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Neurology: Frequently Asked Questions

What is the background to the Expert Review of Records of Deceased Patients of Dr Watt?

On 1 May 2018, Belfast Health and Social Care Trust (Belfast Trust) announced a recall of 2,500 patients in relation to concerns regarding the clinical practice of Dr Watt, a consultant neurologist employed by the Belfast Trust.

On 2 May 2018, the Permanent Secretary to the Department of Health announced the establishment of an Independent Neurology Inquiry, chaired by Brett Lockhart QC, to review the recall of neurology patients by the Belfast Trust. The Health Minister converted this inquiry to a Statutory Public Inquiry on 11 December 2020, under the Inquiries Act 2005. The Independent Neurology Inquiry published its findings on 21 June 2022. For further information, visit: www.neurologyinquiry.org.uk

The Permanent Secretary also directed the Regulation and Quality Improvement Authority (RQIA), Northern Ireland’s regulatory body, to:

• undertake a Review of governance arrangements of outpatient services in the Belfast HSC Trust, with a focus on Neurology and other high volume specialties (published in February 2020)
Review governance arrangements in independent hospitals and hospices in Northern Ireland (published in June 2021).
• commission an expert review of the records of all patients or former patients of the consultant neurologist, who had died over the previous ten years. This is known as The Expert Review of Records of Deceased Patients of Dr Watt (2008-2018).

RQIA and the DoH subsequently agreed a phased approach to the Expert Review, given the potential scale and complexity of the work.

Is the Review different to the Independent Neurology Inquiry?

Yes, this Review is separate to the Independent Neurology Inquiry (INI) announced by the Permanent Secretary in 2018. The Health Minister changed the status of the INI to a Statutory Public Inquiry in December 2020. The Independent Neurology Inquiry published its findings on 21 June 2022. For further information, visit: www.neurologyinquiry.org.uk

How is the Review being carried out?

Given the potential scale and complexity of the work involved in reviewing the records of deceased patients who were at some point under the care of Dr Watt between 2008 and 2018, the Department of Health agreed that RQIA should take a phased approach to the Expert Review. Phase One, which was a preparatory phase, concluded in November 2020 with the formal adoption of operational protocols and a legal framework to ensure access to the relevant records and the appropriate infrastructure to enable robust, ethical and sensitive delivery of the review.

The outcome of Phase Two, which examined 44 patient records, was published in November 2022.

The approach to next steps and the future approach of the Expert Review has been considered by the Department of Health and RQIA, based firmly in line with the findings of an Independent Evaluation of the family experience of Phase Two, learnings from the work undertaken to date, the outcome of engagement with families who have come forward since the commencement of Phase Two and against the consideration of resource and cost implications. A key factor in this process has been to ensure the complex ethical considerations associated with this work are given due cognisance.

On 3 July 2024, the Health Minister announced the next steps and future approach to the Neurology Deceased Patients Review.

RQIA will begin the planning, preparation and initiation of Phase Three of this review process. This Phase will involve 18 families who have approached RQIA to confirm that they wish to proceed with an expert review of their relative’s clinical records. RQIA has contacted these families to advise that the expert review process will now commence. In addition, the Department of Health has asked any further families of deceased patients of Dr Watt who wish to explore involvement with the Expert Review to contact the RQIA, no later than 31 December 2024. Please:

• phone on Freephone number 0800 052 0012 between 10am and 5pm, Monday to Friday, to speak to a member of our Family Liaison Team; or leave a voice message and our Family Liaison Team will get back to you

• email us at expert.review@rqia.org.uk;

• use our 'Contact Us' form to send us your contact details.

What phase is the Review at now?

Phase Two commenced in April 2021. This phase involved commissioning the Royal College of Physicians (RCP) to establish an Expert Panel of neurologists from outside of Northern Ireland. The RCP reviewed the clinical records of 44 deceased patients (Group 1 and Group 2) and, where available, considered the testimony of families, to report on the findings.

RQIA published an overarching report on Phase Two, which includes the RCP’s Group 1 and Group 2 reports, in November 2022. This report highlighted significant learning, which RQIA has committed to utilising in order to support improvement across the HSC system through the delivery of ‘Legacy Commitments’. You can read the report here.

RQIA welcomed Minister Nesbitt’s announcement on 03 July 2024 on the next steps and future approach to the Expert Review. He has directed RQIA to commission the undertaking of Phase Three, which will involve 18 families who have approached RQIA to confirm that they wish to proceed with an expert review of their deceased relative’s clinical records. In common with Phase Two, the process will include the opportunity for families to provide their testimony for consideration by the Expert Review Panel. The primary purpose being to provide the opportunity to impart answers, if possible, to the families in respect of the quality of care and treatment provided to their deceased relatives.

RQIA has contacted these families to advise that Phase Three of the Expert Review will now commence and will remain in contact with them until completion of Phase Three and publication of its findings and report.

Minister Nesbitt’s statement also confirmed that a six-month period will be provided for any additional families who are interested in having their deceased family member’s clinical records reviewed to contact the RQIA to explore involvement in the process.

Therefore, any family who wishes to come forward to explore involvement with the Expert Review have until 31 December 2024 to contact RQIA. The Expert Review Family Liaison Team will engage with any affected family who makes contact by 31 December 2024. Following this process, the Department of Health and RQIA will clarity next steps for this stage of the Expert Review.

Please:

• phone on Freephone number 0800 052 0012 between 10am and 5pm, Monday to Friday, to speak to a member of our Family Liaison Team; or leave a voice message and our Family Liaison Team will get back to you

• email us at expert.review@rqia.org.uk;

• use our 'Contact Us' form to send us your contact details.

Hearing about the Review has caused me distress, is there anywhere I can get some support?

RQIA is aware that our contact with families may prove difficult and painful and may further impact on their grief and sorrow and we apologise for any potential distress this may cause. However, we aim to be transparent and open about the review, and family members and next of kin have been offered the option to choose to be informed about the progress.

We have identified a number of organisations who can offer support to family members, should that be of benefit. The Family Liaison Team can assist with this and contact details are included on our website www.rqia.org.uk, and in our Coping with Grief leaflet .

RQIA appreciates that some families may wish to have no further engagement with us in relation to this Review and respect decisions in this regard.

What can the 18 families who have decided to become involved with Phase Three of the Expert Review expect?

The Family Liaison Team engaged with families who, since the commencement of Phase Two, had approached RQIA expressing an interest in participation in a future phase of the Expert Review.

The purpose of this engagement was to provide interested families with information on what an expert review of clinical records entails, including the potential benefits and limitations, and to share feedback we received from several families involved in Phase Two of the Expert Review about their experience of the process and its outcomes.

Other families of deceased patients of Dr Watt are welcome to contact RQIA. You can do this in a number of ways:
Please:

• phone on Freephone number 0800 052 0012 between 10am and 5pm, Monday to Friday, to speak to a member of our Family Liaison Team; or leave a voice message and our Family Liaison Team will get back to you

• email us at expert.review@rqia.org.uk;

• use our 'Contact Us' form to send us your contact details.

What members of our family will the Family Liaison Team be speaking to with regards to our relative who died?

The Family Liaison Team have sought to identify one or two people who would have knowledge of their relative’s care and treatment. This could also be one family member accompanied by a friend or an advocate.

What will RQIA do with the information provided by families?

Prior to sharing any information with RQIA’s Review Team, our Family Liaison Team will discuss and agree this matter with families.

Will I receive feedback on the findings in relation to the care of my relative?

The RQIA Family Liaison Team will keep in regular contact with the 18 families involved in Phase Three of the Expert Review. to advise on progress and to provide them with the findings of the Expert Review Panel, if they wish to receive this.

My relative received care from Dr Watt on a private basis. Will private records be included in the review?

Yes, where required, RQIA will seek to obtain relevant records relating to those who received care from Dr Watt on a private basis.

If I do not wish to be involved in the Review can I still receive feedback on the findings relating to my family member?

Yes, bespoke arrangements will be put in place for the next-of-kin or family members of individual deceased patients involved in the next Phase of this Review.

Can my relative’s records be reviewed?

RQIA welcomed Minister Nesbitt’s announcement on 03 July 2024 on the next steps and future approach to the Expert Review. He has directed RQIA to commission the undertaking of Phase Three, which will involve 18 families who have approached RQIA to confirm that they wish to proceed with an expert review of their deceased relative’s clinical records. In common with Phase Two, the process will include the opportunity for families to provide their testimony for consideration by the Expert Review Panel. The primary purpose being to provide the opportunity to impart answers, if possible, to the families in respect of the quality of care and treatment provided to their deceased relatives.

RQIA has contacted these families to advise that Phase Three of the Expert Review will now commence and will remain in contact with them until completion of Phase Three and publication of its findings and report.

Minister Nesbitt’s statement also confirmed that a six-month period will be provided for any additional families who are interested in having their deceased family member’s clinical records reviewed to contact the RQIA to explore involvement in the process.

Therefore, any family who wishes to come forward to explore involvement with the Expert Review have until 31 December 2024 to contact RQIA. The Expert Review Family Liaison Team will engage with any affected family who makes contact by 31 December 2024. Following this process, the Department of Health and RQIA will clarity next steps for this stage of the Expert Review. Families are welcome to contact RQIA by using any of the following methods:
• phone on Freephone number 0800 052 0012 between 10am and 5pm, Monday to Friday, to speak to a member of our Family Liaison Team; or leave a voice message and our Family Liaison Team will get back to you

• email us at expert.review@rqia.org.uk;

• use our 'Contact Us' form to send us your contact details.

Where can I read the overall findings of Phase 2?

You can read the findings of The Expert Review of Records of Deceased Patients of Dr Watt (2008-2018) here.

I'm a journalist, where do I make media queries in relation to this work?

Any media queries should be directed to RQIA’s Senior Communications Manager: malachy.finnegan@rqia.org.uk

How do I find out about the Neurology Recall Compensation Scheme?

The Neurology Recall Compensation Scheme is being managed through the Department of Health. Information in relation to this scheme is available on their website, here.

This includes a link to a series of frequently asked questions.