Health and Social Care Bill

AMENDMENTS
TO BE MOVED
IN COMMITTEE

Clause 2

BARONESS HOLLINS

LORD PATEL

 

Page 2, line 15, after “of” insert “physical and mental”

LORD WARNER

LORD PATEL

 

Page 2, line 16, at end insert—

“(c) the clinical integration of the delivery of health and social care”

 

Page 2, line 19, after “provision” insert “and integration”

 

Page 2, line 23, after “effectiveness” insert “and integration”

 

Page 2, line 28, at end insert—

“(5) In discharging the duty under sections 1 to 3 the Secretary of State shall after appropriate consultation make regulations governing the eligibility for and assessment of individuals for adult social services on a consistent basis throughout England, including portability of assessments between areas, the charging arrangements for services provided, the assessment of carers needs and the integration of such assessments with those for continuing care under the NHS such regulations shall be subject to the affirmative resolution procedure; be laid within 3 years of Royal Assent; and kept under review.

(6) In this section

“integration” means integration of the assessment and delivery of health and social care and services to individuals that benefit their treatment and care”

Clause 5

LORD WARNER

LORD PATEL

 

Page 3, line 17, after “service” insert

“(b) development of research findings for clinical application in the health service, including the necessary informatics skills and technology support” and in next line substitute “(c)” for “(b)”

 

Page 3, line 19, at end insert—

“( ) In discharging his duty under this section the Secretary of State shall ensure robust arrangements for safeguarding the funding of research and its application to health services.”

Clause 6

LORD ROOKER

LORD PATEL

 

Page 3, line 38, at end insert “, and

“(c) must include at least one member who is a registered public health specialist and who has a broad range of professional expertise in public health.”

Clause 8

LORD WARNER

LORD PATEL

 

Page 4, line 26, at end insert “using the best scientific and other evidence available and without regard to special interests”.

 

Page 4, line 27, leave out “may” and insert “shall”

 

Page 4, line 37, at end insert “to the public to assist them in taking responsibility for improving their health and wellbeing, including access to their own medical records;”

 

Page 5, line 7, at end insert—

“( ) In discharging this duty the Secretary of State will appoint for terms of 5 years and after consultation with appropriate bodies and individuals with expertise relevant to public health, an independent Standing Advisory Committee on Public Health of no more than 15 persons whose advice he will seek on a regular basis and who will make reports to the Secretary of State on any matters of concern they have about the state of public health, such reports also being made available to Parliament and the public.”

Clause 11

LORD WARNER

LORD PATEL

 

Page 7, line 12, at end insert “; or

(c) in the integration of the health and social care delivered to those persons”

Clause 20

LORD WARNER

LORD PATEL

 

Page 15, line 37, leave out first “the” and insert “a maximum of five obligatory and five desirable”

 

Page 16, line 26, at end insert “and be prepared to inform Parliament of any major reservations expressed by the Board in writing on the practicality of meeting those objectives or requirements within the resources to be made available to the Board.”

 

Page 17, line 14, at end insert—

“(2) In discharging its duty under this section the Board shall jointly with Monitor, within six months of Royal Assent, establish an independent panel, on a basis agreed by the National Audit Office, to formulate minimum acceptable standards of financial, performance and asset management information to be included in the audited accounts on a standardised basis for all bodies commissioning and providing NHS services with a minimum annual turnover of £500,000 in order to render comparable public accountability for the cost and quality of like NHS services and activities; and to keep these standards under review.

(3) The Board shall implement the recommendations of the independent body as mandated by the Secretary of State and on joint basis agreed with Monitor.”

 

Page 17, line 14, at end insert—

“(5) In discharging this duty the Board must annually agree with Monitor new currencies for pricing under the national tariff that incentivise more efficient integrated clinical care pathways for patients, especially those with long-term conditions, and that minimise the use of inpatient hospital services”

BARONESS HOLLINS

LORD PATEL

 

Page 17, line 19, after “of” insert “physical and mental”

LORD WARNER

LORD PATEL

 

Page 17, line 23, at end insert “and using appropriate contractual and financial means, require commissioners and providers of NHS services to bring into operation within a timescale specified in a Secretary of State mandate (but not exceeding ten years after Royal Assent) a networked electronic patient record for the use of any clinician treating NHS patients.”

LORD ROOKER

 

Page 17, line 27, after “services,” insert—

“( ) patients have been informed when an adverse event, incident or error has occurred in their care or treatment,”

LORD WARNER

LORD PATEL

 

Page 17, line 28, at end insert “including timely access to services”

LORD ROOKER

 

Page 18, line 10, after “any)” insert “and Local Healthwatch”

LORD WARNER

LORD PATEL

 

Page 18, line 11, at end insert “including access to or holding of their own medical records.”

 

Page 18, line 14, leave out from “aspects” to end of line 15 and insert “the access, location and provider of the health services available to them at all stages of their life, including information about the performance of different service providers.”

 

Page 18, line 25, at end insert “and the procurement of goods and services”

 

Page 21, line 19, at end insert “including its annual operating costs as defined in (6) below”

 

Page 21, line 28, at end insert—

“(6) The board’s operating costs at inception shall not exceed the costs incurred by strategic health authorities, primary care trusts or the Department of Health in discharging functions transferred to the board as audited by the National Audit Office, less a discount of 30% or any different figure mandated with published reasons by the Secretary of State; and any annual increase in these operating costs shall not exceed the latest Consumer Price Index percentage unless mandated by the Secretary of State.”

 

Page 21, line 32, at end insert “together with an annual statement on the financial and service performance of its own commissioning and that of clinical commission groups in a format specified.”

Clause 22

LORD WARNER

LORD PATEL

 

Page 29, line 7, at end insert—

“(c) do not exceed the number of primary care trusts abolished, less any further reduction that the board considers better meets its duty under section 13D.

(2A) The total operating costs of all approved clinical commissioning groups shall not exceed the comparable costs of abolished primary care trusts, as audited by the National Audit Office, less 20%”

 

Page 29, line 33, at end insert “providing that it can demonstrate that it can meet the requirements of commissioning competence specified by the Board.”

 

Page 29, line 45, at end insert “and that specifies the competencies required to commission health services.”

LORD ROOKER

 

Page 30, line 19, at end insert—

“( ) that the application has the support of the local authority and the Clinical Commissioning Group for the area”

LORD WARNER

LORD PATEL

 

Page 30, line 26, at end insert “competently”

LORD ROOKER

 

Page 32, line 7, at end insert—

“( ) evidence that such an application for merger has the support of the local authority and the local Healthwatch for the area”

LORD WARNER

LORD PATEL

 

Page 33, line 15, at end insert “including an accountable officer who is the most suitable senior employee of the group.”

 

Page 33, leave out lines 19 and 20 and insert—

“( ) the standards of good governance of any elected or appointed public body authorised by Parliament.”

 

Page 34, after line 2, at end insert—

“(8) The Board shall specify the minimum standards of financial and performance information that all clinical commissioning groups are required to publish annually.”

Clause 23

LORD ROOKER

 

Page 36, line 3, at end insert “in order to ensure that the health needs of the people in the area are met”

BARONESS HOLLINS

LORD PATEL

 

Page 36, line 8, after “of” insert “physical and mental”

LORD WARNER

LORD PATEL

 

Page 36, line 11, after “provision” insert “and integration”

 

Page 36, line 15, after “effectiveness” insert “and integration”

 

Page 36, line 19, at end insert—

“(5) in this section—

“integration” means integration of the assessment and delivery of health and social care services to individuals that benefit their treatment and care.”

LORD ROOKER

 

Page 36, line 34, leave out from “any)” to the end of line 35 and insert “and the local Healthwatch for the area, in any decision about commissioning and provision of health services to patients”

LORD WARNER

LORD PATEL

 

Page 36, line 43, leave out from “aspects” to end of line and insert “the access, location, and provider of the health services available to them at all stages of their life including information about the performance of different service providers.”

LORD ROOKER

 

Page 38, line 11, after “that” insert “Local Healthwatch and”

 

Page 38, line 24, at end insert—

“( ) in developing commissioning proposals based on needs described by people in the area of the consortium”

BARONESS HOLLINS

LORD PATEL

 

Page 40, line 32, at end insert—

“( ) The Board must publish guidance, updated on an annual basis, for clinical commissioning groups on conducting a high quality joint strategic needs assessment (“JSNA”) to ensure that the JSNA captures as accurately as possible the current and future needs of consortia populations in their entirety.”

LORD ROOKER

 

Page 42, line 33, after “consult” insert “Local Healthwatch and”

BARONESS HOLLINS

LORD PATEL

 

Page 43, line 47, after “14Z” insert “and how it has taken guidance issued by the NHS Commissioning Board (on ensuring that JSNAs captures as accurately as possible the current and future needs of consortia population in their entirety) into account when conducting their JSNA”

Clause 27

LORD PATEL

LORD ROOKER

 

Page 55, line 33, leave out “acting jointly with” and insert “with the approval of”

 

Page 56, line 4, at end insert “, and

“(g) the exercise of the authority’s functions in relation to the control of any outbreak of disease or other public health emergency”

 

Page 56, line 5, at end insert “will be directly accountable to the chief executive of the local authority, and”

 

Page 56, line 6, at end insert—

“( ) The individual so appointed must be a registered public health specialist who has a broad range of professional expertise in public health.

( ) The director of public health shall be a person for whom the head of the paid service is directly responsible and shall be required to report directly to the authority as to the exercise of the post”.

LORD PATEL

 

Page 56, line 6, at end insert—

“( ) The individual so appointed must be a registered public health specialist.”

 

Page 56, line 6, at end insert—

“( ) The individual so appointed must be a person with a broad range of professional expertise in public health.”

 

Page 56, line 6, at end insert—

“( ) The director of public health shall be a person for whom the head of the paid service is directly responsible and shall be required to report directly to the authority as to the exercise of the responsibilities of the post.”

LORD PATEL

LORD ROOKER

 

Page 56, line 27, leave out “consult” and insert “have the consent of”

Clause 28

LORD PATEL

LORD ROOKER

 

Page 56, line 35, at end insert—

“( ) A local authority shall have the function of leading the response to any outbreak of disease or other public health emergency in its area and in so doing, shall have regard to any document published by the Secretary of State.”

 

Page 57, line 2, at end insert—

“( ) the exercise of the authority of its functions under section 73A.”

Clause 50

LORD WARNER

LORD PATEL

 

Page 83, line 23, at end insert “and its integrated working with adult social care services”

Clause 53

LORD WARNER

LORD PATEL

 

Page 84, line 15, at end insert—

“( ) On the abolition of the Health Protection Agency, the Secretary of State will allocate their functions and any others he considers appropriate to an Executive Agency with its own chief executive as accounting officer within the Department and with a management board with at least three non-Executive Directors with expertise in its functions selected by the Department’s Chief Scientific Adviser.”

After Clause 57

LORD PATEL

 

Insert the following new Clause—

“Employment conditions for public health specialists

Any registered public health specialist or other person employed in the exercise of public health functions by a local authority or in an executive agency of the Department of Health shall be employed on terms and conditions of service no less favourable than those of persons in equivalent employment in the National Health Service.”

LORD WILLIS OF KNARESBOROUGH

LORD PATEL

LORD KAKKAR

LORD WARNER

 

Insert the following new Clause—

“The Health Research Authority

(1) There shall be a body corporate called the Health Research Authority (referred to as “the HRA”).

(2) The Secretary of State shall make all necessary regulations to establish the HRA within 12 months of the Act receiving Royal Assent.

(3) The HRA shall manage a co-ordinated process for all aspects of the approval of health research involving human participants or their data, including—

(a) the provision of ethics committee opinions and other approvals,

(b) with the National Institute for Health Research and NHS Trusts, delivering a consistent, efficient process for obtaining permission for research carried out under the scope of the Research Governance Framework for Health and Social Care (referred to as “NHS R&D permissions”),

(c) with the Medicines and Healthcare Products Regulatory Authority, improving the regulation of clinical trials of medicinal products, and

(d) other such functions as may be specified in regulations including those currently being undertaken by organisations which will cease to function following the implementation of future legislation.

(4) The HRA shall have the following general functions—

(a) providing general oversight and guidance as it considers appropriate in relation to activities within its remit,

(b) publishing annual metrics and indicators on all research approvals within its remit,

(c) working with relevant bodies across England, Wales, Scotland and Northern Ireland to address differences in practice and legislation, and providing supporting guidance or codes of practice that apply across the UK,

(d) superintending compliance with requirements imposed by legislation relevant to its remit,

(e) monitoring developments relating to activities within its remit, and

(f) facilitating and promoting health research involving human participants or their data.

(5) The HRA must carry out its functions effectively, efficiently and economically.

(6) In carrying out its functions, the HRA must, so far as relevant, have regard to the principles of best regulatory practice (including the principles under which regulatory activities should be transparent, accountable, proportionate, consistent and targeted only at cases in which action is needed).

(7) The Special Health Authority known as the Health Research Agency is abolished and its functions transferred to the HRA.”

LORD PATEL

 

Insert the following new Clause—

“Public Health England

(1) There is to be a special health authority known as Public Health England, with the function of assisting the Secretary of State in the delivery of his or her public health functions.

(2) Section 44 of this Act shall not apply to this authority.”

Clause 59

BARONESS WARNOCK

LORD PATEL

 

Page 87, line 15, after “effective” insert “as demonstrated through regular published comparable financial and performance information”

LORD WARNER

LORD PATEL

 

Page 87, line 21, at end insert “and in discharging this duty will conduct and publish within one year of Royal Assent a review of the anti-competitive barriers that restrict NHS patients from benefitting from new or existing organisations providing new or extended NHS services that met defined quality standards, together with their proposals for removing these barriers.”

Clause 114

LORD WARNER

LORD PATEL

 

Page 122, line 19, at end insert—

“(d) the scope for paying providers incentives to integrate service delivery to individuals both within the NHS and with social care, especially to reduce unnecessary use of hospital inpatient services and by paying for periods of care rather than individual episodes, and”

Clause 151

LORD WARNER

LORD PATEL

 

Page 151, line 6, at end insert “having full regard to the recommendations of the independent body established by section 13D of the National Health Service Act 2006.”

Clause 171

LORD WARNER

LORD PATEL

 

Page 164, line 28, at end insert—

“(4) Where the regulator considers that the conditions for making such an order are likely to exist within a year, he shall, after consultation with the National Commissioning Board, appoint an independent panel of no more than six people with expertise in health and social care, to make proposals to the regulator and Board, within an agreed timetable, for the reconfiguration of services in the health economy within which the trust operates that would provide sustainable services for patients in the area affected.

(5) Recommendations from the Panel shall be subject to public consultation within a timescale specified by Monitor.

(6) Monitor shall, after consulting the National Commissioning Board, determine the service reconfiguration required to achieve clinical and financial sustainability of services unless the Secretary of State notified Parliament of his reasons for replacing those arrangements with alternative ways of achieving sustainable health services in the area.

(7) Where matters become so serious that the regulator is required to act under Sections 3(1) and 3(2) the Regulator shall incorporate the work of any such panel in any order or report made under Sections 5(5) and 5(6) as conditions to which the trust special administrator must have full regard in discharging his responsibilities.”

Clause 178

LORD ROOKER

 

Page 175, line 20, leave out “appointed” and insert “elected from local Healthwatch organisations”

 

Page 175, line 24, after “assistance” insert “and make recommendations”

 

Page 176, line 9, after “information” insert “, recommendations”

 

Page 176, line 22, after “advice” insert “or recommendations”

 

Page 176, line 24, at end insert “or recommendations and any action it intends to take”

 

Page 176, line 25, leave out “may” and insert “must”

 

Page 176, line 26, after “advice” insert “or recommendations”

 

Page 176, line 28, at end insert “and recommendations and any actions it intends to take”

 

Page 176, line 47, at end insert—

“( ) send a copy of each such report to all local Healthwatch organisations”

 

Page 177, line 20, at end insert—

“( ) The Secretary of State shall consult local Healthwatch organisations before issuing such directions.”

Schedule 15

LORD ROOKER

 

Page 399, line 26, after “appointment” insert “and election”

Clause 180

LORD ROOKER

 

Page 179, line 39, at end insert—

“( ) The Secretary of State shall by regulations make provision requiring Healthwatch England to make arrangements under this section for members of local Healthwatch to have indemnity cover against the risk of a claim arising out of the carrying out of their duties in local Healthwatch organisations”

Clause 181

LORD ROOKER

 

Page 180, line 16, at end insert—

“( ) Local Healthwatch is not to be regarded as a servant or agent of A”

Clause 182

LORD ROOKER

 

Page 181, line 4, after “appropriate” insert “in relation to the needs of people”

 

Page 181, line 12, at end insert—

“( ) a complaint under section 114(1) and (2) of the Health and Social Care Act (Community Care and Standards) 2003”

 

Page 181, line 26, delete subsection (4)

Clause 183

LORD ROOKER

 

Page 183, line 7, at end insert—

“(4A) Section 224 (Local Government and Public Involvement Act) is amended in subsection (2)(c) for “Primary Care Trusts” substitute “Clinical Commissioning groups””

Clause 192

LORD WARNER

LORD PATEL

 

Page 193, line 31, leave out “an integrated manner” and insert “a manner that integrates the delivery of services to individuals.”

 

Page 194, line 10, at end insert

“integration” means the integration of the assessment and delivery of health and social care services to individuals that benefits their treatment and care.”

Clause 193

LORD WARNER

 

Page 194, line 17, at end insert

“(3) A local authority may agree with the National Commissioning Board that a Health and Wellbeing Board that the authority has established may assume responsibility for some or all of the functions (and associated funding) of a clinical commissioning group where such a group agrees that this is in the best interests of patients, particularly where it improves the integration of service delivery for individuals.”

After Clause 217

LORD PATEL

 

Insert the following new Clause—

“Public Health specialists

(1) In section 25 of the National Health Service Reform and Health Care Professions Act 2002, in subsection 3 (regulatory bodies regulated by the Council for the regulation of health care professionals), insert—

“(k) those statutory bodies responisible for the regulation of public health specialists including those from backgrounds other than medicine.”

(2) In this Act “registered public health specialists” means a person recognised as such on a register maintained by those statutory bodies responsible for the regulation of public health specialists, including those from backgrounds other than medicine.”

Clause 231

LORD WARNER

LORD PATEL

 

Page 232, line 11, leave out “may direct NICE to prepare statements of standards” and insert “shall each year agree with NICE a programme of clinical quality standards to be completed or revised”.

Clause 234

LORD WARNER

LORD PATEL

 

Page 234, line 8, at end insert—

“The Secretary of State shall by regulations continue the responsibility of NICE to assess the cost-effectiveness to the health service of new pharmaceutical products until this matter is incorporated in a system of quality standards as provided for in section 231.”

Clause 247

LORD WARNER

LORD PATEL

 

Page 240, line 7, leave out “may prepare and” and insert “shall”

 

Page 240, line 8, at end insert “governing the collection, processing and dissemination of information.”

 

Page 240, line 10, leave out “in relation to the processing of information” and insert “for the efficient and effective collection, processing and dissemination of information that benefits the commissioning and provision of health and adult social care services, helps improve public health and wellbeing, enables the public to be informed about the quality and performance of those services and to exercise informed choice by ensuring maximum transparency of dissemination.”

Clause 250

LORD WARNER

LORD PATEL

 

Page 241, line 33, at end insert—

“(e) the need for a publicly available independent audit of their processes in each 3 year period.”

Prepared 13th October 2011