You may have hit a brick wall at a local appeal for NHS Continuing Healthcare, and you want to take things further. Your next step is a Continuing Healthcare Independent Review Panel (IRP) hearing.
This is a regional level appeal and involves a panel with an independent Chair plus members of health and social care from outside your area. It’s supposed to give you the opportunity to have your Continuing Healthcare appeal reviewed by people who weren’t involved before.
However, we’re hearing increasing accounts of Continuing Healthcare Independent Review Panel meetings being less than independent. Families are coming up against the same flawed arguments, incompetence and obstruction as in the local appeal process.
As well as involving people from outside the area, many IRPs now also seem to invite the same local assessors whose maladministration led to the appeal being needed in the first place. The IRP can turn into a battle of ‘their word against yours’, which is hardly the independent review it should be.
This article is not to discourage you from pursuing an IRP. People do win. Our aim is to highlight what you may come up against – so you can prepare for it and keep labouring every point the Panel may want to simply dismiss.
David contacted us about his mother’s recent IRP. He recounted what happened in the meeting – and afterwards. He shares his story here:
“My sister and I attended the IRP meeting and were very optimistic at the end of it. The Chair of the meeting had said that he was impressed that we had prepared such a good case. Additionally, the representative of the local NHS Trust Continuing Healthcare Department (who said she had nothing to add when asked to comment on our case by the Chair) remarked after the discussion was over that, with cases like ours, it’s pretty obvious what the outcome would be.
We took this to mean that the Trust had decided not to oppose us, and that they thought the IRP would overturn the recent decision to refuse funding.
We had taken with us a 10-minute video of our mother, which seemed to have a profound impact on the three Panel members and Clinical Advisor. It showed our mother to be unable to communicate and to be completely reliant on others for all her needs.
But our optimism was dashed when, eight weeks later, we received the notification saying our mother did not qualify for Continuing Healthcare funding! The same language used in previous rejections was used to justify the decision: “Her needs are merely incidental or ancillary to the provision of accommodation and of a nature which an Authority, whose primary responsibility is to provide social services, could be expected to provide. Consequently she does not have a primary health need.”
Our challenges in respect of how, according to NHS definitions of social need versus health need, our mother had a health need, were ignored. And our challenges around the Behaviour domain where previously it was interpreted as aggressive behaviour (contrary to NHS definitions which specifically mention the passive self-neglect behaviour of dementia suffers) were also ignored.
Behaviour was again defined as “verbal or physical aggressive behaviour such as biting, scratching or hitting out”. The IRP went on to say, “The Panel noted that the dictionary definition of behaviour was the way in which a person behaves in response to a particular situation or stimulus. This suggested that some type of response or reaction was needed in order for this to be considered as behaviour.” On this words fail me!!
They are making up domain definitions however they wish – from the dictionary!! What they should be doing is using the very precise definition in the NHS Continuing Healthcare documents. I did refer them to this in writing and verbally at the meeting.
We don’t know who had the biggest input to the IRP decision but we are sure that the member of the Panel who acted as Clinical Advisor took offence at us referring him to the definitions in Continuing Healthcare documents during the discussion, when he was constantly getting his definitions (particularly around behaviour) wrong.
They did move the Behaviour domain up from No Needs to Low, and the Nutrition domain from Moderate to High, but that was all. However, our main argument was not what domain scores she gets but the fact that the very descriptions of her condition in NHS documents show that (by the NHS’s own definitions), she has a health need not a social need. But those arguments were not addressed.
We are now convinced that the IRP is not ‘independent’ at all. The arguments used and the errors in assessment made were identical to the two previous local Panels – right down to the wording used to reject her case. And, as before, nobody on the IRP seemed to show the slightest interest in using the NHS’s own published definitions, but would rather use their own arbitrary ones.
We are obviously now going to the Ombudsman, however we wonder if they too will be part of this same conspiracy to stop any dementia patients getting Continuing Healthcare funding.”
Have you taken your case to an NHS Continuing Healthcare Independent Review Panel?
If so, what was the outcome for you?