Mrs A’s representative complained that the Health Board had failed to follow due process when handling a retrospective review of eligibility for NHS continuing care. Mrs A’s representative complained that the Health Board failed to arrange an appropriate peer review; external ratification of the claim was sought and completed prematurely; no Decision Document was provided to her and the negotiation meeting with the Health Board’s clinical advisor was unsatisfactory.
The assessment found that the ratification of the claim was undertaken prematurely, and a Decision Document had not been provided. That amounted to maladministration resulting in an injustice.
To resolve that part of the complaint, the Health Board agreed to set aside the premature ratification decision and, within 3 months, to arrange ratification by a different IRP Chair based on the information/evidence available following the negotiation process and to proceed as that Chair determined, i.e., either the decision of no eligibility is confirmed, and a Decision Document completed and shared with the complainant, or a decision to convene an Independent Review Panel is made.
The assessment found that a suitable peer review had been undertaken and did not consider that an investigation of the concerns regarding the meeting was merited.