Job overview

NHS South West London ICB is looking for an experienced, registered health professional to join our All Age Continuing Care (AACC) service as Appeals and Retros Clinical Manager.

Working alongside the Clinical Lead for Appeals and Retros, you will case manage appeals and retrospective assessments for the AACC service across south west London. You will liaise with clients, their families and representatives, and other key people, to make sure the National Framework for NHS Continuing Healthcare (CHC) and NHS-funded Nursing Care was applied correctly at the outset and that the appeals process is followed through each of its stages.

Where appropriate, you will represent the ICB at NHS England Independent Review Panels and make sure the learning from them is shared with AACC teams across the ICB. You will also deputise for the Clinical Lead, support the development of staff in the team, and help shape how the service develops.

You will bring strong CHC clinical assessment experience, an excellent working knowledge of the National Framework, and the ability to analyse complex and conflicting evidence and turn it into clear, well-reasoned recommendations. Experience of managing appeal and retrospective cases and presenting at Independent Review Panels would be an advantage.

Main duties of the job

Triage all appeal and retrospective review referrals, liaising with applicants to make sure each referral holds enough information to trigger a full appeal or retrospective review.

Manage a delegated caseload of CHC appeal and retrospective review cases, scrutinising clinical records, care plans, Decision Support Tools and MDT evidence against the National Framework, and prioritising work so that statutory and internal timescales are met.

Write clear, evidence-based rationales, appeal summaries, case reviews and eligibility recommendations for Local Resolution Meetings, Independent Review Panels and internal governance panels.

Represent SWL ICB AACC at Independent Review Panels hosted by NHS England, presenting cases with empathy and professionalism and offering assurance and apology where needed.

Communicate sensitive and complex information, including diagnosis, prognosis and life-changing decisions, to clients, families, staff, NHS England and partner organisations.

Working for our organisation

On 1 July 2022, NHS South West London Integrated Care Board (ICB) was established. The ICB, as part of South West London Integrated Care System (ICS), is a partnership of organisations that come together to plan and deliver joined up health and care services to improve the lives of people in our six boroughs: Croydon, Merton, Kingston, Richmond, Sutton and Wandsworth.

Each ICS consists of two statutory elements:

·         an Integrated Care Board, bringing the NHS together with its partners locally to improve health and care services

·         an Integrated Care Partnership (ICP): the broad alliance of organisations and representatives concerned with improving the care, health and wellbeing of the population, jointly convened by the ICB and local authorities in the area.

ICBs are statutory NHS bodies responsible for planning and allocating resources to meet the four core purposes of integrated care systems (ICSs): 

·            to improve outcomes in population health and healthcare;

·            tackle inequalities in outcomes, experience and access;

·            enhance productivity and value for money and;

·            help the NHS support broader social and economic development.  

NHS South West London Integrated Care Board decides how the South West London NHS budget is spent and develops plans to improve people's health, deliver higher quality care, and better value for money.