Health and Social Care Bill (HC Bill 221)

(3) A commissioning consortium must ensure that its revenue resource use
in a financial year does not exceed the amount specified by direction of
the Board.

(4) Any directions given in relation to a financial year under subsection (6)
5of section 223D apply (in relation to that year) for the purposes of this
section as they apply for the purposes of that section.

(5) The Board may by directions make provision for determining to which
consortium a use of capital resources or revenue resources is to be
attributed for the purposes of this section or section 223J.

(6) 10Where the Board gives a direction under subsection (2) or (3), it must
notify the Secretary of State.

223<no value\>J Financial duties of consortia: additional controls on resource use

(1) The Board may direct a commissioning consortium to ensure that its
capital resource use in a financial year which is attributable to matters
15specified in the direction does not exceed an amount so specified.

(2) The Board may direct a commissioning consortium to ensure that its
revenue resource use in a financial year which is attributable to matters
specified in the direction does not exceed an amount so specified.

(3) The Board may direct a commissioning consortium to ensure that its
20revenue resource use in a financial year which is attributable to
prescribed matters relating to administration does not exceed an
amount specified in the direction.

(4) The Board may give directions, in relation to a financial year, specifying
uses of capital resources or revenue resources which must, or must not,
25be taken into account for the purposes of subsection (1) or (as the case
may be) subsection (2) or (3).

(5) The Board may not exercise the power conferred by subsection (1) or (2)
in relation to particular matters unless the Secretary of State has given
a direction in relation to those matters under subsection (1) of section
30223E or (as the case may be) subsection (2) of that section.

(6) The Board may not exercise the power conferred by subsection (3) in
relation to prescribed matters relating to administration unless the
Secretary of State has given a direction in relation to those matters
under subsection (3)(a) of section 223E.

223<no value\>K 35Payments in respect of quality

(1) The Board may, after the end of a financial year, make a payment to a
commissioning consortium.

(2) For the purpose of determining whether to make a payment under
subsection (1) and (if so) the amount of the payment, the Board must
40take into account at least one of the following factors—

(a) the quality of relevant services provided during the financial
year;

(b) any improvement in the quality of relevant services provided
during that year (in comparison to the quality of relevant
45services provided during previous financial years);

(c) the outcomes identified during the financial year as having
been achieved from the provision at any time of relevant
services;

(d) any improvement in the outcomes identified during that
5financial year as having been so achieved (in comparison to the
outcomes identified during previous financial years as having
been so achieved).

(3) For that purpose, the Board may also take into account either or both of
the following factors—

(a) 10relevant inequalities identified during that year;

(b) any reduction in relevant inequalities identified during that
year (in comparison to relevant inequalities identified during
previous financial years).

(4) Regulations may make provision as to the principles or other matters
15that the Board must or may take into account in assessing any factor
mentioned in subsection (2) or (3).

(5) Regulations may provide that, in prescribed circumstances, the Board
may, if it considers it appropriate to do so—

(a) not make a payment that would otherwise be made to a
20consortium under subsection (1), or

(b) reduce the amount of such a payment.

(6) Regulations may make provision as to how payments under subsection
(1) may be spent (which may include provision as to circumstances in
which the whole or part of any such payments may be distributed to
25members of the commissioning consortium).

(7) A commissioning consortium must publish an explanation of how the
consortium has spent any payment made to it under subsection (1).

(8) In this section—

• “relevant services” means services provided in pursuance of
  30arrangements made by the consortium—

  (a)

  under section 3 or 3A or Schedule 1, or

  (b)

  by virtue of section 7A or 12;

• “relevant inequalities” means inequalities between the persons for
  whose benefit relevant services are at any time provided with
  35respect to—

  (a)

  their ability to access the services, or

  (b)

  the outcomes achieved for them by their provision.”

25 Requirement for primary medical services provider to belong to consortium

(1) In section 89 of the National Health Service Act 2006 (general medical services
40contracts: required terms), after subsection (1) insert—

“(1A) Regulations under subsection (1) may in particular make provision—

(a) for requiring a contractor who provides services of a prescribed
description (a “relevant contractor”) to be a member of a
commissioning consortium;

(b) as to arrangements for securing that a relevant contractor
appoints one individual to act on its behalf in the dealings
between it and the consortium to which it belongs;

(c) for imposing requirements with respect to those dealings on the
5individual appointed for the purposes of paragraph (b);

(d) for requiring a relevant contractor, in doing anything pursuant
to the contract, to act with a view to enabling the consortium to
which it belongs to discharge its functions (including its
obligation to act in accordance with its constitution).

(1B) 10Provision by virtue of subsection (1A)(a) may in particular describe
services by reference to the manner or circumstances in which they are
performed.

(1C) In the case of a contract entered into by two or more individuals
practising in partnership—

(a) 15regulations making provision under subsection (1A)(a) may
make provision for requiring each partner to secure that the
partnership is a member of the consortium;

(b) regulations making provision under subsection (1A)(b) may
make provision as to arrangements for securing that the
20partners make the appointment;

(c) regulations making provision under subsection (1A)(d) may
make provision for requiring each partner to act as mentioned
there.

(1D) Regulations making provision under subsection (1A) for the case of a
25contract entered into by two or more individuals practising in
partnership may make provision as to the effect of a change in the
membership of the partnership.

(1E) The regulations may require an individual appointed for the purposes
of subsection (1A)(b)—

(a) 30to be a member of a profession regulated by a body mentioned
in section 25(3) of the National Health Service Reform and
Health Care Professions Act 2002, and

(b) to meet such other conditions as may be prescribed.”

(2) In section 94 of that Act (regulations about arrangements under section 92 of
35that Act for provision of primary medical services), after subsection (3) insert—

“(3A) Regulations under subsection (3)(d) may—

(a) require a person who provides services of a prescribed
description in accordance with section 92 arrangements (a
“relevant provider”) to be a member of a commissioning
40consortium;

(b) make provision as to arrangements for securing that a relevant
provider appoints one individual to act on its behalf in dealings
between it and the consortium to which it belongs;

(c) impose requirements with respect to those dealings on the
45individual appointed for the purposes of paragraph (b);

(d) require a relevant provider, in doing anything pursuant to
section 92 arrangements, to act with a view to enabling the
consortium to which it belongs to discharge its functions

(including its obligation to act in accordance with its
constitution).

(3B) Provision by virtue of subsection (3A)(a) may in particular describe
services by reference to the manner or circumstances in which they are
5performed.

(3C) In the case of an agreement made with two or more persons—

(a) regulations making provision under subsection (3A)(a) may
require each person to secure that the persons collectively are a
member of the consortium;

(b) 10regulations making provision under subsection (3A)(b) may
make provision as to arrangements for securing that the
persons collectively make the appointment;

(c) regulations making provision under subsection (3A)(d) may
require each person to act as mentioned there.

(3D) 15Regulations making provision under subsection (3A) for the case of an
agreement made with two or more persons may make provision as to
the effect of a change in the composition of the group of persons
involved.

(3E) The regulations may require an individual appointed for the purposes
20of subsection (3A)(b)—

(a) to be a member of a profession regulated by a body mentioned
in section 25(3) of the National Health Service Reform and
Health Care Professions Act 2002, and

(b) to meet such other conditions as may be prescribed.”

25Further provision about local authorities’ role in the health service

26 Other health service functions of local authorities under the 2006 Act

(1) The National Health Service Act 2006 (c. 41)National Health Service Act 2006 (c. 41) is amended as follows.

(2) In section 111 (dental public health)—

(a) in subsection (1) for “A Primary Care Trust” substitute “A local
30authority”,

(b) in subsection (2)—

(i) for “Primary Care Trust” (in each place where it occurs)
substitute “local authority”, and

(ii) in paragraph (b) for “other Primary Care Trusts” substitute
35“other local authorities”, and

(c) after subsection (2) insert—

“(3) In this section, “local authority” has the same meaning as in
section 2B.”

(3) In section 249 (joint working with the prison service) after subsection (4)
40insert—

“(4A) For the purposes of this section, each local authority (within the
meaning of section 2B) is to be treated as an NHS body.”

27 Appointment of directors of public health

In Part 3 of the National Health Service Act 2006 (local authorities and the
NHS) before section 74 insert—

“73A Appointment of directors of public health

(1) 5Each local authority must, acting jointly with the Secretary of State,
appoint an individual to have responsibility for —

(a) the exercise by the authority of its functions under section 2B,
111 or 249 or Schedule 1,

(b) the exercise by the authority of its functions by virtue of section
106C,

(c) anything done by the authority in pursuance of arrangements
under section 7A,

(d) the exercise by the authority of any of its functions that relate to
planning for, or responding to, emergencies involving a risk to
15public health,

(e) the functions of the authority under section 325 of the Criminal
Justice Act 2003, and

(f) such other functions relating to public health as may be
prescribed.

(2) 20The individual so appointed is to be an officer of the local authority and
is to be known as its director of public health.

(3) Subsection (4) applies if the Secretary of State—

(a) considers that the director has failed or might have failed to
discharge (or to discharge properly) the responsibilities of the
25director under—

(i) subsection (1)(b), or

(ii) subsection (1)(c) where the arrangements relate to the
Secretary of State’s functions under section 2A, and

(b) has consulted the local authority.

(4) 30The Secretary of State may direct the local authority to—

(a) review how the director has discharged the responsibilities
mentioned in subsection (3)(a);

(b) investigate whether the director has failed to discharge (or to
discharge properly) those responsibilities;

(c) 35consider taking any steps specified in the direction;

(d) report to the Secretary of State on the action it has taken in
pursuance of a direction given under any of the preceding
paragraphs.

(5) A local authority may terminate the appointment of its director of
40public health.

(6) Before terminating the appointment of its director of public health, a
local authority must consult the Secretary of State.

(7) In this section, “local authority” has the same meaning as in section 2B.”

28 Exercise of public health functions of local authorities

In Part 3 of the National Health Service Act 2006 after section 73A insert—

“73B Exercise of public health functions of local authorities: further
provision

(1) 5A local authority must, in the exercise of any functions mentioned in
subsection (2), have regard to any document published by the Secretary
of State for the purposes of this section.

(2) The functions mentioned in this subsection are—

(a) the exercise by the authority of its functions under section 2B,
10111 or 249 or Schedule 1,

(b) the exercise by the authority of its functions by virtue of section
6C,

(c) anything done by the authority in pursuance of arrangements
under section 7A,

(d) 15the functions of the authority under section 325 of the Criminal
Justice Act 2003, and

(e) such other functions relating to public health as may be
prescribed.

(3) The Secretary of State may give guidance to local authorities as to the
20exercise of any functions mentioned in subsection (2).

(4) The director of public health for a local authority must prepare an
annual report on the health of the people in the area of the local
authority.

(5) The local authority must publish the report.

(6) 25In this section, “local authority” has the same meaning as in section 2B.”

Abolition of Strategic Health Authorities and Primary Care Trusts

29 Abolition of Strategic Health Authorities

(1) The Strategic Health Authorities continued in existence or established under
section 13 of the National Health Service Act 2006 are abolished.

(2) 30Chapter 1 of Part 2 of that Act (Strategic Health Authorities) is repealed.

30 Abolition of Primary Care Trusts

(1) The Primary Care Trusts continued in existence or established under section 18
of the National Health Service Act 2006 are abolished.

(2) Chapter 2 of Part 2 of that Act (Primary Care Trusts) is repealed.

35Functions relating to fluoridation of water

31 Fluoridation of water supplies

(1) Chapter 4 of Part 3 of the Water Industry Act 1991 (fluoridation), as amended
by the Water Act 2003, is amended as follows.

(2) In section 87 (fluoridation of water supplies at request of relevant authorities),
in subsection (3)(a) for sub-paragraph (i) substitute—

“(i) in relation to areas in England, are to the Secretary of
State;”.

(3) 5After subsection (3) of that section insert—

“(3A) The Secretary of State may make a request under subsection (1) only if
the Secretary of State is required to do so by section 88G(2) (following
the making of a fluoridation proposal in accordance with section 88B).”

(4) In subsection (4) of that section, for paragraph (a) substitute—

“(a) 10in relation to England, such area as the Secretary of State
considers appropriate for the purpose of complying with
section 88G(2);”.

(5) After subsection (7) of that section insert—

“(7A) The Secretary of State must, in relation to the terms to be included in
15any arrangements under this section, consult any local authority whose
area includes, coincides with or is wholly or partly within the specified
area.

(7B) In this section and the following provisions of this Chapter “local
authority” means—

(a) 20a county council in England;

(b) a district council in England, other than a council for a district
in a county for which there is a county council;

(c) a London borough council;

(d) the Common Council of the City of London.”

(6) 25After subsection (7B) of that section (as inserted by subsection (5) above)
insert—

“(7C) If the Secretary of State and the Welsh Ministers request a particular
water undertaker to enter into arrangements in respect of adjoining
areas—

(a) 30they must co-operate with each other so as to secure that the
arrangements (taken together) are operable and efficient; and

(b) if suitable terms are not agreed for all the arrangements, a
combined reference may be made by them under section 87B
below to enable the terms of each set of arrangements to be
35determined so that they are consistent.

(7D) If the Secretary of State requests a water undertaker to vary
arrangements for an area which adjoins an area in respect of which the
Welsh Ministers have made arrangements with the same water
undertaker, the Secretary of State must co-operate with the Welsh
40Ministers so as to secure that following the variation the arrangements
(taken together) will be operable and efficient.

(7E) If the Welsh Ministers request a water undertaker to vary arrangements
for an area which adjoins an area in respect of which the Secretary of
State has made arrangements with the same water undertaker, the
45Welsh Ministers must co-operate with the Secretary of State so as to
secure that following the variation the arrangements (taken together)
will be operable and efficient.

(7F) If suitable terms are not agreed for a variation to which subsection (7D)
or (7E) applies, a combined reference may be made by the Secretary of
State and the Welsh Ministers under section 87B below so that
(following the variation) both sets of arrangements are consistent.”

(7) 5Omit subsections (8) to (10) of that section.

(8) In subsection (11) of that section for “a relevant authority” substitute “the
Welsh Ministers”.

(9) In section 87A (target concentration of fluoridation), after subsection (3)
insert—

“(3A) 10If the Secretary of State proposes to—

(a) make arrangements which provide for the concentration in the
specified area (or any part of it) to be lower than the general
target concentration, or

(b) vary existing arrangements so that they so provide,

15the Secretary of State shall consult any local authority whose area
includes, coincides with or is wholly or partly within the specified
area.”

(10) In section 87B (fluoridation arrangements: determination of terms), in
subsection (2) —

(a) 20for paragraph (a) substitute—

“(a) the Secretary of State may—

(i) determine the terms of the arrangements as the
Secretary of State sees fit; or

(ii) refer the matter for determination by such other person
25as the Secretary of State considers appropriate; and”,
and”

(b) omit paragraph (b).

(11) In that section, in subsection (4) for the words from the beginning to “section
87(8)(b) or (10)” substitute “Where a combined reference is made under section
3087(7C)(b) or 87(7F)”.

(12) In section 87C (fluoridation arrangements: compliance), omit subsection (8).

(13) In section 89—

(a) in the heading, after “Consultation” insert “:Wales”,

(b) in subsections (1) and (4) for “a relevant authority” substitute “the
35Welsh Ministers”,

(c) in subsection (1) for “the appropriate authority” (in each place where it
occurs) substitute “the Welsh Ministers”,

(d) in subsection (3), in paragraph (a) for “relevant authorities” substitute
“the Welsh Ministers”,

(e) 40in subsection (4) for “the appropriate authority so directs” substitute
“the Welsh Ministers so direct”, and

(f) omit subsection (5).

(14) In section 90A (review of fluoridation) after subsection (5) insert—

“(5A) The relevant authority must, in exercising its functions under
45subsection (1)—

(a) consult any local authority affected by the arrangements at such
times as the relevant authority considers appropriate, and

(b) in particular, consult any such local authority before it
publishes a report under paragraph (b) of that subsection.”

32 5Procedural requirements in connection with fluoridation of water supplies

After section 88A of the Water Industry Act 1991 insert—

“88B Requirement for fluoridation proposal: England

(1) The Secretary of State may not request a water undertaker to enter into
arrangements under section 87(1) unless a fluoridation proposal is
10made to the Secretary of State.

(2) A fluoridation proposal is a proposal that the Secretary of State enter
into arrangements with one or more water undertakers to increase the
fluoride content of the water supplied by the undertaker or undertakers
to premises within such area or areas in England as may be specified in
15the proposal.

(3) A fluoridation proposal may be made by one or more local authorities
in England.

(4) A local authority may not make a fluoridation proposal unless its area
includes, coincides with or is wholly or partly within the area, or at least
20one of the areas, specified in the proposal.

(5) In the following provisions of this Chapter, “proposer”, in relation to a
fluoridation proposal, means the local authority or authorities which
made the proposal.

(6) Any reference in the following provisions of this Chapter to a local
25authority affected by a fluoridation proposal is a reference to a local
authority whose area includes, coincides with or is wholly or partly
within the area, or at least one of the areas, specified in the proposal.

88C Initial consultation etc. on fluoridation proposal

(1) This section applies if a fluoridation proposal is made.

(2) 30The proposer must consult the Secretary of State as to whether the
arrangements which would result from implementing the proposal
would be operable and efficient.

(3) The proposer must consult each water undertaker who supplies water
to premises within the area or areas specified in the proposal as to
35whether the arrangements which would result from implementing the
proposal, insofar as they might affect the undertaker, would be
operable and efficient.

(4) Each person consulted under subsection (2) or (3) must give the
proposer its opinion on the matter mentioned in that subsection.

(5) 40The proposer must notify the Secretary of State of the opinion of each
water undertaker consulted under subsection (3).

(6) If the Secretary of State informs the proposer that the Secretary of State
is of the opinion that the arrangements would not be operable and
efficient, no further steps may be taken in relation to the proposal.

88D Additional requirements where other local authorities affected

(1) 5This section applies where—

(a) a fluoridation proposal is made,

(b) the Secretary of State is of the opinion that the arrangements
which would result from implementing the proposal would be
operable and efficient,

(c) 10one or more local authorities other than the proposer are
affected by the proposal, and

(d) the proposer wishes to take further steps in relation to the
proposal.

(2) The proposer must notify any other local authority which is affected by
15the proposal.

(3) The proposer must make arrangements for enabling the authorities
affected by the proposal to decide whether further steps should be
taken in relation to the proposal.

(4) The Secretary of State must by regulations—

(a) 20make provision as to the arrangements which must be made for
the purposes of subsection (3), and

(b) prescribe conditions, with respect to the outcome of the
arrangements, which must be satisfied before any further steps
may be taken in relation to the proposal.

88E 25Decision on fluoridation proposal

(1) This section applies where—

(a) a fluoridation proposal is made,

(b) the Secretary of State is of the opinion that the arrangements
which would result from implementing the proposal would be
30operable and efficient,

(c) in a case where section 88D applies, the conditions prescribed
under subsection (4)(b) of that section are satisfied, and

(d) the proposer wishes to take further steps in relation to the
proposal.

(2) 35The proposer must comply with such requirements as may be
prescribed in regulations made by the Secretary of State as to the steps
to be taken for the purposes of consulting and ascertaining opinion in
relation to the proposal.

(3) The proposer may (after any requirements imposed by regulations
40under subsection (2) have been complied with) modify the proposal.

(4) But the proposal may not be modified so as to extend the boundary of
any area to which it relates, or to add another area, except in
circumstances prescribed in regulations by the Secretary of State.

(5) The proposer must (after any requirements imposed by regulations
45under subsection (2) have been complied with) decide whether to