This meeting of the Healthier Communities Select Committee was scheduled to receive updates from a number of local organisations about their work on a range of issues affecting the health of Lewisham residents, including the NHS charging policy for some migrants, the Learning Disabilities Implementation Plan, and a new community mental health pilot scheme.

Lewisham Hospital’s Charging Policy for Patients Ineligible for Free NHS Care

The Committee was scheduled to receive a presentation from the University Hospital Lewisham on its policy for charging some patients who are not eligible for free NHS care. These patients were previously referred to as 'overseas visitors'. The presentation notes that the Trust is legally required to charge some patients for care. The Trust says that an independent panel including local and national stakeholders made a number of recommendations about how the Trust should approach charging in 2021, and that those recommendations have all been implemented. The report also notes that the Department of Health and Social Care visited the Trust in November 2024 to review our best practices.

The presentation says that the policy of charging some migrants for NHS care has had a negative impact on the wellbeing of refugees and asylum seekers, quoting Rosario Guimba Stewart, CEO of the Lewisham Refugee and Migrant Network, as saying We know the harmful impacts that migrant charging practices can have on the wellbeing of people seeking sanctuary and look forward to continuing to work together with LGT.¹

The presentation also provides some figures on the amount the Trust earns from charging migrants for NHS care, saying:

LGT treat over 600 patients a year ineligible for free care, across 119 specialities which earns £2.7m. However, this is in the context of £800m in total revenue for the Trust.

The presentation goes on to describe how the Trust has implemented a range of policies to support vulnerable patients, including:

• A compassionate maternity policy
• A vulnerable patients policy
• A debt write-off policy

The presentation then describes a number of challenges faced by the Trust in implementing the policy, including that some patients do not know that they will be charged for their care. The presentation describes the steps that the Trust is taking to try to address these challenges. Finally, the presentation concludes by suggesting a number of ways in which the Council can help to support the Trust to improve the implementation of the policy, including working to raise awareness of healthcare entitlements for migrants.

Update Report on The Lewisham Learning Disabilities Implementation Plan (Adults and Young People) 2024-2029 And The Lewisham Learning Disability Partnership Board.

The Committee was scheduled to receive a report on the progress of the Lewisham Learning Disabilities Implementation Plan 2024-2029 ('the Plan') and the Lewisham Learning Disabilities Partnership Board.

The Plan contains a set of actions and commitments designed to improve the lives of people with learning disabilities. The Plan is based on seven priority areas:

1. A Good Place to Live
2. Health and Wellbeing
3. A Life with Opportunities
4. Support for Family Carers
5. Managing Risks & Staying Safe
6. A Sustainable Workforce
7. Developing the Local Market

The Plan sets out actions designed to achieve the ambitions set out for each priority area. The report notes that these ambitions are aspirational, but says that there is a requirement for the plan to be a living document to reflect changes in the environment, resources and priorities.

The report describes the governance arrangements that were put in place to deliver the actions set out in the Plan, including the re-establishment of a Learning Disability Partnership Board, to oversee the delivery of the plan, and five working groups to work on actions related to the priority areas.

The report highlights the work of the Partnership Board to improve accessibility, saying that it has invested in PhotoSymbols, and used these to produce:

• Easy read terms of reference
• Easy read agendas and minutes
• A hard words guide
• A guide to help people take part in meetings
• A guide for making presentations to the board

The report describes some examples of joint working that the board has initiated, including working with:

• The Freedom Pass team
• The Council's Communications Team
• Local Hospitals
• The arts organisation Entelechy Arts

The report provides a summary of the work of each of the subgroups. It says that the group working on A Good Place to Live is yet to be established, due to changes in senior personnel, but says that the Lewisham Housing Team has developed an easy-read housing policy, and that it is developing the role of a housing champion. The report notes the work being undertaken by the Health and Wellbeing subgroup, including work to improve the take-up of annual health checks. It also describes the work of the Life with Opportunities subgroup, and in particular its audits of day opportunities services, which have led to the identification of a number of new activities. The report then notes that actions related to the Support for Family Carers and Managing Risks and Staying Safe priorities cut across all of the subgroups. Finally, the report describes the work of the Sustainable Workforce subgroup, including its work with Lewisham Works² to improve the recruitment and retention of staff, and the work of the Developing the Local Market subgroup.

Lewisham Neighbourhood 2 Adult Community Mental Health Pilot & VCSE Procurement Cooperative

The Committee was scheduled to receive a presentation describing a new pilot project for adults with serious mental health needs, being delivered by South London and Maudsley NHS Foundation Trust (SLaM), one of the largest mental health trusts in the UK.

The presentation says that the pilot is scheduled to be implemented in Neighbourhood 2, which includes Hither Green, Lee, Catford, Blackheath, Brockley and Lewisham Central.

The pilot will test a new 24/7 community mental health model. This model includes a community mental health team (CMHT) and an associated network of voluntary and community partners. It will involve significant expansion of the existing team, including staff who can address social drivers of mental health need, and basic physical health care, who the report says will reduce the need to refer patients to other services.

The presentation provides more detail on the pilot, saying:

The central aim of the team will be to help all people to be citizens, achieve their aspirations and be kept safe (moving away from a culture that views people as passive recipients of care, focus on their deficits and is dominated by risk). The team will offer a defined set of clinical and social interventions as indicated by NICE guidelines. Each person will have a keyworker and a micro-MDT, and a clear and purposeful personal project (care plan) for their needs and goals.

The presentation notes that Lewisham was selected by NHS England as one of six national pilot sites following a highly competitive bid process. It says that funding has been secured for 2 years, with £2.5m being provided per year, and that the new model will be based at Heather Close, a building owned by the Trust.

The presentation provides some background on the development of the pilot, saying:

The priorities for the pilot have been developed following over a year of workshops, meetings and visits with local patients, carers, clinicians, community organisations, operational managers, executives and others.

The presentation goes on to describe the key features and principles of the new model, saying that it is:

• Trusting
• Continuous
• Neighbourhood based
• Open access
• Collaborative
• Co-produced

The presentation then describes what SLaM expects good to look like, including that:

• Service users can access 24/7 support
• There is no need for a referral
• Service users have a dedicated keyworker

It also provides detail on how the pilot will be evaluated, including that data will be collected on the following:

• Quality of life and treatment satisfaction, using the DIALOG³ tool
• Clinical outcomes
• Access to evidence-based care
• Use of other services
• Admissions under the Mental Health Act 1983
• Referrals, interventions and outcomes data

Finally, the presentation provides a timeline for the implementation of the pilot, and details of the financial implications. It concludes by noting a number of potential risks, and their proposed mitigations, as well as the potential equalities implications, climate change and environmental implications, and the health and wellbeing implications.

Select Committee Work Programme Report

The Committee was scheduled to consider its work programme for the 2025/26 municipal year. The report notes that the Committee met five times during the 2024/25 municipal year, and lists the key issues that were discussed at those meetings. The report also provides details of the timetable for setting the 2025/26 work programme, and suggests that Members should give consideration to issues of local importance and decisions due to be made by Mayor and Cabinet.

The report provides detail on the Council's seven Corporate Priorities, saying that the Committee should choose items that relate to one or more of these. It notes that the Committee's work is likely to relate most closely to the 'Health and Wellbeing' priority, and that:

The work of the Healthier Communities Select Committee will relate most closely to the ‘Health & Wellbeing’ priority, which commits the Council to:

• ensuring that everyone can access food and other essentials through our Lewisham Food Action Plan;
• aiming to mitigate and ultimately end structural racism and discrimination as a driver of health inequalities;
• progressing towards a fairer care system and improving conditions for care workers to ensure they feel valued;
• working with the local NHS to deliver the services Lewisham residents need and creating the Lewisham Health Care & Wellbeing Charter;
• collaborating with other organisations to deliver places, activities and programmes that our residents need in order to live a physically active lifestyle.

The report provides the Committee's terms of reference, and a set of guidelines for effective scrutiny. It provides a forward plan of key decisions, and details of the financial, legal, equalities, climate change and environmental, crime and disorder, and health and wellbeing implications.