Agenda item

Resolved: the committee noted the report and agreed to refer its views to the Trust. The committee also agreed to refer its views to Mayor and Cabinet in the following terms:

The committee was concerned to learn of the arrangements that have recently been in place at Lewisham and Greenwich NHS Trust for identifying and charging patients who are not eligible for free healthcare. The committee was particularly concerned to learn about the automatic sharing of data with the credit reference agency, Experian, to check whether patients were economically active in the UK (as part of the process for assessing “ordinary residence”). While the Trust is required by law to charge patients who are not eligible, the committee is concerned about the impact that the Trust’s implementation of this policy has on Lewisham’s status as a sanctuary borough. The committee therefore asks Mayor and Cabinet to explore good policy and practice in other councils in London and beyond in order to make links and help to create a campaign with those councils.

Jim Lusby (Director of Strategy and Integration, Lewisham and Greenwich NHS Trust) introduced the report. The following key points were noted:

1.1      Charging patients who are not eligible for free healthcare is a legal requirement and all NHS Trusts and foundation trusts are bound by the Government guidance on this.

1.2      Concerns about Lewisham and Greenwich NHS Trust’s arrangements for charging patients who are not eligible for free healthcare were first highlighted by staff and local campaigners. The Trust has since suspended the use of Experian and referred itself to the Information Commissioner in regards to issues around patient confidentiality and consent and data protection.

1.3      The Trust has also commissioned an independent review of the process it followed and established an independently-chaired oversight panel to review national guidance and current arrangements. The Trust is mindful of the tension between the Trust’s processes for charging those not eligible and Lewisham’s status as a sanctuary borough.

1.4      The committee noted that many people who are very ill will not be economically active and expressed concern about testing for economic activity as part of the process for determining whether a patient is eligible for free healthcare.

1.5      The Trust noted that it was not looking to defend the process that was set up but explained that the test for economic activity was used as an initial non-discriminatory test to trigger a number of other lines of enquiry to determine eligibility. The Trust noted that two thirds of the charges identified in 2018/19 had to be claimed back from the CCG because they could not be recovered. 

1.6      The Trust agreed to respond to the committee in writing to clarify whether NHS charges apply to emergency treatment and those with ongoing appeals and asylum applications. The Trust also agreed to provide assurance in writing that bailiffs have not been used since the recent concerns came to light.

1.7      Representatives of the Save Lewisham Hospital Campaign noted that they were pleased that the campaign had been invited to be involved in the review of the Trust’s processes. The campaign representatives also noted, however, that while the Trust is legally required to charge patients who are not eligible, Lewisham is a sanctuary borough and the Council should work to explore good policy and practice in other councils.   

Resolved: the committee noted the report and agreed to refer its views to the Trust. The committee also agreed to refer its views to Mayor and Cabinet in the following terms:

The committee was concerned to learn of the arrangements that have recently been in place at Lewisham and Greenwich NHS Trust for identifying and charging patients who are not eligible for free healthcare. The committee was particularly concerned to learn about the automatic sharing of data with the credit reference agency, Experian, to check whether patients were economically active in the UK (as part of the process for assessing “ordinary residence”). While the Trust is required by law to charge patients who are not eligible, the committee is concerned about the impact that the Trust’s implementation of this policy has on Lewisham’s status as a sanctuary borough. The committee therefore asks Mayor and Cabinet to explore good policy and practice in other councils in London and beyond in order to make links and help to create a campaign with those councils.