The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012

[F1 NHS England's] duty: reviewing decisions E+W

23.—(1)  [F1 NHS England] must—

(a) appoint such number of persons to act as chairs of the panels referred to in paragraph (4) (“chairs”) as [F1 NHS England] considers reasonable to ensure that applications for a review under paragraph (3) can be considered by such a panel within a reasonable time; and

(b) establish a list consisting of the following persons—

(i) at least one person (“ [F2 an integrated care board] member”) appointed by [F1 NHS England] in respect of each [F2 integrated care board], and

(ii) at least one person (“a social services authority member”) appointed by [F1 NHS England] in respect of each social services authority.

(2) In complying with its duty under paragraph (1), [F1 NHS England] must ensure that the persons it—

(a) appoints under paragraph (1)(a); or

(b) includes in a list pursuant to paragraph (1)(b),

reside in locations that have a sufficient geographical distribution to ensure that a review panel can be held in any social services authority area in England.

(3) Where a person, or someone lawfully acting on a person's behalf—

(a) is dissatisfied with—

(i) the procedure followed by a relevant body in reaching a decision as to that person's eligibility for NHS Continuing Healthcare pursuant to regulation 21(5), or

(ii) the primary health need decision by a relevant body pursuant to regulation 21(5)(b); and

(b) the person has—

(i) used the resolution procedure of the relevant body in question, but that has not resolved the matter, or

(ii) not used that resolution procedure and [F1 NHS England] is satisfied that requiring the person to do so would cause undue delay,

that person may apply in writing to [F1 NHS England] for a review of that decision.

(4) Following receipt of an application for a review under paragraph (3), [F1 NHS England] may refer the matter for a decision to a panel of members (“a review panel”) consisting of—

(a) a chair;

(b) one [F2 integrated care board] member drawn from the list established under paragraph (1)(b) who has been appointed in respect of a [F2 integrated care board], other than [F2 an integrated care board] whose procedure or decision is the subject of the review; and

(c) one social services authority member drawn from that list who has been appointed in respect of a social services authority other than one in whose area is situated all or part of the area of [F2 an integrated care board] whose procedure or decision is the subject of the review.

(5) Where an application for a review under paragraph (3) relates to the procedure followed by, or a decision taken by, [F1 NHS England], it must ensure that in organising a review of that decision, it makes appropriate arrangements as regards the manner in which it organises such a review so as to avoid any conflict of interest.

(6) The procedure and operation of the review panel are to be a matter for the chair of the review panel, having regard to the National Framework.

(7) [F1 NHS England] must, as soon as reasonably practicable, give notice in writing of the review decision and the reasons for it to the applicant and, where the relevant body is [F2 an integrated care board], to the [F2 integrated care board] whose decision has been the subject of review.

(8) A relevant body must, unless it determines in accordance with paragraph (9) that there are exceptional reasons not to do so, implement the decision of the review panel as soon as reasonably practicable.

(9) In determining whether under paragraph (8) there are exceptional reasons, a relevant body must have regard to the National Framework.

Textual Amendments

F1 Words in Regulations substituted (6.11.2023) by The Health and Care Act 2022 (Further Consequential Amendments) (No. 2) Regulations 2023 (S.I. 2023/1071), reg. 1(1), Sch. para. 1

F2 Words in Regulations substituted (1.7.2022) by The Health and Care Act 2022 (Consequential and Related Amendments and Transitional Provisions) Regulations 2022 (S.I. 2022/634), reg. 1(2), Sch. para. 1(1)(3) (with Sch. para. 1(2))