Questioning the Independence of Continuing Healthcare Independent Review Panel Chairs

John Petters made this Freedom of Information request to NHS England

This request has been closed to new correspondence from the public body. Contact us if you think it ought be re-opened.

The request was successful.

Dear NHS England,
My late mother, Doreen Cowell has been unlawfully refused NHS Continuing Healthcare (CHC) funding until a few days before her death. She should have been entitled by law to CHC since being admitted to Moutnessing Court, in Essex, which is run by the SEPT NHS Trust. In breach of statute as admitted by the Chief Executive, Sally Morris, SEPT failed to lawfully discharge her in compliance with the Delayed Discharge Directions.

SEPT commenced the CHC Checklist, but did not inform me as attorney, nor enter it in the medical records, nor complete it as required by statute. Therefore her discharge to Essex County Council Social Care was unlawful and this was not addressed by social worker Gill Lazarou, who was responsible for the discharge.

Sally Morris, CEO SEPT stated in response to a Statutory Complaint under The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009,
“I agreed with you that the checklist was not completed adequately….Please accept my apology that the proper process was not pursued….I accept your comments that it was unprofessional. Staff have been reminded that this process must be approached in a professional manner”.

Since the Delayed Discharge Directions are mandatory, a legal discharge cannot have occurred. Notwithstanding this, Essex County Council unlawfully took responsibility for my mother’s care and proceeded to pursue me for her care fees, which were in excess of £80,000 when she died in September last year.

A CHC assessment was undertaken in March 2014, by nurse Stephanie Williams, who was aware my mother suffered from epilepsy and she was asked to ensure a qualified person was present as part of the multi-disciplinary team (MDT) which was to assess my mother for CHC funding. She failed to do this and the MDT comprised her and social worker, Lisa Rollisson, who admitted she had no medical knowledge.

I hired an independent expert who warned of the dangers of seizures from the use of the drug Galantamine. Stephanie Williams stated, as the audio recording evidences,

"That's going to be outside my sphere of expertise….it's well outside my field of expertise which is why a neurologist and a psychiatrist get paid so much more than I do".

Lisa Rollisson stated:

"I fell a bit out of my depth commenting on this because I'm not medically trained...I'm between moderate and high."

In the Drug therapies domain, on the decision support tool, the MDT finally agreed after considering what the independent expert said, that my mother should score “High” in that domain. Notwithstanding this, the local panel unlawfully reduced the scoring to “Moderate”.
A so called NHS Independent Review Panel (IRP) Chaired by Peter Brown a retired NHS employee, looked at my complaint and refused to agree with the expert and refused CHC funding, despite the fact that my mother was continually having falls, which resulted in broken limbs.

The Parliamentary & Health Service Ombudsman (PHSO) took up my complaint and stated a new IRP chair would do a desk top review of the case as he agreed that drug therapies domain should have been ‘High’.

Instead of a Desktop Review, the new chair, Sue Cooper, another retired NHS employee, and hardly someone as independent as a judge or lawyer, decided to reconvene the original panel which comprised Sue Crinson, a retired Local Authority employee, hence, as in the case of the chair, someone whose independence can be questioned as well as Anne Jones, another retired NHS employee.

As expected, the findings were again against what our medical expert and the PHSO had found, viz, my mother should have had a high score in the drug therapies domain. CHC funding was again denied. The panel was hardly likely to overturn its view whereas a fresh IRP as the PHSO suggested could have.

Chair Sue Cooper made a number of fundamental factual errors. Her report negligently stated,
“her last seizure had been in 1960 which was some considerable time before the assessment took place”.

This is factually incorrect. My mother’s medical records states:
“01 Jan 1970 Major Epilepsy”
Her seizures were occurring in 1970 as the GP records testify. Apparently Ms Cooper is unable to accurately read medical notes, which questions her competence to reach lawful decisions in her role as so called independent chair of an IRP.
Sue Cooper continued,
“The review members noted the Ombudsman's concerns and view that the weighting in this domain should be increased. The review members felt that there was no indication that Mrs Cowell's condition was fluctuating”.

This conclusion is fatally flawed given the evidence we from the consultant at Southend Hospital, which would have been available to Ms Cooper had she bothered to look for it.

Dr Alquist, in response to a statutory complaint stated: On 16 April 2017:
“your mother was further reviewed where it was noted that her movements on her right side were restricted. It was suggested that she may have suffered a seizure and was postictal (altered state of consciousness after an epileptic seizure). She was treated with anticonvulsant medication and an E E G (electroencephalogram – a measurement of the electrical activity of the brain measured from an array of electrodes on the scalp) and a C T scan of her head were planned”.

My mother’s death certificate records epilepsy as one of the causes of death.
Had Ms Cooper operated an open review, I would have be given the opportunity to present evidence, but this was done behind closed doors and without my knowledge.

A statutory complaint to Simon Stevens, CEO of NHS England concerning the independence of the chair and panel members of the IRP brought a response from Dr Lynne Wigens, Regional Chief Nurse, NHS England (Midlands & East), who stated:

“I note your concern that Ms Cooper, the Chair who carried out the desk top review, is a former employee of the NHS. Ms Cooper was appointed as an Independent Review Panel Chair in February 2014 and has not been employed by the NHS since 2010. All IRP Chairs go through a stringent interview process to ensure that they act in an independent capacity. In line with paragraph 17 of Annex E of the National Framework, while current NHS staff or board members of NHS organisations should not be considered for the role of IRP Chairs, people who have formerly held such a position are eligible to apply.”

My questions are:
1. How many chairs of the IRP in the Midlands and Eastern Region are not former employees of the NHS?
2. What is the fee paid to IRP chairs and panel members?
3. What expenses are they entitled to claim?
4. Who pays the fees and the expenses?
Yours faithfully,

John Petters

FOI, England (NHS ENGLAND), NHS England

Dear Mr Petters,

 

Thank you for your communication received on 27 February 2018.

 

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Freedom of Information

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FOI, England (NHS ENGLAND), NHS England

Dear Mr. Petters,

 

Re:      Freedom of Information request (Our Ref: FOI-055784)

 

Thank you for your Freedom of Information (FOI) request dated 27 February
2018.

 

Your exact request was:-

 

“My questions are:

1.How many chairs of the IRP in the Midlands and Eastern Region are not
former employees of the NHS?

2.What is the fee paid to IRP chairs and panel members?

3.What expenses are they entitled to claim?

4.Who pays the fees and the expenses?”

 

NHS England holds this information.

 

How Many Chairs of the IRP in the Midlands and East Region are not former
employees of the NHS?

 

The Midlands and East region has 14 Chairs and of these, 12 are not former
employees of the NHS.

 

 What is the fee paid to IRP chairs and panel members?

 

Chairs are paid the following fees:-

 

·         A preview rate per case of £40 per hour up to a maximum of £80

·         For cases that do not proceed to a full panel and a short report
is required a fee of £240 per case applies

·         For cases that do proceed to a full panel a rate of £290 per
case or a rate of £400 for cases that are deemed by NHS England to be
exceptional applies

·         A report writing fee of £320

·         In exceptional cases a rate of £40 per hour may be used in
respect of other services or work

 

Panel members are not paid a fee as they are usually supplied by a
Clinical Commissioning Group or Local Authority.

 

Furthermore, in certain circumstances where additional capacity is
required or an Independent Clinical Advisor is asked to attend, they are
paid a fee of £190 or £230 for cases that are deemed by NHS England to be
exceptional.

 

 What expenses are they entitled to claim?

 

Chairs and Independent Clinical Advisors can claim travel expenses.  These
are paid in line with NHS England’s Expenses Policy at a rate of 56p per
mile. 

 

Who pays the fees and the expenses?

 

NHS England pays the fees and expenses.

 

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o [1]http://www.england.nhs.uk/terms-and-cond....

 

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Please do not reply to this email. This message has been sent from a
central mailbox. To communicate with NHS England regarding Freedom of
Information (FOI) requests, enquiries or complaints we ask these are sent
directly to NHS England’s customer contact centre. This is to ensure all
communications are progressed correctly. Their postal address, telephone
number and email details are as follows:- PO Box 16738, Redditch, B97 9PT;
0300 3 11 22 33, [5][NHS England request email].

 

 

Yours sincerely,

 

Freedom of Information

Corporate Communications Team

Transformation and Corporate Operations Directorate

 

NHS England

PO Box 16738

REDDITCH

B97 9PT

 

Tel: 0300 311 22 33

Email: [6][NHS England request email]

 

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