Only 2 Hours for an appeal to Independent Review Panel!

If your local NHS Clinical Commissioning Group has rejected your application for NHS Continuing Healthcare funding, you always have the option to appeal to an NHS England Independent Review Panel (IRP).

A few years ago, if you attended an Independent Review Panel (IRP), you might have expected to be there for – well, as long as it took to deal with your complaints and to give you the opportunity to discuss all the needs of your family member. This would be a face-to-face meeting with a representative from the CCG, the panel members, and a clinical adviser, you, and possibly your advocate.

Everyone had a hard copy of the document file, and the IRP members could discuss the file with you whilst everyone turned to the relevant pages together.

Everything changed with the onset of COVID-19. The NHS had a period of about 6 months where no IRPs were held. When they were eventually up and running again, IRPs were all done online (remotely) – the indication is that this way of working will continue indefinitely going forward, even with the lifting of COVID-19 restrictions.

So now, if you are invited to an IRP, you will receive your documents, likely via secure email, and you will be invited to a Microsoft Teams Meeting, online. Some people find this daunting, and although we believe that face-to-face meetings are better for families, the good thing about MS Teams is that you can take part in the IRP from the comfort of your own home. And, because more meetings can be held, it has enabled the NHS to clear a long backlog of cases.

As a result, you will get to attend an IRP within a reasonable time frame, possibly 3-6 months, rather than waiting 18 months to 2 years, which was the norm in the past.

If you have never used MS Teams before, the NHS will send you instructions, and you can always ask for the help of a friend or family member.

The NHS has also started to restrict the amount of time that IRPs run, now aiming to complete within 2 hours.  This is a tall order given there are 12 areas of need (care domains) to discuss, then there are the 4 key characteristics, and also any complaints that you might have about the process so far.  That’s a lot to cram into just 2 hours!

In order to use your time wisely, we would recommend that you think carefully about how long you spend talking about each item.

So here are some handy hints:

• Set out your complaints and everything that you want to say in writing in advance of the meeting and send this to the CCG or NHS England as requested – you should be asked to do this as a matter of course. You should make sure that you say which levels of need you disagree with and why – and try to back this up with examples from the clinical evidence if you can. If you have an advocate such as a solicitor, they will likely send in the written submissions on your behalf some weeks in advance of the IRP.
• If you have not got 2 computer screens, it can be difficult to look at the emailed IRP documents at the same time as taking part in the meeting. You might want to print key documents or key pages to help you refer to them during the IRP, or make a written note of the page number, dates and content, ready to be able to quote to the IRP members.
• During the meeting, focus more on the levels of need and the 4 key characteristics than the process, as this is where you can get the eligibility decision changed. Any complaints about the process will more than likely just be acknowledged by the IRP and the CCG told to get it right next time. Whereas changes to the levels of need and 4 key characteristics are more likely to lead to changes to the decision to award CHC funding.
• Spend more time discussing needs that are Moderate, High and Severe, than on needs that are Low – but don’t forget that even Low needs, particularly if they take up a lot of time in terms of care needed, can change the decision from ineligible to eligible!
• There will be some levels of need that you have agreed with, and others that you haven’t. Spend more time discussing the levels of need that you disagree with, but don’t ignore levels of need that you do agree with, if key care details have been missed or underestimated. For example, there might be practical considerations around the care needs that have not been taken into account; such as, in ‘Mobility,’ the original decision might not have considered the frequency or times of any falls. Falls might have been happening frequently at night when less carers were available to assist. Or, the original decision might not have looked at needs that overlapped. For example, there might be a Moderate or High in ‘Behaviour’, impacting on care needs in other areas of needs (domains), such as ‘Continence’ care, making it more difficult or more time-consuming for carers to provide the care in those other areas of need – you should discuss or emphasise these links.
• The 4 key characteristics – this is perhaps the most difficult part of the IRP for families to understand. It is the part of the IRP where you need to look at all the needs and how they interact with each other and then consider how this affects the Nature, Intensity, Complexity and Unpredictability of the needs. This comes at the end of the IRP, when you might be feeling a bit tired, so our tip is to have your points written out in advance, and submit them to the IRP in advance (you should be requested to do so by the CCG or NHS England), also have them printed out and in front of you during the IRP meeting; use a highlighter pen to pick out the most important points before the IRP starts, and use your highlights to help you to summarise concisely.
• During the IRP, keep your eye on the time and try to apportion your time well – aim to have no longer than 20 minutes at the start to discuss any complaints you have about the process. When discussing the areas of need (domains) aim for about 5-7 minutes per area of need – increase this slightly for higher-level needs and reduce it slightly for lower-level needs. Don’t forget there are 12 areas of need, so the time soon mounts! You need to leave time for the IRP members to ask you questions on each of the areas of need. At the end of the IRP, take about 20 minutes to discuss the 4 key characteristics and for the NHS to make their closing statements.
• The Chair of the IPR will likely set the pace for the meeting, but it is worth keeping an eye on the time yourself, so you don’t have to rush any of your points. Some IRP Chairs will let the time overrun, if needed.
• The MS Teams meeting will end for you and the CCG’s representative, but the rest of the IRP members will carry on discussing the case after your 2 hours is up, in order to make their decisions and conclusions.
• Make good use of your time in the IRP and maximise your chances of being successful!

Conclusion

Good preparation and use of time is paramount with such dramatically reduced appeal hearing slots.

Don’t get side-tracked into discussing matters which are irrelevant, waste precious time and could even undermine your case.

Focus on the good points you want to make to support your case.

As the IRP really is considered the last realistic chance to get valuable CHC funding awarded, many families use the opportunity to seek professional advocacy support to ensure that their appeal has the best chance of success. A good advocate will analyse the evidence, prepare detailed written appeal submissions and take the stress and strain off your shoulders. If you need legal help, visit our 1-2-1 page or get in contact via our website.

For additional reading around the subject, look at these helpful blogs:

Rejected for CHC Funding? Part 2: How to appeal the Local Resolution Decision

An exclusive Q & A interview with an IRP Chair – a rare insight into conducting your appeal and knowing what to expect on the day

Preparation, Preparation, Preparation! Never Take MDT Outcomes For Granted

June’s feature on flawed CHC assessments and the importance of good record keeping

PART 1- Looking At The 4 Key Indicators: Unlocking the basics

PART 2 – Looking At The 4 Key Indicators: Gathering pieces of evidence

PART 3 – Looking At The Four Key Indicators: Completing the Jigsaw

PART 4 – Looking At The Four Key Indicators: Drafting Your Conclusions

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