By Rosalind Hughes, founder, Just Caring Legal
What is an independent review panel?
NHS England is required to establish arrangements to independently review the decisions of Clinical Commissioning Groups (CCGs) on NHS Continuing Healthcare funding. Anyone has the right to request an independent review panel (IRP) once they have exhausted local CCG dispute resolution procedures.
Does the NHS have to agree to an independent review panel?
The independent review process is co-ordinated by NHS Continuing Healthcare teams in each of NHS England’s regions. Before agreeing to an independent review, NHS England will decide if the CCG has “taken all appropriate steps” to resolve the case informally. Then the Chair of the particular panel will decide whether a full IRP will proceed.
The National Framework for NHS Continuing Healthcare is the set of rules that governs all NHS CHC processes. It says NHS England does have the right to decide not to convene an independent review panel in any individual case. It says “it is expected that” this will only be where the individual falls well outside the eligibility criteria, as set out in the standing rules. Alternatively, it may be where the case is “very clearly not appropriate” for the independent review panel to consider.
Why is it getting harder to get to an independent review panel?
There is precious little detail on what this part of the National Framework actually means in practice. Consequently, there is a high degree of latitude for NHS England to shut cases down before they get to the IRP stage. And the temptation is great, with the NHS facing a massive backlog of NHS Continuing Healthcare applications and appeals, as well as huge budgetary constraints.
We have recently heard of NHS England refusing cases for independent review on the flimsiest of grounds. For example, one recently refused to grant a review because the family had failed to reply to one of the CCG’s letters. This was in the dim and distant past and had been superseded by a whole slew of more recent correspondence.
What can we learn from this?
Where NHS England decides not to convene an independent review panel, the individual, their family or carer should receive a “clear written explanation of the basis” for this. They should also get a reminder of their rights under the NHS complaints procedure.
But the most important takeaway here is to make sure that in your local dispute with the CCG, you dot all the i’s and cross all the t’s. Reply to letters, meet deadlines, check timeframes. Bear in mind that any failure to do so might cost you dear further down the line.
We are all too aware that the NHS CHC appeals procedure is a time-consuming and complex process. If you feel unable to deal with it alone, why not give us a call? We can take the pressure off by guiding you through all the necessary hoops. And we can ensure that any unfair decisions are robustly challenged. Have you met a brick wall in your NHS CHC journey you can’t seem to get over? Then call or email us today for a free initial assessment. We may just be able to give you the boost you need to clear it.