The Continuing Healthcare Independent Review Panel (IRP) stage is not immune from criticism by families
The IRP stage of the Continuing Healthcare funding appeal process comes after all assessments and despute resolution processes have been exhausted at local CCG level.
The IRP is supposed to give families an opportunity for someone to take a fresh and independent look at their Continuing Healthcare case.
However, some families report that they feel the IRP panel has been biased or lacking in knowledge of the case they are reviewing. Some families also report being sat face to face with the assessors from their own local CCG who carried out the potentially flawed assessments in the first place – and whose behaviour may have been aggressive and intimidating during that process. This is the feedback we have received from some families.
The IRP process is organised by NHS England. It must – at all times – be impartial. If you have reason to believe that the IRP in your case was not impartial, you may find these points helpful:
1. What if no Panel is convened?
The National Framework Annex E paragraph 14 (Page 129) states:
“The Board does have the right to decide in any individual case not to convene an IRP. It is expected that such a decision will be confined to those cases where the individual falls well outside the eligibility criteria, or where the case is very clearly not appropriate for the IRP to consider. Before taking such a decision, the Board should seek the advice of the chair of the IRP, who may require independent clinical advice. In all cases where a decision not to convene an IRP is made, the Board should give the individual, their family or carer a full written explanation of the basis of its decision, together with a reminder of their rights under the NHS complaints procedure.”
Let’s look at the phrase, “where the individual falls well outside the eligibility criteria”. Who has decided that? If you’re in this situation, make it very clear you expect to know how that point has been decided impartially, who decided it – and why. How has it been justified in your case?
2. Is the chair independent?
The chair of the IRP MUST be independent and any advice the chair may have obtained relating to the clinical needs of the person being reviewed must also be independent. Ask where the chair has obtained the advice. The NHS England Operating Model for NHS Continuing Healthcare further states that:
“IRP chairs are independent. They are not employed in the NHS or social care and have been appointed because they are able to chair review panel meetings with impartiality and understanding.”
Make sure you are satisfied that this true in your relative’s case.
3. Who is on the Panel?
NHS England sets out the requirements for who should be on an IRP panel and they mention the ‘clinical advisor’. Make sure you ask who the clinical advisor is, how they justify their impartiality and what potential conflicts of interest might be relevant regarding their day-to-day work and reporting structure within the CCG.
These are the essential people who should be at the IRP:
- an independent chair
- a representative nominated by the CCG and who is not involved in the case
- a representative from the Local Authority and who is not involved in the case
- at times, also a clinical advisor
- a notetaker
- and of course the family representative(s)
It probably won’t escape most families’ notice that, although the CCG representative should not be involved in the case, that person does of course work for the same CCG that holds the purse strings.
There may also be one of the CCG assessors who carried out original assessment and who is there to answer questions from the Panel about why they refused to recommend Continuing Healthcare funding.
There should also be a facilitator/administrator available to the family before and after the IRP – to answer questions and arrange the actual IRP and the date. This person is not on the actual Panel.
Extra tips about Independent Review Panel hearings
This video, What to expect from an Independent Review Panel, highlights what NHS England says should happen at an IRP. It’s produced by NHS England and it obviously portrays a straightforward process. Many families report that it doesn’t always happen this way, so compare this to what happens/happened at your own IRP, and complain in the strongest terms if you believe the IRP hasn’t been conducted fairly or impartially.
Note these points in particular:
- Check that each member of the Panel has received AND read AND understood the paperwork relating to your case. It may be a substantial amount of paperwork; Panel members still have a duty to properly understand your case and your relative’s care needs.
- Some families report being told that there is a time limit for the actual IRP meeting. It needs to take as along as it takes. If there is a substantial amount of paperwork then of course it’s going to take longer – and that’s just fine. Don’t let anyone tell you the meeting has to stop or the process be curtailed just because the Panel members need to be somewhere else. This is your appeal – and it must be thorough.
- Prepare really well in advance. Make sure you know the eligibility criteria inside out and how your relative should have scored in each domain – and why. Make sure you’ve read the Continuing Healthcare guidelines and you are ready to highlight everything you believe to have been done incorrectly in your case.
- Address every point you need to – and every point you disagree with.
- Hold the members of the Panel to account over their statements and assumptions. They MUST abide by the law and the Continuing Healthcare guidelines.