When we got back from Japan, we had a letter waiting for us outlining the result of the Independent Review Panel that we attended in Leeds back in March. I may have remarked at the time that it had taken over two years and a lot of hard work (and much detailed analysis from Denise) and frustration to get to the IRP and challenge the Clinical Commissioning Group’s decision that my mother did not have a primary health need.
So, it is somewhat gratifying to report that the IRP concluded that the CCG’s decision was unsound and that across three of the four criteria used to determine need (nature, intensity and complexity) my mother’s condition clearly indicated a primary health need. The IRP also upheld my concerns about failure in process although, a little surprisingly, it did not consider that this unduly impacted on the decision making process. This was a little disappointing, as one of the reasons we continued to pursue the case was that we wanted to see the application of the criteria for continuing healthcare funding delivered in a much fairer and transparent way. It still seems to me that for the IRP to overrule the original decision so conclusively indicates a clear misapplication of process and failure to use available evidence appropriately. I’d also argue that the use of the Decision Support Tool (DST) was partial and as a basis for declining by default rather than as a guide to establishing need accurately, which is how it is designed.
Finally, unfortunately and somewhat perversely, the IRP has no power of enforcement and the CCG now has 14 working days to write and let us know how they will proceed. As NHS England stated in its letter accepting the IRP findings, and as we know from our successful appeal for my dad, it should only be in the most exceptional circumstances that the CCG would not accept the recommendation of the IRP, so keep an eye out for the final instalment.