17. It is our role to decide whether NHS England’s IRP acted in line with the National Framework when it considered whether Mrs V was eligible for CHC. The National Framework sets out the principles and processes ICBs and NHS England should follow when considering if someone is eligible for CHC.
18. We cannot consider the discretionary decisions the IRP made when it decided on eligibility. This includes the decisions it makes based on clinical judgement and clinicians’ opinions. We can only consider if the IRP has followed the National Framework. This means we can only uphold a complaint about a CHC eligibility decision if we find the IRP did not follow the National Framework when it made its decision.
19. The IRP reviews if the ICB should have found the person to have a primary health need and therefore be eligible for CHC. It also reviews the ICB’s procedures when it was coming to its eligibility decision to make sure it was acting in line with the National Framework. If the IRP does find the ICB made a mistake, it can: • recommend the ICB reconsiders if the patient had a primary health need, and • recommend the ICB addresses any procedural faults the IRP identified.
20. When we look at a complaint about an IRP, we consider if it took into account all the relevant information when it made its eligibility decision.
21. We understand Mr K is concerned the IRP did not give his family’s views enough weight. When we weigh up the evidence we can see the IRP report shows detailed discussions and captures what the family said comprehensively. We appreciate the IRP did not always agree with the family’s evidence, but there is strong evidence it took it into account. We do not think it got something wrong here.
22. We set out its consideration of their evidence in the parts of the IRP it disputes in the next section.
Domains
23. Mr K has told us he disagrees with how the IRP considered the mobility, psychological and emotional needs, behaviour and drug therapies and medication domains. We have looked at how the IRP considered these in turn.
Mobility
24. Mr K disagrees with the IRP's weighting of this domain. He says it should have been high, but the IRP weighted his mother's needs as moderate.
25. Mr K says his mother was at a high risk of falls. He said she had a history of falls, including one before the original assessment (August 2021), had an unsteady gait and was taking risperidone (a drug which helps patients with their mental health). He says her cognitive issues made this worse. He says the IRP did not take enough note of the family's evidence that the records did not adequately document her falls history and risk. This included Mrs V needing an ambulance due to falls three times in the previous 12 months. It said the home had taken away her stick which made her mobility worse.
26. The IRP said Mrs V had only had one fall and no calls for an whilst at the care home around the time of the CHC assessment. The home had judged her falls risk as medium. It said she was able to weight bear. She could move independently but often used furniture to support her while she walked and had a habit of wandering which put her at some risk of a falls. It said the home removing her stick would not have been possible if she had been at a high risk of falls. It said there did not appear to be a high level of challenge in caring for Mrs V.
27. The descriptor for a moderate weighting for this domain is:
‘Not able to consistently weight bear.
or Completely unable to weight bear but is able to assist or cooperate with transfers and/or repositioning.
or In one position (bed or chair) for the majority of time but is able to cooperate and assist carers or care workers.
or At moderate risk of falls (as evidenced in a falls history or risk assessment).’
28. The descriptor for a high weighting for this domain is:
‘Completely unable to weight bear and is unable to assist or cooperate with transfers and/or repositioning or Due to risk of physical harm or loss of muscle tone or pain on movement needs careful positioning and is unable to cooperate or At a high risk of falls (as evidenced in a falls history and risk assessment) or Involuntary spasms or contractures placing the individual or others at risk.’
29. The IRP report shows us there was a detailed consideration of the extent of Mrs V’s falls risk. It describes the conversation at the IRP meeting about this and explains how it weighed up the different pieces of evidence. We cannot know whether the care home’s records adequately reflected Mrs V’s falls risk, which Mr K is concerned about. Our role is to consider how the IRP weighed up the complainant’s and advocate’s evidence, along with that of the ICB.
30. We asked our adviser about this. They said the evidence supports the IRP’s decisions on Mrs V’s mobility. We can see from the records Mrs V could mobilise independently with a walking stick or frame, but her cognitive impairment meant she sometimes forgot to use these. The records show she was unsteady when on her feet and did experience some falls. Her carers had to know where she was, as Mrs V could wander into other people’s rooms and take things. We can see from the records the home had taken Mrs V’s walking sticks, as she was hitting out with them, but she still had other walking aids.
31. We appreciate Mrs V’s falls were distressing for her family. Our adviser also said there was a question as to whether Mrs V became more unsteady after she had been prescribed risperidone. They also said the records did not show Mrs V had frequent or repeated falls within the relevant period. The IRP was considering the ICB’s assessment of Mrs V’s needs in August 2021. It had to look at the evidence of her needs at that time. The falls Mr K referred to happened April and May 2021. This was before she moved into the care home and her needs were settled. The IRP could not consider these as evidence of her needs in August 2021.
32. The key issue was the level of risk Mrs V had in this domain. The records indicate this risk was higher when she was living at her home than when she moved to the care home. We can see the IRP took into account her falls risk at the time of the assessment when it made its decision.
33. The records do not indicate Mrs V was unable to bear her weight at all or could not cooperate with transfers. She did not need careful repositioning nor did she have involuntary spasms or contractures which placed herself or other people at risk.
34. We can see the IRP commented on Mrs V’s needs in detail. We can see Mrs V had a history of falls. We can also see there was a difference of opinion about what the records showed and what her family felt had happened to her regarding falls and her level of risk. Mrs V clearly had needs around her mobility, which made life difficult for her. When we weigh up the evidence, it appears the IRP acted in line with the DST guidance when it considered Mrs V’s needs in this domain. There is no indication of what the IRP would have needed to see to give a higher weighting here. We think it considered the relevant evidence in detail, including Mr K’s concerns. Based on the evidence it had, the IRP’s rationale for its decision appears to be sound. We have not seen indications of a failing regarding its decision in this domain.
Psychological and emotional needs
35. Mr K disputes the IRP's weighting of this domain as moderate. He says it should be high.
36. He says his mother had frequent and significant periods of distress, paranoia and hallucinations which had a detrimental effect on her health. In particular, he said her paranoia around her food affected her nutritional status. He says this interacted with her challenging behaviour to make her harder to care for and impacted on her wellbeing. She was also under the care of the local mental health team and was prescribed medication for her mood. He also says the IRP chair did not fully allow the family to put forward their views on her needs in this domain. He thinks the IRP marginalised his mother’s needs and did not apply the well managed needs principle as it should here.
37. The IRP said Mrs V was prone to anxiety, restlessness, mood changes and hallucinations and paranoia. She would occasionally shout out or scream. It said this may have been because she did not like being in the care home due to being very independent. It said her condition was being addressed satisfactorily at the time under consideration and she had a settled sleep pattern. It felt there were no notably adverse consequences for her care and her condition did not have a severe impact as given in the DST descriptor.
38. The descriptor for a moderate weighting in this domain is:
‘Mood disturbance, hallucinations or anxiety symptoms, or periods of distress, which do not readily respond to prompts, distraction and/or reassurance and have an increasing impact on the individual’s health and/or well-being.
or Due to their psychological or emotional state the individual has withdrawn from most attempts to engage them in care planning, support and/or daily activities.’
39. The descriptor for a high weighting is:
‘Mood disturbance, hallucinations or anxiety symptoms, or periods of distress, that have a severe impact on the individual’s health and/or well-being.
or Due to their psychological or emotional state the individual has withdrawn from any attempts to engage them in care planning, support and/or daily activities.’
40. The relevant part of the descriptors is the first part, about mood disturbance, hallucinations and anxiety or periods of distress. The key difference between moderate and high needs is the impact those things are having on the person’s health or wellbeing.
41. We asked our adviser about this. They said the evidence shows Mrs V did not respond to reassurance, was paranoid and had fixed ideas. For example, she would refuse food and drink because she thought it was poisoned or toxic. This was regardless of who prepared it or if food had been opened in front of her. She also refused medication because of her fear of being poisoned. Mrs V needed support from the community mental health team (CMHT) and took risperidone for her mental health.
42. When we look at the IRP report, we can see it considered this domain in depth. This includes detailed descriptions of her family’s points about her needs. Mr K says the IRP chair did not allow the family to answer a particular point. We have no reason to disbelieve Mr K. It is not clear what point this was, nor how this would have changed the IRP’s overall decision on this domain. We also have not seen indications it did marginalise her care, as it discussed this area in some detail.
43. But our adviser said there were aspects of her needs which appeared to have a severe impact on Mrs V. In particular, she refused her medication (and food and drink) until the home and her family adopted a covert method of giving it to her. Until then Mrs V was not receiving the correct medication for her needs and her physical health was also suffering. So the evidence indicates she had needs in this domain that went beyond those set out in the moderate descriptor. It does not appear the IRP considered this domain as robustly as it should have done.
44. We can see an indication of a failing in how the IRP considered this domain. We think the IRP may not have considered Mrs V’s needs in line with the DST guidance. We set out our view on the impact of this later.
Behaviour
45. Mr K disagrees with the IRP's weighting of this domain as high. He says it should be severe.
46. He says his mother posed a significant risk to others, including having hit people with her walking stick and thrown plates. She also attacked other care home residents and had been found with a concealed weapon. He says the IRP did not take enough account of the original social worker’s weighting of this domain as severe and concentrated on the frequency rather than the severity of her challenging behaviours.
47. The IRP said her behaviour was predictable and did not require additional skills to care for her. It said her actions were not frequent and the risk to other residents, rather than care home staff, were incidental. It said she could be very aggressive, but also settled and her needs were being successfully managed and Mrs V’s behaviour did not require any care or support outside planned interventions. It said she did socialise in the communal areas and care interventions were generally of a low level, including methods such as reassurance and supervision and there were no ‘ABC charts’ (tools used to analyse and assess someone’s behaviour) for her.
48. The descriptor for a high weighting in this domain is:
‘‘Challenging’ behaviour of type and/or frequency that poses a predictable risk to self, others or property. The risk assessment indicates that planned interventions are effective in minimising but not always eliminating risks. Compliance is variable but usually responsive to planned interventions.’
49. The descriptor for a severe weighting is:
‘‘Challenging’ behaviour of severity and/or frequency that poses a significant risk to self, others or property. The risk assessment identifies that the behaviour(s) require(s) a prompt and skilled response that might be outside the range of planned interventions.’
50. We can see from the records the IRP discussed Mrs V’s needs in this domain in depth, including Mr K’s concerns. This included that the social worker and nurse assessor at the original ICB eligibility decision meeting had disagreed as to whether her needs were high or severe and what happened afterwards. He thinks the IRP should have taken more note of the social worker’s weighting for this domain. Mr K says it did not consider sufficiently the ICB’s decision to overrule the social worker saying Mrs V’s needs were severe in the behaviour domain. Mr K says this had materially affected the ICB’s decision and then also impacted on the IRP’s overall eligibility decision.
51. An IRP’s decision is a fresh consideration of the evidence and supersedes any CHC decision made by an ICB. We can see that, when the IRP looked at the behaviour domain, it specifically highlighted that the social worker and nurse assessor had disagreed as to whether this should be weighted severe. We can see it considered carefully the weighting of this domain. We have not seen indications the ICB’s decision to weight that domain as high meant the IRP got something wrong when it made its decision.
52. The IRP considered whether the care home had ever looked to move Mrs V to one-to-one care. We can see it considered different incidents, including when she was found with a weapon, in detail to help it decide how far her actions were severe or frequent and the risk they posed. We can see the IRP also considered carefully the types of interventions which these required and what this indicated in terms of the weighting of the domain. The records do not indicate the IRP focused on the frequency of the incidents rather than severity and risk to others. We can see it considered, for example, the different risks to staff and other residents.
53. Our adviser said the IRP report is detailed and explains the rationale for it weighting the domain as high. We can see from the records Mrs V did refuse personal care, food and drink and medication. She could shout and scream at other residents and would sometimes go into their rooms and take other people’s items. We can also see she committed aggressive acts such as stamping on someone’s foot, throwing a cup of juice and trying to put drawing pins in her mouth.
54. Our adviser also said the approach the home used was not outside of planned interventions. The records indicate Mrs V did not resist when carers took items off her to return them to their rightful owners. Our adviser said the evidence indicates her behaviour was not of a severity or frequency to pose a significant risk in line with the severe descriptor.
55. We understand how distressing Mrs V’s behaviour was for her family to witness. She could be challenging and aggressive. This was upsetting and worrying for them.
56. When we weigh up the evidence, it appears the IRP acted in line with the DST guidance when it considered Mrs V’s needs in this domain. We have not seen indications of what the IRP would have needed to see to give a higher weighting here. There are no indications of a failing in its decision in this domain.
Drug therapies and medication
57. Mr K disagrees with the IRP's weighting of this domain as moderate. He says it should be high.
58. Mr K says his mother’s drug regime (especially her lorazepam prescription and her recent prescription for risperidone) had to be managed and administered by trained members of staff. He says difficulties the staff had in giving her medicine shows it was complex to administer to her, which he feels the IRP disregarded. He also says his mother was still prescribed lorazepam but she refused to take it so the home stopped giving it her. He says this shows her medication needs were complex. He says they required a high level of monitoring.
59. The IRP says the home had not given Mrs V lorazepam, although it had tried and she had refused to take it. It said her medication regime was being overseen by a registered nurse but it did not need to be administered only by a clinical professional. The ICB was paying FNC for Mrs V’s nursing care. The ICB said covert attempts by the home to give her medication had been successful and there were no recorded adverse effects when Mrs V refused to take her prescriptions.
60. The descriptor for a moderate weighting in this domain is:
‘Requires the administration of medication (by a registered nurse, carer or care worker) due to: non-compliance, or type of medication (for example insulin), or route of medication (for example PEG).
or Moderate pain which follows a predictable pattern; or other symptoms which are having a moderate effect on other domains or on the provision of care.’
61. The descriptor for a high weighting is:
‘Requires administration and monitoring of medication regime by a registered nurse, carer or care worker specifically trained for the task because there are risks associated with the potential fluctuation of the medical condition or mental state, or risks regarding the effectiveness of the medication or the potential nature or severity of side-effects. However, with such monitoring the condition is usually non-problematic to manage.
or Moderate pain or other symptoms which is/are having a significant effect on other domains or on the provision of care.’
62. We asked our adviser about this. They said the IRP provided a detailed narrative to explain its decision on this domain. We can see from the records Mrs V refused to take her medication. The home, her nurses and her GP put in place a covert medication plan. Mrs V was then compliant with her medication and the records do not indicate there were any obvious side effects from her previous refusals. This is in line with the moderate descriptor, as there were no fluctuations of her condition or severe side effects as a result, for example.
63. We can see the IRP considered this domain in detail. This included considering how far the home did not give her some medication because it felt she did not need it, rather than her refusal to take it. We can see it considered who monitored and administered her medications and whether it had to be administered by a clinical professional. We can see it considered whether her prescribed medication was straightforward to administer and monitor in terms of the framework and whether this went beyond what a care home would be expected to do. We think it reviewed these points in detail.
64. We appreciate Mr K’s concerns about this domain. His mother refused medication and a new policy had to be implemented in order to get her to take it. His own account of her needs is in line with the moderate descriptor. For the IRP to have given a higher weighting, we would have needed to see risks such as the fluctuation of her medical condition associated with her medication regime. There was no evidence of this.
65. When we weigh up the evidence, it appears the IRP acted in line with the DST guidance when it considered Mrs V’s needs in the drug therapies and medication domain. We have not seen indications of what the IRP would have needed to see to give a higher weighting here. There are no indications of a failing regarding its decision in this domain.
The four key characteristics
66. The IRP also applies an eligibility test to help it make a decision about a person’s CHC eligibility. This is called the four key characteristics – the nature, intensity, complexity and unpredictability of their needs. This test is used to establish if the quantity or type of a person’s care needs are more than what the local authority can provide. This indicates they have a primary health need, which in turn indicates they are eligible for CHC. This is not a reconsideration of a person’s specific needs in each domain.
67. The National Framework sets out questions for the IRP to consider helping establish a person’s level of need. They are outlined in Practice Guidance 3 ‘When identifying a primary health need, how should the four key characteristics be approached?’ (PG3). The National Framework is clear the questions it provides are not meant to be strictly applied and are there to guide the IRP’s considerations. It does not have to consider them exactly as laid out in PG3. We use these questions when we are looking at whether the IRP properly considered the key characteristics of a person’s needs. We have also considered what the IRP did with regards to our view on the psychological and emotional needs domain, as we described above.
68. Mr K disputes the IRP's decision on each of the four key characteristics. He says it did not consider the questions outlined in the practice guidance section of the National Framework for any of the characteristics as it should, and did not consider sufficiently how his mother's needs interacted, especially regarding her paranoia. He says her records show she needed monitoring and care beyond that which the local authority could provide.
Nature
69. For the nature characteristic, the National Framework says the IRP must consider the particular characteristics of an individual’s needs (which can include physical, mental health, or psychological needs), and the type of those needs. This also describes the overall effect of those needs on the individual, including the type (‘quality’) of interventions required to manage them.
70. Mr K says the IRP did not consider properly how his mother’s needs interacted or the severity of the nature of those needs. He says it did not consider whether Mrs V’s needs were deteriorating or improving.
71. We asked our adviser about this. They said the clinical records supported the IRP’s decision. Our adviser said the records show the IRP had considered all the evidence presented to it when making its decision. We can see it described the nature of Mrs V’s needs and how those were met, as we would expect. It considered her care plans in respect of her identified care needs and whether she needed changes in her care, for example regarding her nutrition. This indicates it considered whether her needs were deteriorating or improving.
72. Mr K says the IRP did not consider properly whether his mother was at high risk of malnutrition or her severe paranoia about this. He says she needed input beyond what the local authority could provide. He also says it did not consider the nature of her high risk of falls and mobility issues enough, or her psychological and emotional needs.
73. We can see the IRP had considered these factors when looking at the individual domains. It referenced the level of her needs when considering the nature characteristic and considered the skills needed for her care and treatment. We can see it described and considered the level of her needs in detail here and whether additional skilled interventions were needed. We have not seen evidence that it did not look at these points or factor them into its decision.
74. The IRP said Mrs V’s care was not above what a local authority could provide. When we weigh up the evidence, we think the IRP considered all the relevant evidence and how this related to her needs as robustly as we would expect. We think the IRP acted in line with the National Framework and DST when making its decision on the nature of Mrs V’s needs.
Intensity
75. The National Framework says the intensity characteristic is about both the extent (‘quantity’) and severity (‘degree’) of the needs and the support required to meet them, including the need for sustained or ongoing care (‘continuity’).
76. Mr K says the IRP did not consider sufficiently how long each intervention required and it underestimated how the unpredictability of Mrs V’s needs impacted on the intensity characteristic. He says the IRP should have considered her paranoia, malnutrition and lack of cognition further. He says her needs were escalating, especially for her physical aggression.
77. We can see the IRP considered whether her needs could be anticipated. The records show it discussed when her actions were most intense and said these could be anticipated and planned for. This includes whether her aggression created a barrier for others providing her with care. We can see it discussed how her physical limitations, including her mobility, and her cognition affected her needs and how these were managed. This includes how these needs interacted. This is what we would expect it to do.
78. We also asked our adviser about this. They said the IRP considered all of the evidence presented. We can see the IRP considered this characteristic in detail. Our adviser told us the records show Mrs V’s care could be delivered by carers following a care plan that has been assessed, planned and monitored by registered nurses and carers within the care home and the GP was consulted when required. They said this was not beyond what a local authority could provide and did not indicate Mrs V’s needs were intense.
79. Mrs V’s records support the IRP’s decision that the intensity of her needs did not indicate a primary health need at that time. We have not seen indications she needed skilled interventions beyond what a local authority could provide because of the intensity of her needs. When we weigh up the evidence, we think the IRP acted in line with the National Framework when making its decision on this characteristic.
Complexity
80. The National Framework says the complexity characteristic is concerned with how the person’s needs present and interact to increase the skill required to monitor the symptoms, treat the condition(s) and/or manage their care. It may also include situations where an individual’s response to their own condition has an impact on their overall needs, such as where a physical health need results in the individual developing a mental health need.
81. Mr K says the IRP understated how the unpredictability of his mother’s needs and her high risk of falls, impacted on the complexity characteristic. He says the IRP did not properly consider that Mrs V’s paranoia had a direct and severe impact on her nutritional needs and her challenging behaviours made managing her care complex. He says prompt and skilled responses were needed, along with heightened knowledge. He says care staff found this difficult to manage.
82. We asked our adviser about this. They said the records show there were interactions between Mrs V’s needs across the domains. They said her care could be delivered by carers following a care plan that had been assessed, planned and monitored by a registered nurse. They said the records did not indicate her was care was either difficult or complex to manage, or that she required regular, intensive input from a specialist team.
83. When we look at the records, we can see the IRP considered potential and known interactions between Mrs V’s needs. It considered the risks and the potential risks which came from these and the type and level of care needed. This included whether her care needs were complex enough to require specialist care. We can see it considered how Mrs V’s medication regime had changed to give her medication covertly, and that this had appeared to resolve the issue around the time of the assessment. It also considered the extent to which her nutritional needs had stabilised. We can see it considered her behaviours and whether these required any specialist care. We have not seen indications her care plans changed to deal with these, as we might expect.
84. We understand Mr K’s concerns about his mother’s falls risk and behaviour. We have not seen indications these were complex for her carers to manage. There are no indications she needed specialised medical support or carers or that her needs were beyond what the local authority could provide. The IRP appears to have described her needs well here. We think it acted in line with the National Framework when it considered the complexity characteristic.
Unpredictability
85. Mr K says the IRP did not refer to the consequences of his mother’s needs not being met in the unpredictability characteristic. He says it failed to address the extent of monitoring Mrs V needed across the totality of her care. He said anticipation of his mother’s needs indicated these were unpredictable, as carers could not predict each incident or their severity. This included her aggressive behaviours and falls. He says the ICB did not consider this point in line with the National Framework.
86. The National Framework says the unpredictability characteristic is about the degree to which needs fluctuate and thereby cause challenges in their management. It does not mean whether everything a patient does can be predicted. Therefore, whether a specific individual event can be anticipated is not in itself an indication of whether a person has a primary health need in this characteristic.
87. We asked our adviser about this. They said the IRP considered the evidence presented. There were interactions between Mrs V’s domains which were influenced by her underlying conditions. But the records do not show her needs fluctuated unduly on a daily basis. Her care plans did not require amendment, and care did not have to change suddenly. Her care followed a natural format that was appropriate to her underlying conditions. Mr K says carers had to give his mother close monitoring and respond spontaneously to incidents. We have looked at the records and not seen evidence which indicates this made her care unpredictable to manage.
88. The IRP appears to have described her needs here in line with what the evidence shows. We have not seen indications of the things we would expect to see which would have indicated to the IRP that Mrs V’s needs were unpredictable. When someone has unpredictable needs, we would expect to see frequent or sudden changes in their care plans, or frequent need for carers to intervene outside of the care plan. There is no indication this was the case for Mrs V. The records indicate her carers were aware of her falls risk and that she could be aggressive. The IRP considered this. When we weigh up the evidence, we think the IRP acted in line with the National Framework when making its decision on this characteristic.
89. We understand why Mr K thinks Mrs V had a primary health need at the time the ICB assessed her. She was clearly not well. When we weigh up the evidence, we think the IRP report explained Mrs V’s needs and how they interacted in detail for each characteristic. The report considered the questions for each characteristic as we would expect it to and provided a detailed explanation of why it made its decision. We have not seen any indications her needs or care plan to deal with these changed suddenly or unexpectedly or that her care was particularly difficult to manage. Carers appear to have known how to deal with her and did not need a higher level of skill or training to do this.
90. We have thought about whether it would have made a difference to the overall eligibility decision if the IRP had weighted the psychological and emotional needs domain higher. There is only one higher weighting that the IRP could have given, which was high.
91. The individual domain weightings only confirm if someone has a primary health need if one of these is weighted as being a priority need. On most occasions a person a weighting of severe in two domains would also mean they are eligible for CHC. Mrs V scoring one more high weighting (alongside the existing severe and two high weightings the IRP had agreed) would not have led to the IRP automatically finding her eligible for CHC based on the domain weightings alone. We have therefore looked at how it evaluated her psychological and emotional needs in that area when it considered the four key characteristics.
92. We can see the IRP considered Mrs V’s psychological and emotional needs in particular when looking at each of the key characteristics. The records show it considered how her needs interacted and the level of care she needed across the four key characteristics. This included the amount and extent of the healthcare and other support she needed for her psychological and emotional needs. The records show the IRP considered her care arrangements and plans and the types of care she needed. We can see her family raised points for each characteristic which it felt showed Mrs V did have a primary health need and that the IRP reviewed these points carefully.
93. When we weigh up the evidence, we think the IRP’s consideration of Mrs V’s psychological and emotional needs throughout the four characteristics accurately captured the care she needed for these. We appreciate this is an aspect of her care which was very concerning for Mr K. It appears the IRP reached its decision that Mrs V was not eligible for CHC in line with the National Framework. We have not seen an indication of a failing in its decision.
The other actions of the IRP
94. Mr K says the IRP ignored how the ICB’s procedural errors had impacted on its CHC decision and did not do enough about this. He says the IRP should have given a stronger recommendation to the ICB about what it got wrong here in the ICB’s decision about the behaviour domain and the disagreement between the nurse assessor and social worker about the weighting.
95. An IRP has two tasks. It should make a new decision about whether a person had a primary health need and consider the process the ICB followed in reaching its decision. We have considered how it made its decision on the behaviour domain above. So here we are looking at what learning it recommended for the ICB based on process issues.
96. When we look at the records, we can see the IRP did find the ICB got something wrong in how it recorded the disagreement. Its report said the ICB should have explained how it came to its decision more thoroughly. It made recommendations for the ICB to follow in the future. It also made recommendations on other procedural matters where it felt the ICB had got something wrong. This is what we would expect it to do. We do not think the IRP got something wrong here.
97. We recognise how stressful this process and Mrs V’s condition and needs were for her and Mr K. We hope our decision reassures him that the IRP made its decision as it should.