If the Local Dispute Resolution Meeting results in a decision to uphold the original decision not to fund care then an application can be made for the claim for funding to go to an Independent Review Panel (IRP) which is usually heard at the HQ of NHS England.
Appealing To An Independent Review Panel (IRP)
This appeal stage is in a more formal setting and this is reflected in the proceedings. The panel adjudicating on the matter at this juncture is comprised of an Independent Chair employed by NHS England, a Clinical Advisor, a Health Representative, a Social Care Representative and a Representative from the CCG. The Family and the patient together with their legal and medical representatives can also attend.
At the IRP hearing, the family of the Applicant are asked to give a portrait of the patient from their personal experience and legal submissions are invited. The Chair of the IRP revisits the DST and comes to a decision after consideration of all the evidence. Following the hearing, a reasoned decision in the form of a report is handed down which makes recommendations as to eligibility regarding the funding. This report is also sent back to the CCG who will then decide whether to follow those recommendations. The reality is that the CCG will usually defer to the recommendations of the Independent Review Panel.
It is not lost on us that this stage in the appeal process has the word ‘Independent’ and whilst this may suggest a degree of external and ‘agenda free’ input, this is not always the case.
Careful review of the evidence needs to be undertaken and this is where a medico-legal team really helps in the presentation of the case.
Ultimately if there is no primary health need found, then it is usual that the Applicant will be forced to pay for some, most or all of their care – and with costs in some instances being over £1,000.00 per week for care, it makes sense to ensure that your Application is done properly with all the evidence fully considered – this is what our medics and lawyers do.