FOI-03079

#Request Original request: _I am making this request under the Freedom of Information Act 2000._ _It concerns the NHS Business Services Authority’s statutory and contractual role in administering and overseeing applications for, and the ongoing eligibility of, individuals receiving help with NHS costs in England through HC2 and HC1 schemes (including associated exemptions), and any equivalent schemes administered by NHSBSA that involve eligibility checks for access to NHS-funded services or resources._ _This request is made in the context of the binding judgment of the UK Supreme Court in For Women Scotland Ltd v Scottish Ministers (No. 2) [2024] UKSC 12, confirming that the term “sex” in the Equality Act 2010 refers to biological sex, and the continuing statutory duty under section 149 of the Equality Act 2010 (Public Sector Equality Duty)._ _1. Eligibility Checks, Fraud Prevention, and Immigration Controls_ _Please provide, for the period 1 January 2019 to the date of your response, all recorded information (including policies, operational guidance, training, case reviews, audits, meeting minutes, and correspondence) held by NHSBSA or by any third-party contractors or agents acting on its behalf relating to:_ • The eligibility criteria applied for HC2/HC1 determinations, including checks on immigration status, residency, or other lawful entitlement to public resources; • Changes to eligibility processes or evidence requirements since 2019, including any linked to Home Office policy or ministerial direction; • Fraud detection, prevention, and recovery activity relating to HC2/HC1 misuse, including internal or external audit reports, briefing papers, and statistical summaries; • Cases where eligibility was refused, withdrawn, or challenged on the basis of immigration status or ineligibility for public funds; • Annual or quarterly statistical summaries showing the number of HC2/HC1 applications refused, withdrawn, or terminated for reasons including immigration ineligibility, fraud, or misrepresentation. _2. Equality Act 2010 and Safeguarding_ _Please provide recorded information showing:_ • How the NHSBSA ensures compliance with the Equality Act 2010 (including s.149 PSED) in administering HC2/HC1 applications and determinations; • Any changes to processes, forms, terminology, or guidance following the For Women Scotland ruling; • Safeguarding protocols for preventing discrimination, ensuring service-user safety, and protecting staff against compelled belief or ideological coercion in relation to HC2/HC1 administration; • Equality impact assessments, legal advice, or internal reviews relevant to the above. _3. Misuse of Public Resources_ _Please provide any recorded information relating to:_ • Identified misuse of public resources within the HC2/HC1 system or equivalent schemes, including improper allocation to ineligible individuals or entities; • Actions taken to recover misused funds, including legal actions, repayment plans, or reporting to enforcement agencies; • Correspondence with other public bodies, ministers, contractors, or auditors regarding prevention of misuse. _4. Legal Rationale for Non-Action_ _If the NHSBSA has not taken action to amend its policies, eligibility checks, or operational practices in any of the above areas where law or binding legal precedent requires it, please provide:_ • The recorded legal rationale for not taking such action; • Any internal or external legal advice (final or draft) supporting this position; • Any records of ministerial or external direction that influenced the decision; • Any monitoring or review documents showing why no change was deemed necessary. _5. Scope, Format, and Definitions_ o “Recorded information” includes but is not limited to: guidance documents, policies, case management notes, reports, meeting minutes, emails, handwritten notes, and any other relevant record in any format. o “Correspondence” includes communication in any medium between NHSBSA staff, contractors, ministers, and other public authorities. o “Equivalent schemes” includes any NHSBSA-administered schemes involving eligibility checks for NHS-funded services or resources (e.g., maternity exemption, prescription prepayment, or other cost-reduction schemes). o Please provide the information in electronic format (PDF or the native format in which it is held). o Where exemptions are applied, please specify the exact statutory basis and provide a full public-interest test.’ __Clarification requested on 3 September 2025:__ _Please note that HC1/HC2 is not a scheme; HC1 is an application form and HC2 is a potential outcome of the HC1 application, alongside an alternative HC3 outcome. For further information, please see our website - NHS Low Income Scheme (LIS) - NHS._ _Please also be advised that with regards to Help with Health Costs, the sex of the applicant(s) has no relevance on how the assessments are completed._ _Considering the above information, if you wish to proceed with your request, we require you to clarify the scope and timeframe of your request. This is due to the volume of information potentially held by the NHSBSA from the date range 1 January 2019 to present._ _For example, during this timeframe, there are 32 previous versions of the Claims Assessment Manual (CAM) that are held. The CAM is approximately 400 pages long and will require redactions which would place a grossly oppressive burden on the NHSBSA resources to carry out. The most recent CAM is publicly available via the following link_ https://opendata.nhsbsa.net/dataset/foi-02754 _In addition, the term ‘correspondence’ is a very broad term and would require searching all colleagues’ Microsoft outlook accounts, as well as the NHSBSA systems to determine if the requested information is held. This is likely to exceed the appropriate limit as set out under section 12 of the FOIA. The limit has been specified in The Freedom of Information and Data Protection (Appropriate Limit and Fees) Regulations 2004 and represents the estimated cost of one person spending 18 hours in determining whether the NHSBSA holds the information, and locating, retrieving, extracting and checking the information._ _Likewise, expanding the scope of the request to include ‘equivalent schemes’ is also likely to exceed the appropriate limit under section 12 of the FOIA._ _Therefore, I would be grateful if you can confirm if you wish to narrow the timeframe of your request to 1 January 2025 to present and to only include the current version of a document if there are previous versions available. To note, the scope of your clarified request will include the NHS Low Income Scheme only.’_ __Clarification received on 3 September 2025:__ _Provide current versions only of procedural manuals (e.g., the CAM) and policies relevant to HC1/HC2 eligibility, fraud prevention, immigration status checks, and safeguarding._ _Restrict searches for correspondence to senior leadership, compliance/fraud teams, and policy/governance teams._ _Retain the 2019–present date range for policy records, statistics, equality compliance documentation, and safeguarding protocols._ Prioritise disclosure of: • Fraud detection, prevention, and recovery activity • Immigration checks and eligibility criteria • Equality Act 2010 compliance (including EIAs) • Safeguarding protocols • Legal advice or ministerial direction shaping these policies • Exclude “equivalent schemes” beyond the Low-Income Scheme if their inclusion would breach cost limits.’ __Second clarification requested on 3 September 2025:__ _To ensure we have a clear and unambiguous understanding of your request, could you please confirm exactly what you are seeking following the clarification you provided? This will help us avoid applying any potentially incorrect interpretations when comparing your original request with the clarification received today._ __Second clarification received on 3 September 2025:__ _Scope of Request (Clarified):_ _1. Provide current versions only of procedural manuals (e.g., the CAM) and policies relevant to HC1/HC2 eligibility, fraud prevention, immigration status checks, and safeguarding._ _2. Restrict searches for correspondence to senior leadership, compliance/fraud teams, and policy/governance teams._ _3. Retain the 2019–present date range for policy records, statistics, equality compliance documentation, and safeguarding protocols._ _4. Prioritise disclosure of:_ • Fraud detection, prevention, and recovery activity • Immigration checks and eligibility criteria • Equality Act 2010 compliance (including EIAs) • Safeguarding protocols • Legal advice or ministerial direction shaping these policies _5. Exclude “equivalent schemes” beyond the Low Income Scheme if their inclusion would breach cost limits._ o Fraud detection, prevention, and recovery activity o Immigration checks and eligibility criteria o Equality Act 2010 compliance (including EIAs) o Safeguarding protocols o Legal advice or ministerial direction shaping these policies’ __Third clarification requested on 22 September 2025:__ _Q2:_ _Please can you define what is meant by ‘senior leadership’? Do you mean anyone at Head of Service level and above?_ _To confirm, we have a NHSBSA LCFS team, but the Department of Health and Social Care (DHSC) are responsible for policy decisions in relation to Help with Health Costs, so you may wish to redirect your request direct to DHSC, as the Policy team sits within DHSC._ _Please you also clarify the scope for correspondence searches (i.e., what is the subject matter of the correspondence) and clarify the time parameters of the searches required._ _Q3:_ _As confirmed above, DHSC are responsible for making policy decisions; therefore, Policy records will be help by DHSC. For information, the NHSBSA will use statutory instruments to update the Claims Assessment Manual._ _Please confirm what statistics you require. For your information, an applicant would not be unsuccessful based on ‘immigration’ or ‘ineligibility for public funds’, therefore, these figures are not held by the NHSBSA. Whether an applicant qualifies for HC2 or HC3 support is dependent on their financial circumstances only._ _In relation to ‘equality compliance documentation and safeguarding protocols’, please can you clarify what documentation you require. Please be advised that we don't have an Equality Impact Assessment completed for Help with Health Costs due to the implementation date of the service._ _However, we can provide a blank form to demonstrate how we would assess the impact to any significant changes made to the delivery of the service (excluding policy decisions) and how these would be identified and mitigated. As explained above, you may wish to redirect your request to the DHSC as responsible for implementing policy changes._ _We do hold an Equality, Diversity and Inclusion Policy which ensures that service users are not discriminated against when accessing NHSBSA services. We also hold a Safeguarding Policy which outlines how we protect service users from risk of harm._ _Q4:_ _Please clarify if the date range for these specific points – is this from 1 January 2019?_ _With reference to ‘immigration checks and eligibility criteria’. To reiterate, immigration is not relevant to the scheme._ _In relation to ‘legal advice or ministerial direction sharing these policies’, we suggest you redirect your request to DHSC as they are responsible for policy decision._ __Third clarification received on 23 September 2025:__ _Clarification (final):_ • “Senior leadership” = Heads of Service and above (Band 8d or equivalent). • Subjects for correspondence search = fraud detection/recovery, eligibility checks, Equality Act compliance (including safeguarding and compelled belief), and any legal or ministerial direction on HC1/HC2. • Date range = 1 January 2019 to present for all elements. • Statistics = annual totals of HC1/HC2 applications, approvals, refusals, withdrawals, and fraud investigations or recoveries (even if refusals are not categorised by immigration). • Equality/safeguarding docs = current Equality, Diversity & Inclusion Policy, Safeguarding Policy, and any blank or completed Equality Impact Assessments relating to Help with Health Costs. • Policy oversight = I accept that overarching policy decisions sit with DHSC and will approach them separately. NHSBSA should proceed with the above operational and governance material.’ #Response I can confirm that the NHS Business Servies Authority (NHSBSA) does hold some of the requested information. Please be advised that, following the clarifications above, this response has been provided in the context of the NHS Low Income Scheme only. __1. Provide current versions only of procedural manuals (e.g., the CAM) and policies relevant to HC1/HC2 eligibility, fraud prevention, immigration status checks, and safeguarding.__ A copy of the information is attached. • Claims Assessment Manual, version 67 • Claims Assessment Manual Desk Aid, version 39 • Fraud, Error and Loss Strategy • Fraud, Bribery and Corruption Policy and Response Plan • Equality Impact Assessment Template (please be advised that the formatting of this template has changed due to the process of converting to CVS format). • Safeguarding Policy Please be advised that personal data is redacted from the Safeguarding Policy. This is because the information exempt under section 40(2) of the FOIA (personal information). Section 40(2) is an absolute, prejudice-based exemption and therefore is exempt if disclosure would contravene any of the data protection principles. In order for disclosure to comply with the lawfulness, fairness, and transparency principle, we either need the consent of the data subject(s) or there must be a legitimate interest in disclosure. In addition, the disclosure must be necessary to meet the legitimate interest and finally, the disclosure must not cause unwarranted harm. As we do not have the consent of the data subject(s), the NHSBSA is therefore required to conduct a balancing exercise between legitimate interest of the applicant in disclosure against the rights and freedoms of the data subject(s). The NHSBSA acknowledges that you have a legitimate interest in disclosure of the information included within the policy, and this legitimate interest can be met without the unnecessary disclosure of personal information of NHSBSA colleagues. We are therefore satisfied that section 40(2) is engaged. Please see the following link to view the section 40 exemption in full - https://www.legislation.gov.uk/ukpga/2000/36/section/40 The Equality, Diversity and Inclusion Policy is available via our website and is therefore exempt from disclosure under section 21 of FOIA. This provides an exemption from the duty to disclose information where this is reasonable accessible to an applicant by other means. The Policy can be accessed via the following link - https://view.officeapps.live.com/op/view.aspx?src=https%3A%2F%2Fwww.nhsbsa.nhs.uk%2Fsites%2Fdefault%2Ffiles%2F2021-03%2FEquality%252C%2520Diversity%2520and%2520Inclusion%2520Policy%2520V3.docx&wdOrigin=BROWSELINK Please see the following link to view the section 21 in full - https://www.legislation.gov.uk/ukpga/2000/36/section/21 The Department of Health and Social Care (DHSC) are responsible for policy decisions in relation to NHS Help with Health Costs. You may therefore wish to redirect your request direct to DHSC, as the Policy team sits within DHSC. __2. Restrict searches for correspondence to senior leadership, compliance/fraud teams, and policy/governance teams.__ __From 1 January 2019. Senior Leadership is defined as Band 8d and above within the NHS Low Income Scheme.__ __Scope of correspondence search:__ __a. Fraud detection/recovery__ __b. Eligibility checks__ __c. Equality Act compliance (including safeguarding and compelled belief), and any legal or ministerial direction on HC1/HC2.__ __Senior Leadership:__ Please be advised that there are no colleagues in the role at Band 8d or above within the NHS Low Income Scheme, or within the Health Exemption Services Department. __Fraud/Compliance:__ The NHSBSA cannot confirm or deny if the requested information is held, as this information is exempt under section 31(1)(a) of the FOIA (law enforcement) as disclosure would be likely to prejudice the prevention or detection of crime. Section 31 is a qualified, prejudice-based exemption and is subject to the public interest test. This means that not only does the information have to prejudice one of the purposes listed, but before the information can be withheld, the public interest in preventing that prejudice must outweigh the public interest in disclosure. This exemption includes activities related to fraud detection, prevention, and recovery, which are essential to maintaining the integrity of our systems and protecting public funds. __Public Interest Test:__ __Considerations in favour of disclosure:__ • Contribute to public understanding of the NHSBSA’s fraud prevention, detection and recovery procedures and actions. • Assist in the accountability of public money being spent. __Considerations against disclosure:__ • The inherent public interest in maintaining the integrity and security of the NHSBSA’s systems. • Enable individuals to circumvent controls or investigative processes. If NHSBSA’s procedures are perceived as easily manipulated, it could subsequently erode public trust in the fairness and accountability of public spending. • Undermine future enforcement or recovery efforts. • Reveal details about the NHSBSA’s fraud detection capabilities and/or limitations. __Public Interest Test Conclusion:__ The NHSBSA recognises that there is a public interest in disclosure of the requested information to contribute to public understanding of the NHSBSA’s fraud prevention, detection and recovery procedures. However, in all the circumstances of the case, the public interest in maintaining the exemption outweighs the public interest in disclosing the information as more weight is afforded to the arguments outlined above in maintaining the exemption. Please see the following link to view the section 31 exemption in full - https://www.legislation.gov.uk/ukpga/2000/36/section/31 Please note, Equality Act compliance is not the scope of the NHSBSA Loss and Prevention Team, so this requested information is not held. __Policy/Governance:__ As above, the Department of Health and Social Care (DHSC) are responsible for policy decisions in relation to NHS Help with Health Costs. You may therefore wish to redirect your request direct to DHSC, as the Policy team sits within DHSC. The contact details are as follows: Department of Health and Social Care Ministerial Correspondence and Public Enquiries Unit Department of Health and Social Care 39 Victoria Street London SW1H 0EU Online: https://www.gov.uk/government/organisations/department-of-health-and-social-care __3. Statistics from 1 January 2019 and covering:__ Please note, the data is confirmed per calendar year. 2025 data confirm the number of applications received up to 23 September 2025. __a. Annual totals of HC1/HC2 applications__ Please be advised that HC1 is an application and HC2 is an outcome certificate following an application. Alternatively, a HC1 application may result in a HC3 certificate being issued. Therefore, the data provided only relates to HC1 applications. A copy of the data is attached. __b. Approvals__ Please note, the data shows the number of certificates issued from applications received within each calendar year. A copy of the data is attached. __c. Refusals__ Please be advised that the NHS Low Income Scheme does not ‘refuse’ applications. Applicants either meet the criteria and are issued with a HC2 or HC3 certificate, or they do not meet the criteria. The figures of those who did not meet the criteria is the data for a) minus the data for b) and d). __d. Withdrawals__ The data shows the number of HC1 applications received with the latest application status of ‘No further action, claim withdrawn’ split across each calendar year. A copy of the data is attached. __e. fraud investigations or recoveries (even if refusals are not categorised by immigration).__ Please see response to Q2 above. __4. Fraud detection, prevention, and recovery activity:__ Please see response to Q2 above. __5. Immigration checks and eligibility criteria:__ I can confirm that the requested information in relation to the NHS Low Income Scheme is not held by the NHSBSA. Please be advised that an applicant would not be unsuccessful based on ‘immigration’ or ‘ineligibility for public funds’. Therefore, these figures are not held by the NHSBSA. Whether an applicant qualified for HC2 or HC3 support is dependent on their financial circumstances only. __6. Equality Act 2010 and Safeguarding__ Please provide the current Equality, Diversity & Inclusion Policy, Safeguarding Policy, and any blank or completed Equality Impact Assessments relating to Help with Health Costs. Please see the response to Q1 above. __7. Legal advice or ministerial direction shaping these policies__ I can confirm that the requested information is not held by the NHSBSA. You may wish to redirect your request to DHSC as responsible for policy decision. The contact details for DHSC are confirmed above in response to Q2. __Data Queries__ Please contact [email protected] ensuring you quote the above reference if you have any specific questions regarding this response; or, if you feel you may be misunderstanding or misinterpreting the information; or, if you plan on publishing the data. __Reusing the data and copyright__ If you plan on producing a press or broadcast story based upon the data please contact [email protected]. This is important to ensure that the figures are not misunderstood or misrepresented. The information supplied to you continues to be protected by the Copyright, Designs and Patents Act 1988 and is subject to NHSBSA copyright. This information is licenced under the terms of the Open Government Licence detailed at: http://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/ Should you wish to re-use the information you must include the following statement: “NHSBSA Copyright 2025” This information is licenced under the terms of the Open Government Licence: http://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/ Failure to do so is a breach of the terms of the licence. Information you receive which is not subject to NHSBSA Copyright continues to be protected by the copyright of the person, or organisation, from which the information originated. Please obtain their permission before reproducing any third party (non NHSBSA Copyright) information.