Northern Ireland’s health minister has apologised after an independent review concluded that patients treated by consultant neurologist Michael Watt suffered harm from delayed or incorrect diagnoses, inappropriate treatment and failures in communication and support.
Independent review details repeated clinical and governance failures
The Regulation and Quality Improvement Authority (RQIA) published a final report that builds on an earlier 2022 review. The watchdog found that poor diagnostic practice, inadequate communication, isolated clinical decision‑making and weak multidisciplinary oversight meant standards of care “frequently fell below expectations”, the report said.
“strong and clear focus” now being placed on patients and families speaking out
The RQIA’s most recent review examined a further 25 clinical records, including cases referred after a ministerial statement in July 2024 and subsequent family submissions. The earlier 2022 review had examined 44 records. The investigations were prompted after the Belfast Health and Social Care Trust recalled about 2,500 patients amid concerns about Watt’s clinical practice at the Royal Victoria Hospital in Belfast.
Watt was removed from the medical register in 2023 after a finding that he had put patients at risk and that his fitness to practise was impaired. The RQIA’s final report examined records of patients who had died between 2008 and 2018 as well as other cases raised by families and identified further instances of harm.
What the findings mean for patients and families
The RQIA said the majority of concerns raised by relatives were fully or partially upheld by an independent expert panel that reviewed clinical records and family testimony. Relatives who engaged with the review have argued it addressed only a fraction of those under Watt’s care and therefore did not go far enough, a point the watchdog acknowledged by urging continued dialogue with affected families.
- Misdiagnosis and delays: The report found delayed or incorrect diagnoses that led to inappropriate management in some cases.
- Inappropriate treatment: Therapeutic decisions were sometimes not supported by adequate multidisciplinary review.
- Communication breakdowns: Failures in communication and support for patients and families were repeatedly identified.
The publication of the final report has revived calls for stronger clinical oversight, better record‑keeping and more robust systems to ensure multidisciplinary review of complex cases.
Timeline of key events
| Year | Event |
|---|---|
| 2008–2018 | Period covered for records of patients who later died and were reviewed by the RQIA. |
| 2018 | RQIA review began after the Belfast Trust recalled about 2,500 patients. |
| November 2022 | First report published examining 44 patient records and raising concerns. |
| 2023 | Michael Watt was struck off the medical register following fitness‑to‑practise findings. |
| July 2024 | Ministerial statement prompted further family referrals to the RQIA. |
| 2026 | Final RQIA report published with further findings; minister issued an apology. |
Health services face reputational and operational consequences when reviews uphold systemic failures. The RQIA’s findings expose weaknesses in clinical governance that can allow unsafe practices to continue unchecked, especially when multidisciplinary scrutiny and communication are insufficient.
What patients should know
The report underlines the importance of patients and families raising concerns when they feel care is inadequate. Regulators and trusts have a duty to investigate, learn and implement changes that prevent recurrence. The RQIA chair said the review demonstrated the importance of those who come forward and of ensuring relatives’ voices are heard in reviews.
If patients are worried about past or current care, they should contact their treating service, local trust patient liaison or a regulatory body. For medical concerns, always discuss symptoms and treatment options with a clinician rather than self‑diagnosing.
The report’s release is likely to prompt further scrutiny of clinical governance arrangements and could lead to recommendations for improved multidisciplinary oversight, communication processes and record‑keeping to safeguard patients in future.
