inquiry heard extensive evidence concerning injuries sustained by patients, particularly bruises, unexplained marks and signs consistent with physical abuse. Some patients were verbal and were able to express that they had been assaulted by staff, but such direct evidence was very limited. Relatives reported being informed by staff that injuries were caused by self-harm, behavioural incidents or peer-on-peer violence. They were told their relative was clumsy or may have fallen in the night. Over time, many families lost confidence in these explanations, especially where injuries were located on areas of the body difficult to self-inflict or appeared repeatedly in similar patterns. Sometimes injuries were unexplained even when a patient was supposed to be under supervision. The Inquiry also heard evidence of physical abuse captured on CCTV, including forceful handling, dragging, pushing and inappropriate restraint. These incidents provided confirmation that unexplained injuries reported by families over many years could not be attributed solely to patient behaviour or peer-on-peer violence. The presence of injuries alongside incidents captured on CCTV demonstrated that earlier concerns had been justified and should have prompted urgent intervention. The Inquiry notes that families’ concerns were exacerbated by the lack of communication from staff at the hospital about when patients had been injured, and many complained of significant delays in injuries being reported to them. The Panel concluded that injuries such as bruises and marks were not isolated or incidental; they were visible indicators of systemic failure. Dealing with each incident individually resulted in the inability of the organisation to recognise patterns, escalate concerns and protect patients, and allowed physical abuse and neglect to continue unchecked, causing lasting harm to patients and profound distress to their families. Key themes Key patient safety issues highlighted in this report include: Information sharing and co-production Families described not being informed of their rights when relatives were detained under the Mental Health (NI) Order 1986. Many believed decisions were made without consultation, leaving them feeling excluded from their loved one’s care. The Inquiry repeatedly heard that families were informed of decisions rather than involved in making them. Families reported not being able to visit during early stages of admission, removing opportunities to share crucial information. Many families struggled to identify a consistent point of contact or key worker. Restrictive practices The Panel identified serious and persistent concerns regarding the frequency, rationale, recording and governance of restrictive practices over a prolonged period. Seclusion was a particular area of concern. Although policies on seclusion became increasingly prescriptive over time, including requirements for monitoring, the Inquiry heard evidence that implementation was inconsistent, sometimes inadequate and not effectively audited. The use of PRN medication as a form of restrictive practice was also problematic. Although guidance emphasised that PRN medication should only be used with a clear therapeutic rationale and as a last resort, families frequently described experiencing their relatives as sedated, disengaged or ‘zombified’. The Panel accepted that this was not necessarily an indication of overmedication by use of regularly prescribed drugs but may have reflected the use of PRN medication to control behaviour when other non-medical approaches had either not been available or not been attempted. Governance and oversight of restrictive practices were inadequate. Although data on restraint, seclusion and incidents was collected and reported internally, the Inquiry found limited evidence of effective senior management challenge, trend analysis or sustained action to reduce use. Complaints and concerns Evidence revealed widespread confusion, fear and mistrust among families, alongside systemic weaknesses in complaint handling, oversight and organisational learning. Many family members found the complaints system opaque and difficult to navigate, with little clarity about how complaints were investigated, how decisions were reached or what outcomes, if any, resulted. Many families reported finding out about injuries, assaults or significant incidents only during visits, or after long delays. Others described communications they perceived as defensive, dismissive or designed to protect the institution rather than investigate the facts. Some believed that staff were effectively ‘investigating themselves’, creating perceptions of bias and eroding confidence in outcomes. Even when complaints were upheld in part, families often felt responses lacked empathy, apology or accountability. Fear was a major barrier to complaint-raising. Witnesses described explicit or implicit warnings suggesting that complaining could affect their relative’s care or future admissions. Patients themselves were sometimes frightened to speak up. Governance and oversight arrangements were also found wanting. Although complaints data was presented in dashboards and discussed at Muckamore Abbey Hospital management meetings, there was limited evidence of robust analysis, challenge or sustained organisational learning. Previous concerns, previous investigations and warning signs The Panel concluded that Muckamore Abbey Hospital exhibited multiple, persistent and well-documented warning signs long before 2017: sustained understaffing; inadequate specialist supports; unsafe environments; escalating violence and restraint; frequent safeguarding referrals; family complaints; and a geographically and culturally closed institution. While individual allegations were often investigated, the system failed to connect the dots. No single mechanism brought together incident reporting, safeguarding intelligence, complaints and workforce pressures in a way that would have revealed the scale of risk Safeguarding The Panel found that safeguarding systems were fragmented and insufficiently integrated with the Trust’s wider clinical governance and risk management arrangements. Safeguarding investigations were structurally separated to preserve independence, but this separation limited organisational learning. Staff and ward management The Panel concluded that staffing challenges at Muckamore Abbey Hospital were long-standing, well-documented and increasingly severe, yet were never adequately resolved. These systemic workforce failures significantly increased patient vulnerability and contributed to the conditions in which abuse was able to occur and persist. Staffing shortages were persistent from at least 2009 onwards and worsened significantly after 2012, when recruitment freezes and temporary contracts became common due to the anticipated closure of Muckamore Abbey Hospital. The ratio of registered nurses to healthcare assistants was frequently below safe levels, and in some wards fewer than half of staff were registered nurses. Healthcare assistants, who provide the majority of direct patient care, had no specialist training requirements and relied heavily on informal learning. Supervision of healthcare assistants inconsistent, and clinical supervision arrangements fell far below what would be expected in a high-risk inpatient setting. This created a task-focused culture where staff prioritised basic physical care over personal and therapeutic engagement. Throughout this period, senior leadership and the Trust Board repeatedly reassured themselves and external bodies that staffing was safe, even as the regulator and whistleblowers raised escalating concerns. Leadership While extensive governance structures existed, they consistently failed to work to bring relevant information to the Board of Belfast Health and Social Care Trust, and to translate information into understanding of risks or into an active response. There was a resulting lack of insight by the Board into the difficulties faced at Muckamore Abbey Hospital. A central failure identified by the Inquiry was the Trust’s focus on governance processes rather than outcomes. Reports to the Board emphasised the existence of policies, action plans and committees but rarely demonstrated whether these arrangements were effective in protecting patients or improving care. Incident reporting, safeguarding referrals, complaints and staff intelligence were routinely aggregated at Trust level, masking significant variation at hospital level and thus obscuring sustained patterns of harm at Muckamore Abbey Hospital. Risks from Muckamore Abbey Hospital were often downgraded or removed as they ascended the risk register hierarchy, even when underlying conditions persisted or deteriorated. Risks affecting specific services were smoothed out through aggregation and failed to reach the Board as Principal Risks. Even after external regulators raised serious concerns, including the issuing by the Regulation and Quality Improvement Authority (RQIA) of Improvement Notices in 2019, the Board continued to accept assurances that care was safe, often disputing regulators’ findings without providing robust supporting data. Senior leaders failed to reconcile contradictory evidence from inspections, incidents, safeguarding reviews and staffing data. Crucially, the Board did not adequately address structural risk factors such as chronic staffing shortages, excessive use of untrained agency staff and inappropriate ward mixes. Reassurances provided by executive directors were not properly scrutinised for any underlying supporting data. External agencies inspection and oversight The Inquiry concluded that, although multiple agencies were involved with Muckamore Abbey Hospital over many years, none succeeded in identifying, preventing or stopping abuse before it was revealed, exposing significant limitations in the external oversight framework. Between 2009 and 2019, RQIA conducted over 100 inspections of Muckamore Abbey Hospital, initially at ward level and later using a whole-hospital approach. These inspections frequently identified problems such as staffing shortages, safeguarding weaknesses, excessive restrictive practices and governance failings. However, the inspection methodology relied heavily on documentation review and there was limited involvement with staff, patients and families, providing only a snapshot of practice. Inspectors acknowledged that staff behaviour changed when inspectors arrived on the wards and that therefore they were unlikely to observe ‘normal’ ward culture. Despite having statutory powers to do so, RQIA did not review CCTV footage at Muckamore Abbey Hospital, even after CCTV was viewed by the Trust and by Police Service of Northern Ireland and serious concerns were raised. Evidence to the Inquiry suggested that families repeatedly raised concerns through various routes but felt unheard, contributing to a loss of confidence in advocacy and oversight mechanisms. Overall, the Panel concluded that external inspection and oversight failed to operate as an effective safety net. Warning signs, including staffing instability, increased violence, high use of restrictive practices and repeated complaints, were visible and known but not interpreted as indicators of potential abuse. Oversight was reactive rather than preventive. The central lesson is that external regulation and investigation must extend beyond procedural compliance and episodic inspection. For services caring for highly vulnerable people, effective oversight requires proactive, risk-based approaches that: examine culture; triangulate multiple data sources, including where appropriate the use of CCTV; engage directly with families and, where possible, patients; and act decisively when conditions associated with abuse are present. Planning and funding of learning disability services Overall, the Inquiry found there was a failure to align policy, funding, workforce planning and accountability that prevented meaningful transformation of learning disability services. The absence of a coherent, long-term, system-wide approach contributed directly to sustained institutionalisation of individuals at Muckamore Abbey Hospital and to risks in care quality and safety. Redress There is no doubt that patients did suffer as a result of abuse within Muckamore Abbey Hospital but to try to assess the extent of such abuse in relation to individual patients or the nature of the harm caused was deemed as beyond the Inquiry’s capacity. In relation to direct redress, including the consideration of financial compensation, however, our recommendation would be that the Department of Health should set up a small working party to consult with patients, service user groups and individuals connected to those who have suffered abuse at Muckamore Abbey Hospital in relation to what form redress might properly take.

A new study reveals how the immune system behaves in people who have had complications from surgical mesh implants. Result? There is evidence of ongoing, abnormal immune activation throughout the body, not just at the implant site. Most research on mesh complications looks at local problems such as damage or inflammation where the mesh is placed. However, this paper asks a bigger question. Do these patients also have a whole‑body (systemic) immune response, not just a local one? The answer appears to be YES. The study was conducted by a team at the NHS Newcastle Mesh Complication Centre who say the mechanisms underpinning mesh complications remain largely unknown. Also, there are no reports characterising systemic immune dysregulation – in other words, the immune system not working as it should. The paper shows that people with mesh complications have measurable changes in their immune system throughout the body, suggesting complications may be partly driven by systemic inflammation not just local damage.

Sling the Mesh welcomes the speech in Parliament on the 16 April that recognised the mesh‑injured community in the new refreshed Women’s Health Strategy, thanks to Health Minister Karin Smyth who explicitly acknowledged how our pain was ignored for years. That recognition did not happen by accident, it happened because we made a fuss, typing emails furiously – refusing to let the mesh‑injured community be forgotten, downplayed or erased. Listen to it at 12:41. The new Strategy was launched and is a powerful document which recognises that women’s voices are often ignored and downplayed across the health sector. The Strategy outlines 117 calls to action to improve women’s health across their lifetime. Karen Smyth Health Minister, said: “For too long, women have been left to navigate a confusing system, fighting to get the basic care they deserve, and under-represented in health research. Above all, women’s voices and choices have been dismissed, and it is truly shocking how often women have been ignored when telling medical professionals about their pain. From pelvic mesh to endometriosis, we are expected to put up with pain as our lot in life, as if it were normal. But it is not normal, and since coming into office this Government have taken a number of measures to improve women’s health.” Shadow Health Minister Dr Caroline Johnson said: “I find it remarkable that the Minister has the audacity to talk about women harmed by pelvic mesh when, after almost two years in office, the Government have still not responded to the Hughes report. When do they intend to do so?” MP Oliver Ryan said: “I am quite ashamed to say that before being elected to this place, I did not know enough about women’s health issues, and in particular the issues with pelvic and vaginal mesh—the wait for treatment and the struggle to be heard—and endometriosis; people with that condition face a wait for diagnosis and a struggle for recognition. Since I was elected, I have been contacted by tens of women across Burnley, Padiham and Brierfield, who are fighting the fight for recognition of these topics on behalf of women across the country. It is because of that that I am educated enough to stand here today. Those women feel ignored and abandoned by a health service that does not care enough about women’s health issues. Will the Minister give a commitment to campaigners such as the women in Burnley, Padiham and Brierfield who have approached me that because of this strategy, they will now be heard? MP Chris Vince said: “I was shocked by the number of women from my constituency of Harlow who came forward to tell me about their terrible experiences of being gaslit, ignored and disrespected, particularly when it came to endometriosis and the pelvic mesh scandal.”

French actor / theatre director and hernia mesh advocate Arnaud Dennis is in an assisted dying clinic in Belgium. In this powerful interview the 42 year old speaks about how he is awaiting approval for euthanasia after devastating complications from a hernia mesh that destroyed his life. In this final public appeal, he denounces the major health scandal of mesh, giving his last thoughts to the hundreds of implant victims he has represented in France and warns of systemic medical and institutional failures – as well as the conflicts of interests /payments from industry to surgeons, which continue to help fuel the lucrative mesh machine.

This Health Services Safety Investigations Body (HSSIB) report is intended for healthcare organisations, policymakers and the public to help improve patient safety in relation to safety issues identified for people experiencing a mental health crisis who come into contact with urgent and emergency care services. This report focuses on the significant legal, policy and safety gap in the care of people in emergency departments (EDs) in mental health crisis. During consultation on this report, concerns were shared with HSSIB about the current challenges in relation to the resourcing and configuration of mental health services that exacerbate challenges faced in the ED. This is the first of two reports. In October 2025 HSSIB launched two investigations that explore the safety issues for people experiencing a mental health crisis who come into contact with urgent and emergency care services. This interim report was produced due to the early identification of a significant legal, policy and safety gap in the care of people in emergency departments (EDs) in mental health crisis. It is reported that around 3% of all ED attendances are mental health related. However, people experiencing mental health problems are twice as likely as other patients to remain in the ED for more than 12 hours. People in mental health crisis may need to be assessed for admission to a mental health hospital in line with the Mental Health Act 1983. Delays in these assessments being undertaken, and/or the lack of availability of mental health inpatient beds once a person has been recommended for admission, can lead to patients remaining in EDs for prolonged periods. Findings There is an absence of clear legal powers to lawfully prevent vulnerable individuals from leaving the ED while awaiting assessment or admission. This legal ambiguity exposes patients to increased risk of harm and/or being unlawfully deprived of their liberty, and places staff in a position of uncertainty when attempting to manage safety. For those requiring formal admission to a mental health hospital, an application under the Mental Health Act 1983 cannot be completed until a bed has been identified, which can take days. Staff and organisations reported they are often faced with choosing “the least harmful way to break the law” in order to try and keep patients safe. EDs are not designed to provide therapeutic mental health care and prolonged stays may worsen patients’ conditions and create challenges in maintaining a safe environment for everyone. HSSIB makes the following safety recommendations: HSSIB recommends that the Department of Health and Social Care urgently reviews the current legal framework and addresses the current legislative gaps in emergency care for people in mental health crisis and clarify the extension of legal powers for health professionals to hold someone in the emergency department. This will safeguard people who are currently arriving at the emergency department in a mental health crisis and the staff who care for them to support safe, consistent and legally compliant care. HSSIB recommends that the Care Quality Commission works with stakeholders to produce a position statement on existing legal powers, and the expectations for support for staff, for the care of people experiencing a mental health crisis in emergency departments (including mental health emergency departments and mental health crisis assessment services), who are not detained under a formal legal framework. This should include a review of current guidance and existing powers to help support safe, consistent, and legally compliant care in the absence of comprehensive legislation, while minimising harm and addressing the unique challenges of prolonged stays in the emergency department.

Undercover filming exposes the reality of corridor care on patients in North Wales. The programme is in Welsh. Subtitles can be viewed in English.

This report from the House of Lords Public Services Committee finds that medicine supply shortages are not prioritised as the potential national security issue that they represent given the significant risk to people’s health when they cannot access necessary medication. In addition, the UK government and the NHS are key to ensuring patients get the medicines they need, but there is a lack of oversight and coordination over medicine resilience. Reports of medicines shortages are rising. Without access to the right medication, patients may experience worsening health outcomes, stress, and anxiety over their health, and they may fall out of work. In the worst cases, medicines shortages have led to patient deaths. In 2025, 73% of pharmacy team members stated medicine supply issues were putting patient health at risk. Yet despite the significant impact medicines shortages can have, the Department of Health and Social Care (DHSC) were unable to tell us if the number of shortages was rising or falling. Shortages can vary in length and cause–there may be brief interruptions to supply which are swiftly rectified, longer term supply chain disruptions caused by global issues, or complete severance of supply where a medicine is no longer available to the UK. This report sets out the need for clear, proactive leadership from the UK Government to strengthen medicines supply and resilience of supply chains. This leadership needs three strands. Firstly, the DHSC need to better support pharmacies and hospitals to manage shortages. Connectivity presents a key issue here. Currently, community pharmacies and hospitals may only discover a medicine shortage is occurring when they are unable to order medicines for patients, and shortages create extra pressure and work for clinicians trying to support patients, both through sourcing medicines and providing alternatives. The Government needs to improve how it shares information with care providers about shortages and availability of medicine throughout the supply chain, and ensure GPs, hospitals and community pharmacies have the tools they need to access medicines and support patients during shortages. Secondly, the Government needs to better work with the pharmaceutical industry to identify and prevent shortages, through boosting medicines manufacturing and supply chain resilience both globally and once medicines have arrived on UK shores. The Government should clearly signal the importance of stable supply chains to the industry through resilience-focused procurement and contract management. As part of this, the Government should identify and share which medicines they believe are critical for the UK through publishing a Critical Medicines List. The Government should then set out how it plans to boost resilience for medicines on that list. Thirdly, the importance of medicine supply must also be emphasised within government. The impact of medicines shortages goes far beyond the health system, and this should be recognised through more effective cross-government work and putting medicine supply shortages on the National Risk Register. Crucially, this cross-government work must include foreign and trade policy. Problems in medicine supply are not unique to the UK, and governments across the world are taking steps to boost their own medicines resilience. The UK needs to work with international partners to develop a diverse range of medicine resilience measures to make sure the UK is not left behind as other countries shore up their medicine supply. Related reading on the hub: Creon shortages: “It’s just another thing patients with cystic fibrosis could do without” Medication supply issues: Mast cell activation syndrome (MCAS) Medication supply issues: A pharmacist’s perspective Medicines shortages: minimising the impact on patients

There were more than 2.3 million A&E visits during December 2025, with more than 400,000 people admitted to hospital. Resident doctors were also on strike for five days in December, putting hospitals under even greater pressure than usual. Of those admitted to hospital as emergencies, one in four people waited over four hours between admission and staff finding them a bed. One in ten waited over 12 hours. To understand people’s winter A&E experiences, Healthwatch reviewed their feedback on urgent and emergency care from December 2025, focusing on older people. Older and/or frail patients are at greater risk of harm under corridor care, including falls, dehydration and delirium, according to a Health Services Safety Investigation Body report published last month.  Related reading on the hub: Corridor care and patient safety Corridor care guidance needs to move beyond what “should” happen and grapple honestly with why it isn’t (a blog by Claire Cox) The crisis of corridor care in the NHS: patient safety concerns and incident reporting

Time and again members of the mesh community report facing a brick wall of institutional denial when seeking help for their pain and complications. This YouTube video highlights some of the outrageous, unacceptable and inappropriate comments that doctors have said to members of hashtag #slingthemesh support group in a pervasive culture of medical misogyny that should not still exist in modern medicine. Related reading on the hub: Doctors’ shocking comments reveal institutional misogyny towards women harmed by pelvic mesh