Background
The Independent Neurology Inquiry (INI) was established by the Permanent Secretary of the Department of Health in May 2018. This was part of a series of actions taken in response to the recall of neurology patients by the Belfast Health and Social Care Trust.
The inquiry was converted from a non-statutory public inquiry to a statutory Public Inquiry in December 2020 by the Minister of Health, to ensure that the Inquiry had unfettered access to all documentation. The Inquiry had a focus on governance. It was not responsible for the recall of neurology patients, for making decisions in relation to the clinical practice of Dr Watt or for compensation arrangements.
The Inquiry chaired by Mr Brett Lockhart KC, published its final report in June 2022. It makes 76 recommendations to the Department of Health, Healthcare Organisations, the General Medical Council and the Independent Sector. The report stated “The recommendations arise from the totality of the evidence and whereas some are a direct response to a particular single issue others attempt to address broader or more diverse matters. The theme that cuts across all the recommendations, whether expressly or implicitly, is the paramountcy of patient safety in all decisions at every level of healthcare organisations.”
The Independent Neurology Inquiry (INI) closed on 20 September 2022. Further information on the INI can be accessed through the following webpage Independent Neurology Inquiry
The INI Implementation Programme
The Department of Health established an Inquiries Implementation Programme Management Board (IIPMB) to oversee the implementation of not only recommendations from the INI Report but also the Inquiry into Hyponatraemia Related Deaths (IHRD).
The IIPMB will oversee the implementation of the 76 recommendations within the INI Report, in line with the agreed Terms of Reference. All 76 INI Report recommendations have been accepted in principle.
It is clear from engagement with key delivery partners that further improvements to governance systems and processes have been made, and there is an acceptance that more work is required to ensure the full implementation of the INI Report.
The Department of Health is committed to overseeing the INI Implementation Programme and will work in partnership with stakeholders to take forward each of the recommendations. Delivery partners include: the Healthcare Organisations, the General Medical Council (GMC) and the Independent Healthcare Providers, who are also committed to progressing this programme of work.
The INI Implementation Plan
The overarching INI Implementation Plan was published on 27 July 2023. The INI Implementation Plan can be viewed here: Independent Neurology Inquiry (INI) - Implementation and Action Plans | Department of Health (health-ni.gov.uk)
This provided a high-level overview of the approach being taken to progress improvements to healthcare services and systems in Northern Ireland to improve patient safety and restore public confidence following the events leading to the recall of patients of Dr Michael Watt.
The INI Implementation Plan classified the 76 recommendations into two overarching themes, “Assurance and Accountability” and “Information and Data Management”.
Each of the 76 recommendations have been delegated to 5 workstreams:
- Workforce;
- Quality & Safety;
- Governance;
- Information Systems; and
- Information Sharing.
Each workstream has a nominated Departmental policy lead, who will work in collaboration and engage with the relevant organisations and stakeholders, to drive forward and progress each of the recommendations as part of their portfolio of work.
The benefits and outcomes expected from the two Themes, five Workstreams and the required actions against each INI recommendation are outlined within the INI Implementation Plan.
The INI Implementation Plan committed to the publication of an INI Action Plan to outline the specific actions required against each recommendation and the production of an Assurance Framework to support the INI Action Plan.
The INI Action Plan
The work required to implement the recommendations from the INI Report has been ongoing and progressing simultaneously to the development of the INI Action Plan. It is relevant that the INI Report acknowledged that progress and change has already been made within the healthcare system during the completion of the Public Inquiry.
Many of the actions to be taken to implement the INI Report are aligned or interdependent with other Departmental work programmes and work being undertaken in parallel by other relevant organisations.
The INI Action Plan centres on the need to strengthen governance systems and processes and to change and improve the culture, leadership and accountability within health and social care organisations to ensure patient safety. It will be a conduit to support transparency, openness and to help to restore the public faith in the Health and Social Care system in Northern Ireland.
The purpose of the INI Action Plan is to ensure that the needs and safety of patients are at the forefront of our healthcare systems and organisations, and so that our healthcare provision will meet the expectations of service users at all times.
The INI Action Plan can be viewed here: Independent Neurology Inquiry (INI) - Implementation and Action Plans | Department of Health (health-ni.gov.uk)
Delivering the changes identified by the INI report requires a series of coordinated actions across a range of organisations, including the Department, General Medical Council (GMC), Healthcare Organisations and Independent Sector. The INI Action Plan sets out the actions planned and the progress and current status of the 76 recommendations of the INI.
The INI Action Plan outlines the actions and the progress and current status of the 76 recommendations of the INI that sit under two Themes, which will be delivered through the five cross-cutting and complimentary Workstreams that align to ensure the implementation of the recommendations of the INI Report.
The INI Action Plan is not just focused on amending and improving elements of the present system but also to support a sustained and unwavering culture change moving forward. It recognises the need to ensure that patient safety is paramount, supports the development of the healthcare workforce, provides a greater understanding of roles and responsibilities of management and the healthcare workforce, supports effective leadership and accountability and supports the realisation of an improved culture within health and social care organisations which provides openness and transparency.
Implementation of the INI Action Plan will be secured through the delivery of the two Themes, five Workstreams and the actions outlined against each INI recommendation, and the continued commitment of the Department, the Healthcare Organisations, the GMC and the Independent Sector Organisations to work in partnership to fully implement the INI Action Plan.
Programme Structure
Assurance Framework and Process
A proportionate level of independent assurances is essential to ensuring public confidence that the INI recommendations are implemented on a sustained basis.
An overarching Assurance Framework has been developed which will be used when implementing the INI recommendations.
The Assurance Framework provides details on the structured means of identifying and mapping the main sources of assurance for the successful implementation of the INI recommendations.
The IIPMB will be maintain the oversight and provide challenge on the implementation of the 76 recommendations within the INI Report.
To further strengthen the assurance process an independent IIPMB Assurance Subgroup has been established to provide independent scrutiny to support the INI Implementation Programme.
The IIPMB Assurance Sub-group will:
- review the proposed actions and the progress of actions against each INI recommendation;
- report to the IIPMB to provide independent verification on the progress towards implementation;
- make recommendations for further actions to be taken if required; and
- make an evidence-based assessment on whether each INI recommendation has been implemented.
All INI recommendations will have a separate Implementation and Assurance Document. The purpose of each Implementation and Assurance Document is to clarify the intention of the recommendation, outline other interconnected recommendations, identify the actions required to implement the recommendation and critically the evidence required to provide assurance of implementation.
Stakeholder Engagement
Stakeholder engagement has been and continues to be a key element of the INI Implementation Programme. The stakeholder engagement which has taken place since the establishment of the INI Implementation Team in October 2022 has helped to support a clear public understanding of the INI Implementation Programme from the outset.
The implementation of the INI Action Plan will require continued engagement and collaborative working between the Department, the Healthcare Organisations, the GMC, and the Independent Sector organisations, and partnership working with other relevant organisations to complete the required actions under each INI recommendation.
The PCC Neurology Engagement Platform has been instrumental in establishing the Independent Neurology Liaison Group to increase engagement and to focus on the INI Implementation Programme.
The Independent Neurology Liaison Group has been established to align with the work of the IIPMB Assurance Sub-group to further enhance feedback and recommendations from the service user, carer, and families, on the assurance process, by reviewing and providing feedback on the individual INI Implementation and Assurance Documents.
Other Departmental Neurology Related Work Programmes - Useful links
Further details on other Departmental neurology related work programmes are available below:
Neurology Recall
- Cohort 1 - https://www.health-ni.gov.uk/neurologyoutcomesreport
- Cohort 2 - https://www.health-ni.gov.uk/publications/neurology-recall-activity-and-outcomes-report-active-caseload-cohort-2
- Cohort 3 - https://www.health-ni.gov.uk/publications/neurology-recall-cohort-1-2-and-3-summary-report
- Cohort 3 Addendum - https://www.health-ni.gov.uk/news/addendum-neurology-recall-cohort-3-activity-and-outcomes-report-and-neurology-recall-summary-report
- Neurology Compensation - https://www.health-ni.gov.uk/articles/neurology-recall-compensation
- The RQIA Neurology Work Programme - Regulation and Quality Improvement Authority - RQIA
- Review of Neurology Services - Review of Neurology Services - Interim Report | Department of Health (health-ni.gov.uk)
Other useful contacts/links:
- The Independent Neurology Inquiry (INI) - www.neurologyinquiry.org.uk
- The General Medical Council (GMC) – https://www.gmc-uk.org
- PSNI - https://www.psni.police.uk/op-begrain
- The Patient and Client Council (PCC) - Neurology Inquiry - Patient and Client Council Northern Ireland (pcc-ni.net)
- The Belfast Health and Social Care Trust - https://belfasttrust.hscni.net/
- Office of the Mental Health Champion https://www.nidirect.gov.uk/contacts/office-mental-health-champion
Contact Us
For further information please contact us:
Address: INI Implementation Team, Castle Buildings, Stormont Estate, Belfast, BT4 3SQ
By Email: neurologydoh@health-ni.gov.uk
Independent Neurology Inquiry (INI) - Implementation and Action Plans