Health and Social Care Bill

Insert the following new Clause—

“Principles of the Health Service in England

(1) Any person or body performing functions or exercising powers under this Act in relation to the Health Service in England must have regard to the principles and values outlined in the NHS Constitution.

(2) Any person or body performing functions or exercising powers under this Act in relation to the Health Service in England, or providing services as part of the Health Service in England, must provide quality, equity, integration and accountability, not the market.

(3) The primacy of patient care shall not be compromised by any structural or financial re-organisation of the Health Service in England.

(4) There must be transparency and openness wherever taxpayers’ money is being spent, and all accountable individuals and bodies should abide by the Nolan principles.

(5) “The Nolan principles” means the seven general principles of public life set out in the First Report of the Committee on Standards in Public Life (Cm 2850).

(6) Schedule (Principles of the Health Service in England) has effect.”

Page 2, line 1, at end insert—

“(c) in the provision of education and training of the health care workforce”

Page 2, leave out lines 2 to 4 and insert—

“(2) The Secretary of State must for that purpose provide or secure the provision of services according to this Act.”

Page 2, leave out lines 2 to 4 and insert—

“(2) For that purpose, the Secretary of State—

(a) retains ultimate responsibility to Parliament for the provision of the health service in England, and

(b) must exercise the intervention and other functions of the Secretary of State in relation to that health service so as to secure that services are provided in accordance with this Act.”

Page 2, line 3, after “to” insert “provide or”

Page 2, line 7, at end insert—

“( ) The Secretary of State must maintain a system for professional education and training as part of the comprehensive health service.”

Page 2, line 7, at end insert—

“( ) For the purposes of this Act “the health service in England” is defined as those services provided under section 3 of this Act.”

Page 2, line 7, at end insert—

“(4) For the purposes of this section, the intervention functions of the Secretary of State in relation to the health service in England are the functions of the Secretary of State under—

(a) section 13Z1 (failure by the Board to discharge any of its functions),

(b) section 253 (emergency powers),

(c) section 82 of the Health and Social Care Act 2008 (failure by Care Quality Commission to discharge functions),

(d) section 67 of the Health and Social Care Act 2011 (Monitor: failure to perform functions),

(e) section 242 of that Act (failure by NICE to discharge any of its functions),

(f) section 266 of that Act (failure by the Information Centre to discharge any of its functions), and

(g) section 285 of that Act (breaches of duties to co-operate).”

Page 2, line 7, at end insert—

“( ) The Secretary of State must maintain a nationally co-ordinated system for professional education and training as part of the comprehensive health service.”

Page 2, line 7, at end insert—

“( ) The Secretary of State must maintain a “nationally co-ordinated” system for professional education and training as part of the comprehensive health service.”

Page 2, line 12, after “service” insert “by providing services or making arrangements for others to provide services”

Page 2, line 12, leave out “with a view to securing” and insert “to secure”

Page 2, line 13, after “individuals” insert “and area based populations”

Page 2, line 15, leave out first “or” and insert “and”

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

Page 2, line 15, leave out second “or” and insert “and”

Page 2, line 16, at end insert—

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

Page 2, line 16, at end insert—

“(c) the promotion and improvement of the health of all disabled people, including those with co-morbidities”

Page 2, line 18, leave out from “must” to “continuous” and insert “either provide services that ensure, or make arrangements to ensure”

Page 2, line 19, after first “the” insert “health”

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

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

Page 2, line 25, at end insert—

“( ) fairness of access for patients, and

( ) promotion of integrated care”

Page 2, line 25, at end insert—

“( ) equitable provision of services, and

( ) integration with local authority and public health services”

Page 2, line 27, after “the” insert “clinical”

Insert the following new Clause—

“The Secretary of State’s duty to ensure transparency

After section 1A of the National Health Service Act 2006 insert—

“1B Duty to ensure transparency

The Secretary of State must act with a view to securing—

(a) that any persons providing health services should provide, within as short a period as possible, full information to patients, their carers or representative about any incident or omission in or affecting their care which may have caused harm, or may in the future cause harm,

(b) that regulations are introduced to enable the Care Quality Commission to take action against a registered person or body who fail to disclose details of such incidents as set out in those regulations.””

Page 2, line 33, leave out “must have regard to the need” and insert “is required”

Page 2, line 33, leave out “have regard to the need” and insert “seek”

Page 2, line 33, leave out “have regard to the need” and insert “act with a view”

Page 2, line 33, after “need” insert—

“(a)”

Page 2, line 33, leave out “reduce” and insert “reducing”

Page 2, line 34, after “England” insert “in rural and urban areas”

Page 2, line 34, leave out from “England” to end of line 35

Page 2, line 34, after “to” insert—

(a) the outcomes achieved for them by the provision of those services,

(b) their ability to access such services, and

(c) ”

Page 2, line 35, at end insert “but he or she shall have regard to the need to ensure that greater patient choice is not accorded a higher priority than tackling health inequalities”

Page 2, line 35, at end insert—

“(b) to prevent inequalities in clinical treatment and health care developing in the health service as between NHS patients and private patients”

Page 2, line 35, at end insert—

“( ) For the purpose of this Act, where any duties placed on either commissioners or regulators of services conflict with any other duty, the duty to reduce inequalities shall prevail.”

Page 2, line 35, at end insert—

“( ) In fulfilling this duty, the Secretary of State must ensure the publication of comprehensive, publicly available evidence about the extent to which inequalities have been reduced throughout the NHS.”

Page 2, line 35, at end insert—

“( ) In having regard to inequalities the Secretary of State shall have particular regard for—

(a) age;

(b) disability;

(c) gender reassignment;

(d) marriage and civil partnership;

(e) pregnancy and maternity;

(f) race;

(g) religion or belief;

(h) gender;

(i) sexual orientation;

(j) geographical variation;

(k) socio-economic variation.”

Page 3, line 4, after “service” insert “in rural and urban areas”

Page 3, line 6, leave out “securing” and insert “ensuring”

Page 3, line 7, after “exercising” insert “a range of”

Page 3, line 9, leave out “manner that it considers most appropriate” and insert “interests of the health service”

Page 3, line 11, leave out “unnecessary” and insert “disproportionate”

The above-named Lords give notice of their intention to oppose the Question that Clause 4 stand part of the Bill.

Page 3, line 16, leave out “have regard to the need to”

Page 3, line 17, at end insert—

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

Page 3, line 19, at end insert—

“( ) research supported by the health service for the purpose of protecting the public in England from disease or other dangers to health.”

Page 3, line 19, at end insert—

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

Insert the following new Clause—

“The Secretary of State’s duty as to education and training

After section 1D of the National Health Service Act 2006 insert—

“1E Duty as to education and training

(1) The Secretary of State must exercise the functions of the Secretary of State under any relevant enactment so as to secure that there is an effective system for the planning and delivery of education and training to persons who are employed, or who are considering becoming employed, in an activity which involves or is connected with the provision of services as part of the health service in England.

(2) In subsection (1), “relevant enactment” means section 63 of the Health Services and Public Health Act 1968 and any other enactment under which the Secretary of State has functions which could be exercised for the purpose of securing that there is such an effective system as is mentioned in that subsection.””

Insert the following new Clause—

“The Secretary of State’s duty as to education and training

After section 1D of the National Health Service Act 2006, insert—

“1E Secretary of State’s duty as to education and training

For the purposes of improving the quality of patient care, the Secretary of State has a duty to maintain a comprehensive, multi-professional education and training system for health professionals and to ensure the continued professional development of all staff delivering NHS services.””

Insert the following new Clause—

“The Secretary of State’s duty as to national workforce structures

After section 1D of the National Health Service Act 2006, insert—

“1E Secretary of State’s duty as to national workforce structures

The Secretary of State has a duty to maintain a national pay and bargaining system for healthcare staff, to cover those staff providing NHS services and services for the improvement of public health.””

Insert the following new Clause—

“The Secretary of State’s duty as to promoting equality of provision

After section 1D of the National Health Service Act 2006 insert—

“1DA Duty as to promoting equality of provision

In exercising functions in relation to the health service, the Secretary of State must have regard to the need to promote equality for those providing services on behalf of the health service and shall within one year of passing this Act, lay a report before Parliament on the treatment for Value Added Tax of supplies by charities to bodies exercising functions on behalf of a Minister of the Crown of healthcare services or associated goods.””

[Retabled as Amendment 260D]

Page 3, leave out lines 27 to 34 and insert—

“(2) The Board has the function of arranging for the provision of services for the purposes of the health service in England in accordance with this Act and subject to any directions issued by the Secretary of State under section 13Z1 (failure by the Board to discharge any of its functions).

(3) The Board must exercise the functions conferred on it by this Act in relation to clinical commissioning groups so as to secure that services are provided for those purposes in accordance with this Act.”

Page 3, line 33, after “England” insert “in rural and urban areas”

Page 3, line 38, at end insert—

“( ) 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”

Page 3, line 38, at end insert—

“(c) must exercise its functions by overseeing sub-national clinical senates and networks”

Insert the following new Schedule—

1. The NHS provides a comprehensive service, available to all.

2. Access to NHS services is based on clinical need, not an individual’s ability to pay.

3. The NHS aspires to the highest standards of excellence and professionalism.

4. NHS services must reflect the needs and preferences of patients, their families and their carers.

5. The NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population.

6. The NHS is committed to providing best value for taxpayers’ money and the most effective, fair and sustainable use of finite resources.

7. The NHS is accountable to the public, communities and patients that it serves.”

Page 274, line 14, at end insert—

“( ) a former director of Children’s Services”

Page 274, line 24, at end insert—

“( ) The Secretary of State must ensure that a majority of the non-executive members of the Board appointed under subsection (1)(b) have relevant experience of either working in the NHS or serving on an NHS body.”

Page 274, leave out lines 28 and 29

Page 274, line 33, at end insert—

“( ) The Secretary of State must make regulations about the posts held by the executive members (other than the Chief Executive) of the Board, in particular that at least one executive director must be a—

(a) registered doctor,

(b) registered nurse,

(c) qualified accountant,

(d) person nominated by Health Watch England.”

Page 276, line 34, at end insert—

“( ) The total number of staff employed by the Board shall not exceed 500.”

Page 277, line 40, at end insert—

“( ) In the Schedule to the Public Bodies (Admission to Meetings) Act 1960 (bodies to which that Act Applies), in paragraph 1 at the end insert—

“( ) the NHS Commissioning Board”.”

Page 277, line 40, at end insert—

“( ) The Board must hold an annual meeting which is—

(a) open to members of the public, and

(b) attended by a majority of the board of directors who must present the following documents—

(i) the annual accounts,

(ii) any audit of the accounts,

(iii) the annual report.”

Page 4, line 15, at end insert—

“(1A) The areas covered by clinical commissioning groups in respect of general primary care shall, as far as practicable, coincide with local authority boundaries.

(1B) The requirement under subsection (1A) may be modified where clinical commissioning groups provide specialist services.”

Page 4, line 18, at end insert—

“(3) The Secretary of State must publish, and may from time to time revise, a code of conduct for all clinical commissioning groups.

(4) The code must, in particular, incorporate the Nolan principles.

(5) “The Nolan principles” means the seven general principles of public life set out in the First Report of the Committee on Standards in Public Life (Cm 2850).”

Page 4, line 25, at end insert “rural and urban areas of”

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

Page 4, line 26, at end insert—

“( ) The Secretary of State shall report annually on such steps taken.”

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

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 well-being, including access to their own medical records”

Page 4, line 38, at end insert—

“( ) providing services for the prevention and treatment of harmful drinking and alcohol dependence.”

Page 4, line 38, at end insert—

“( ) undertaking an audit of healthcare providers’ processes and outcomes”

Page 4, line 38, at end insert—

“( ) The Secretary of State shall appoint a Chief Environmental Health Officer for England.

( ) The Chief Environmental Health Officer for England shall give advice to and report to the Chief Medical Officer for England on all such aspects of environmental and public health as are relevant to the public health functions referred to in this section and the duties referred to in section 2B of this Act.

( ) The Secretary of State shall report to Parliament annually on the work of the Chief Environmental Health Officer for England.”

Page 5, line 7, at end insert—

“( ) In discharging this duty, the Secretary of State will appoint for terms of 5 years, following 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 or she 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.”

Page 5, line 13, leave out “area” and insert “rural and urban areas”

Page 5, line 14, leave out “may” and insert “must”

Page 5, line 16, at end insert “in rural and urban areas”

Page 5, line 17, leave out “may” and insert “must”

Page 5, line 22, leave out second “or” and insert “and”

Page 5, line 23, at end insert—

“( ) providing services for the prevention and treatment of harmful drinking and alcohol dependence;”

Page 5, line 32, at end insert—

“( ) promoting co-operation between each of the authority’s relevant partners”

Page 5, line 32, at end insert—

“( ) promoting research, and acting on research evidence, as to the causes of ill health”

Page 5, line 32, at end insert—

“( ) undertaking an audit of healthcare providers’ processes and outcomes”

Page 5, line 35, at end insert—

“( ) For the purposes of this section, each of the following is a relevant partner of a local authority—

(a) the district council where the authority is a county council for an area for which there is also a district council;

(b) the police authority and the chief officer of police for a police area any part of which falls within the area of the local authority;

(c) a local probation board for an area any part of which falls within the area of the local authority;

(d) a youth offending team for an area any part of which falls within the area of the local authority;

(e) a clinical commissioning group for an area any part of which falls within the area of the local authority.

( ) The relevant partners of a local authority must co-operate with the local authority in the making of arrangements under this section.”

Page 6, line 3, leave out subsection (1) and insert—

“(1) After section 3 of the National Health Service Act 2006 insert—

“3AA Duties of clinical commissioning groups as to commissioning certain health services

(1) A clinical commissioning group must arrange for the provision of, to such extent as the group considers necessary to meet all reasonable requirements—

(a) hospital accommodation,

(b) other accommodation for the purpose of any service provided under this Act,

(c) medical, dental, ophthalmic, nursing and ambulance services,

(d) such other services or facilities for the care of pregnant women, women who are breastfeeding and young children as he or she considers are appropriate as part of the health service,

(e) such other services or facilities for the prevention of illness, the care of persons suffering from illness and the after-care of persons who have suffered from illness as he considers are appropriate as part of the health service,

(f) such other services or facilities as are required for the diagnosis and treatment of illness.

(2) For the purposes of the duties in subsection (1), services provided under—

(a) section 83(2) (primary medical services), 99(2) (primary dental services) or 115(4) (primary ophthalmic services), or

(b) a general medical services contract, a general dental services contract or a general ophthalmic services contract,

must be regarded as provided by the Secretary of State.

(3) This section does not affect Chapter 1 of Part 7 (pharmaceutical services).

(4) In subsection (1) the clinical commissioning group has responsibility for—

(a) all persons normally resident in the area defined in its constitution;

(b) in relation to urgent or emergency care for all persons present in the area defined in its constitution.””

Page 6, line 4, leave out subsections (2) to (6)

Page 7, line 6, leave out “may” and insert “must”

Page 7, line 12, after “persons” insert “, especially persons with long-term conditions, or

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

Page 7, line 27, after “prison” insert “, immigration detention centre, local authority secure children’s home, police or court cell”

Page 7, line 28, at end insert—

“( ) services and facilities for those with profound and multiple learning disabilities and people with complex needs whose behaviour challenges services”

Page 7, line 29, at end insert—

“( ) Where regulations require the Board to commission services, the regulations must set out how the performance of the Board in relation to the performance of its functions will be managed, and how the Board must agree any plans for commissioning with the appropriate Health and Wellbeing Boards.”

Page 7, line 29, at end insert—

“( ) Regulations must require the Board to commission services for veterans who have lost limbs.”

Page 7, line 33, at end insert—

“( ) Commissioning of highly specialised services must be done in collaboration with sub-national clinical senates that are accountable to the Board.”

Page 8, line 11, leave out subsection (2)

Page 8, leave out lines 24 and 25 and insert—

“(b) give directions to the Board about the exercise of its commissioning functions in relation to high security services;

(c) give directions to the Board about the exercise of its commissioning functions in relation to mental health services.”

Page 8, line 29, after “in” insert “rural and urban areas of”

Page 9, line 24, after “(1)(d)” insert “—

(i) ”

Page 9, line 25, after “authority”” insert “, and

(ii) after “paragraph 7A” insert “and of any other prescribed information relating to the children concerned”, and

(c) in sub-paragraph (2) after “such weighing or measuring” insert “or in relation to information prescribed under sub-paragraph (1)””

The above-named Lords give notice of their intention to oppose the Question that Clause 15 stand part of the Bill.

Page 12, line 32, leave out “Regulations may” and insert “The Secretary of State must draft regulations not less than annually, and shall submit them to the relevant committee of the House of Commons not less than two months before the regulations are to be laid before Parliament.

(1A) Such regulations shall”

Page 12, line 33, leave out “section” and insert “Act”

Page 13, line 32, at end insert—

“( ) The regulations must require a commissioning body to include in every commissioning contract entered into by it with a service provider to which this subsection applies a requirement that the service provider must supply to it such information as the commissioning body may specify for the purpose of responding to a request for information made to the commissioning body relating to—

(a) the performance of the contract;

(b) the ability of the service provider to comply with the terms of the contract, including its record in providing services similar to those provided under the contract; or

(c) any other information relating to the service provider’s facilities, premises, equipment, staff, policies, procedures, performance, deliberations, communications, decisions or actions relating to matters which may affect the physical or mental health or welfare of persons for whom it may have responsibility under the contract or the prevention, diagnosis or treatment of illness of those persons.

( ) This subsection applies to a commissioning contract entered into with a person, office holder or body which is not a public authority for the purposes of the Freedom of Information Act 2000 or the Environmental Information Regulations 2004.

( ) In this section—

“commissioning body” means the Board or a clinical commissioning group;

“request for information” means a request for information made under section 1 of the Freedom of Information Act 2000 or regulation 5 of the Environmental Information Regulations 2004.”

Page 13, line 43, at end insert—

“( ) The regulations must require the Board and clinical commissioning groups to be compliant with section 149 of the Equality Act 2010 (the public sector equality duty).”

Page 13, leave out lines 44 and 45 and insert—

“( ) In extraordinary circumstances, regulations may impose a requirement on one or more named clinical commissioning groups.”

Page 14, line 13, at end insert—

“(11) A Minister of the Crown may not make regulations to which this subsection applies unless a draft of the statutory instrument containing the regulations has been laid before, and approved by a resolution of, each House of Parliament.”

Page 15, line 7, at end insert “on his or her behalf”

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

Page 16, line 5, at end insert “, and

objectives specified under paragraph (a) must include objectives relating to improvement of services for children.”

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 16, leave out lines 27 and 28 and insert—

“(b) Healthwatch England, and”

Page 16, line 30, at end insert—

“and must publish the results of such consultation”

Page 17, line 9, at end insert—

“( ) consult Healthwatch England.”

Page 17, line 14, at end insert—

“(2) In discharging its duty under this section the Board shall establish an independent panel to formulate minimum standards of—

(a) financial,

(b) performance, and

(c) asset,

management information to be included in the audited accounts for all bodies to which this subsection applies.

(3) Subsection (2) applies to all bodies commissioning or providing NHS services under annual contracts of at least £500,000.

(4) The independent panel shall be established—

(a) within 6 months of this Act receiving Royal Assent, and

(b) jointly with Monitor on a basis agreed by the National Audit Office.

(5) The standards formulated by the panel shall be kept under review by the Board and Monitor and, in doing so, they will pay particular regard to the extent to which the standards have ensured levels of public accountability similar to those required of bodies providing comparable services.”

Page 17, line 14, at end insert—

“( ) 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 in-patient hospital services.”

Page 17, line 14, at end insert—

“( ) In discharging its duty under this section the Board shall, after consultation with Monitor under subsection 171(4) and the appropriate clinical commissioning group, advise the Secretary of State whether or not the NHS service configuration in a particular area is financially or clinically unsustainable within the mandate issued or proposed to be issued by the Secretary of State.”

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

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 five years after Royal Assent a networked electronic patient summary record for the use of any clinician treating NHS patients”

Page 17, line 26, at end insert “in delivering better outcomes for patients,”

Page 17, line 27, at end insert—

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

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

Page 17, line 33, after “the” insert “clinical”

Page 17, leave out lines 35 to 42

Page 18, line 2, leave out “have regard to the need” and insert “act with a view”

Page 18, line 4, leave out “reduce” and insert “reducing”

Page 18, line 4, after “inequalities” insert “in rural and urban areas”

Page 18, line 6, leave out “reduce” and insert “reducing”

Page 18, line 6, after “inequalities” insert “in rural and urban areas”

Page 18, line 7, at end insert—

“( ) collect data on the experience and outcomes experienced by all patients and, where the person has a disability, break data down by impairment type”

Page 18, line 7, at end insert—

“( ) reduce health inequalities in the population”

Page 18, line 7, at end insert—

“( ) ensure funding to clinical commissioning groups appropriate to the costs associated with the proportion of poor health conditions, life expectancy and levels of deprivation in their area”

Page 18, line 7, at end insert—

“( ) work in collaboration with Health and Wellbeing Boards and relevant local authorities”

Page 18, line 9, leave out “promote” and insert “secure”

Page 18, line 10, after “patients” insert “in rural and urban areas”

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

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

Page 18, line 11, at end insert—

“( ) In discharging this duty, the Board must publish guidance for clinical commission groups that ensures that patients and their carers and representatives have—

(a) the means to express their views on the quality of services provided,

(b) opportunities to consult with service providers through a variety of means,

(c) access to appropriate information about their care and treatment,

(d) opportunities to consider available treatment options and their risks and benefits,

(e) the opportunity to participate in decisions about their care and treatment and its management, and

(f) the means to ensure informed consent is given to care and treatment.”

Page 18, line 14, leave out from second “to” 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 15, at end insert—

“( ) In this Act “patient choice” is defined as including—

(a) choice to support healthy living;

(b) choice of provider and the way in which care is provided; and

(c) choice of treatment including self-management support.”

Page 18, line 18, after “from” insert “persons or organisations with expertise in the experience of patients and from”

Page 18, line 21, at end insert—

“( ) In its annual report, the Board must report on the advice it has obtained under this section.”

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

Page 18, line 34, leave out “have regard to the need to”

Page 18, line 37, at end insert—

“(c) research approved by the health service for the purpose of protecting the public in England from disease or other dangers to health”

Page 18, line 37, at end insert—

“13L1 Duty in respect of research

The Board must, in the exercise of its functions, have regard to the need to promote—

(a) research on matters relevant to the health service, and

(b) the use in the health service of evidence obtained from research.”

Page 18, line 37, at end insert—

“13L1 Duty in respect of education and training

The Board must promote education and training of the health care workforce, having taken note of the responsibilities of the regulatory authorities, academic and professional organisations.”

Page 18, line 40, leave out “an” and insert “a clinically”

Page 19, line 1, after “inequalities” insert “in rural and urban areas”

Page 19, line 42, leave out from beginning to end of line 1 on page 20

Page 20, line 1, at end insert—

“( ) The Board may take specific action to support the development of the voluntary sector, social enterprises, co-operatives and mutuals as it considers appropriate.”

Page 20, line 2, at end insert—

“13O1 Duty as to staffing ratios of registered and non-registered staff

(1) The Board must, in the exercise of its functions, establish for health services, and may subject to regulations establish for other services, the ratio of registered to non-registered workers required at any given time by reference to any appropriate register established for workers in those areas.

(2) In the discharge of this duty the Board must publish a list of appropriate registers for the purpose of subsection (1).

(3) The Board must produce guidance to health services to assist in the maintenance of ratios for the purpose of subsection (1).

(4) The Board must also issue guidance on the maximum and minimum numbers of patients per registered nurse.”

Page 20, line 2, at end insert—

“13O1 Duty as to mandated staffing ratios and levels

(1) The Board shall, in the exercise of its functions, mandate for health services, and may subject to regulations mandate for other services, the ratio of registered nurses to registered and non-registered health care support workers required at any given time by reference to any appropriate register established for workers in those services.

(2) The Board must publish a list of appropriate registers for the purposes of subsection (1).

(3) The Board must, in exercise of its functions, mandate for health services on the maximum number of patients per registered nurse.

(4) For the purposes of subsection (1), a health care support worker shall be an individual whose work is routinely delegated to them by a registered nurse or midwife or has a qualification in health and social care at level one (or higher) of the Qualifications and Credit Framework in England.”

Page 20, line 8, leave out from second “are” to end of line 9 and insert “consulted”

Page 20, line 8, leave out from “involved” to end of line 9

Page 20, line 8, leave out from “involved” to end of line 9 and insert “(by formal and informal consultation with particular regard to the coherence and navigability of typical care pathways)”

Page 20, line 9, after “ways)” insert “directly and through their representatives”

Page 20, line 20, at end insert—

( ) in obtaining information on the safety of services,

( ) in obtaining appropriate advice,

( ) in promoting innovation, and

( ) in promoting research”

Page 20, line 20, at end insert—

“ensuring that reasonable adjustments are made so that the views of people with any impairments or disabilities can also be sought in relation to arrangements under this section.

Page 20, line 29, leave out “such persons as the Board considers appropriate” and insert—

“(a) the Care Quality Commission;

(b) Monitor;

(c) all clinical commissioning groups;

(d) Healthwatch England; and

(e) Health and Wellbeing Boards.”

Page 20, leave out lines 34 to 36

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

Page 21, line 22, after “13E” insert “, 13L”

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 specified 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 permitted 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”

Page 21, line 38, after “13E” insert “, 13L”

Page 21, line 38, after “13E” insert “, 13M”

Page 22, leave out line 40

Page 23, line 29, leave out from beginning to end of line 5 on page 24 and insert—

“(1) The Secretary of State may give directions to any of the bodies mentioned in subsection (2) about the exercise of any functions.

(2) For the purpose of subsection (1) the bodies are—

(a) NHS Commissioning Board

(b) clinical Commissioning Groups”

Page 23, line 34, leave out from “failing” to “, and” in line 35 and insert “to exercise its functions in a way that the Secretary of State considers to be in the best interest of the National Health Service”

Page 29, line 2, after “services” insert “, primary dental services, primary pharmaceutical service, primary ophthalmic services and primary nursing services”

Page 29, line 2, at end insert—

“( ) The Secretary of State may by regulations make additions to those primary medical services listed in subsection (1) above.”

Page 29, line 2, at end insert—

“( ) Subsection (1) shall not apply to any providers who have any financial interest, directly or indirectly, in the provision of any service that the clinical commissioning group may be required to commission.”

Page 29, line 7, at end insert—

“( ) 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 per cent.”

Page 29, line 7, at end insert—

“( ) are co-terminus with the boundaries of a local authority or a contiguous group of local authorities”

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”

Page 30, line 10, at end insert—

“14BA Guidance on dealing with conflicts of interest

(1) The Secretary of State must issue guidance, for incorporation in clinical commissioning group constitutions, on how conflicts of interest should be dealt with by commissioning consortia as part of their decision making.

(2) Clinical commissioning groups must have regard to that guidance.”

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”

Page 30, line 26, leave out “its functions” and insert “all of its functions as in section 3 of this Act”

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

Page 30, line 42, at end insert—

“( ) the clinical commissioning group assumes the duties as in section 3 of this Act from the date set out in the grant”

Page 31, line 5, at end insert—

“( ) Before applying to the Board, a clinical commissioning group must have consulted with—

(a) persons usually resident within the group’s area,

(b) the relevant local authority,

(c) the relevant Health and Well Being Board,

(d) patients receiving primary medical service from providers within the clinical commissioning group.”

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,”

Page 33, line 9, at end insert—

“( ) collaboration between clinical commissioning groups, including neighbouring clinical commissioning groups, for the purposes of joint commissioning;”

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

Page 33, line 15, at end insert—

“( ) A clinical commissioning group shall have a Chairman of the governing body appointed by the Secretary of State.”

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 33, line 44, at end insert “or (b)”

Page 34, line 2, at end insert “or (b)”

Page 34, line 2, at end insert—

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

Page 34, line 16, leave out “function under section 14L(3)(a)” and insert “functions under section 14L(3)(a) and (b)”

Page 34, line 30, at end insert—

“( ) individuals who are fully aware of the different aspects of specialist provision in the area covered by the clinical commissioning group”

[Withdrawn]

Page 280, line 34, at end insert—

“( ) CCGs must maintain a publicly accessible register of all potential conflicts of interest of those individuals involved in any part of the commissioning process.

( ) The Secretary of State must issue guidance on how conflicts of interest should be dealt with by commissioning consortia as part of their decision making.

( ) Clinical commissioning groups must have regard to that guidance.”

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

Page 36, line 3, at end insert—

“( ) In fulfilling this duty, clinical commissioning groups, in estimating the cost of new or enhanced services, must have regard to any existing service provided by the voluntary sector, the support of which may reduce that cost.”

Page 36, line 6, after “the” insert “clinical”

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

Page 36, line 11, after first “the” insert “clinical”

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—

“( ) 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.”

Page 36, line 23, at end insert—

“( ) In particular, each clinical commissioning group must monitor the performance of primary care practitioners within its area and report its findings to the Board.”

Page 36, line 26, leave out “have regard to the need” and insert “act with a view”

Page 36, line 27, leave out “reduce” and insert “reducing”

Page 36, line 28, at end insert “in rural and urban areas”

Page 36, line 29, leave out “reduce” and insert “reducing”

Page 36, line 30, at end insert “in rural and urban areas”

Page 36, line 33, leave out “promote” and insert “pay regard to”

Page 36, line 34, leave out from “any)” to 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”

Page 36, line 35, at end insert “and must take steps to inform patients, their carers and their representatives of the right to be involved in such decisions”

Page 36, leave out lines 36 and 37

Page 36, line 39, leave out “under subsection (2)” and insert “in accordance with section 13H”

Page 36, line 43, leave out from “to” to end 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 36, line 43, at end insert “and must take steps to inform patients, their carers and their representatives of the right to make such choices”

Page 37, line 3, after “from” insert “persons or organisations with expertise in the experience of patients and from”

Page 37, line 10, at end insert—

“14VI Duty to consult academic bodies

Each clinical commissioning group must, in the exercise of its functions, consult relevant academic bodies within its area, including academic health science partnerships.”

Page 37, line 13, at end insert “in rural and urban areas”

Page 37, line 19, at end insert—

“14X1 Duty in respect of education and training

Each clinical commissioning group must, in the exercise of its functions, promote education and training of the current and future NHS workforce.”

Page 37, line 22, after “services” insert “in rural and urban areas”

Page 37, line 32, after second “services” insert “in rural and urban areas”

Page 38, line 2, at end insert—

“14Y1 Duty to reduce alcohol-related harm

Each clinical commissioning group must, in the exercise of its functions, have regard to the need to reduce alcohol-related harm.”

Page 38, line 2, at end insert—

“14Y1 Duty as to addiction to prescribed drugs

(1) Each clinical commissioning group shall have a duty to provide services to those suffering from addiction and withdrawal from prescribed drugs.

(2) In fulfilling this duty, clinical commissioning groups must co-operate with and take account of the work of non-governmental organisations.”

Page 38, line 2, at end insert—

“14Y1 Duty as to promoting competition only when demonstrably preferable to integration

Each clinical commissioning group must exercise its functions with a view to securing that health services are provided via a model in which different providers compete to provide the same services only where it can demonstrate to the Board that this would—

(a) improve the quality of those services, including the outcomes that are achieved from their provision,

(b) reduce inequalities between persons with respect to their ability to access those services, or

(c) reduce inequalities between persons with respect to the outcomes achieved for them by provision of those services.”

Page 38, line 2, at end insert—

“14Y1 Duty as to ensuring flexibility for clinicians to undertake work for the benefit of the wider NHS

Each clinical commissioning group must ensure that organisations providing health services do so on the understanding that they must allow clinicians working for those organisations reasonable time for the undertaking of work for the benefit of the wider NHS.”

Page 38, line 2, at end insert—

“14Y2 Duty to promote public health

Each clinical commissioning group must, in the exercise of its functions, act in such a way as to contribute to the improvement of public health.”

Page 38, line 6, after “services” insert “in rural and urban areas”

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

Page 38, leave out lines 12 and 13 and insert “consulted—”

Page 38, line 12, leave out from “involved” to end of line 13 and insert “(by formal and informal consultation with particular regard to the coherence and navigability of typical care pathways)”

Page 38, line 13, after “ways)” insert “directly and through their representatives”

Page 38, line 24, at end insert—

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

Page 38, line 40, at end insert—

“( ) Arrangements must be made for two or more clinical commissioning groups to exercise commissioning functions jointly for less common conditions, if the Board advises that these services cannot be effectively commissioned by a particular clinical commissioning group, based on population size.”

Page 40, line 32, at end insert—

“( ) Such guidance must cover commissioning for less common conditions.

( ) The Board must involve a range of groups representing patients and carers with expertise in the services to be commissioned in the development of such guidance.”

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.”

Page 40, line 39, at end insert—

“( ) Clinical commissioning groups must demonstrate to the Board that they have acted on their duty to follow such guidance as is published by the Board.”

Page 40, line 39, at end insert—

“( ) The Board must determine the minimum population size and the care services for that population for commissioning of services for less common conditions.”

Page 40, line 40, leave out from beginning to end of line 11 on page 41

Page 41, line 38, at end insert—

“( ) The plan must explain how the clinical commissioning group proposes to ensure that commissioning services for less common conditions will be done.”

Page 41, line 41, after “14Q” insert “, 14X”

Page 41, line 41, after “14Q” insert “, 14YZ”

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

Page 43, line 47, after “14Q” insert “, 14Y”

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

Page 44, line 24, after “14V” insert “, 14X”

Page 44, line 33, at end insert—

“( ) The Board must also consult providers of health and social care.”

Page 44, line 40, at end insert—

“( ) The Board must make arrangements for the full reports of performance assessments as to be published or made generally available.”

Page 52, line 20, leave out from beginning to end of line 21 on page 53

Page 52, line 34, after “the” insert “health”

Page 53, line 7, leave out from “spent” to end of line 9 and insert “to improve health outcomes”

Page 53, line 40, at end insert—

“( ) Regulations must make provision that no provider shall be a member of a clinical commissioning group if they have any financial interest, directly or indirectly, in the provision of any service that the clinical commissioning group may be required to commission.”

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

Page 55, line 34, after “individual” insert “with appropriate professional qualifications”

Page 56, line 4, at end insert—

“( ) 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.”

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.”

Page 56, line 6, at end insert—

“( ) The individual so appointed must hold a recognised professional qualification, must be a director within the local authority, and must report directly to the Chief Executive.”

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

Page 56, line 35, at end insert—

“( ) A local authority shall have the function of ensuring an effective 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.”

Lord Rea gives notice of his intention to oppose the Question that Clause 31 stand part of the Bill.

Page 75, line 6, at end insert—

( ) In section 130A of that Act (Independent Metal Health Advocates), at the beginning of subsection (7)(a) insert “subject to paragraph (aa) below,”

( ) In section 130A of that Act, after subsection (7)(a) insert—

“(aa) must make provision to ensure that the help of independent mental health advocates is available to those qualifying patients who are minors;”.”

Page 77, line 3, after “steps” insert “after consulting with the Secretary of State”

The above-named Lords give notice of their intention to oppose the Question that Clause 45 stand part of the Bill.

Page 80, line 2, at end insert—

“( ) In exercising functions under subsections (1) and (2), the Secretary of State must set out how the performance of the Board in relation to these functions will be managed, and how the Board must agree any arrangements for provision with the appropriate Health and Wellbeing Boards.”

Page 82, line 32, insert—

“( ) Before a determination is made by the NHS Commissioning Board which relates to pharmaceutical remuneration, it—

(a) must consult a body appearing to it to be representative of persons to whose remuneration the determination would relate, and

(b) may consult such other persons as it considers appropriate.”

Page 83, line 3, after “review” insert “the cost and”

Page 83, line 12, at end insert—

“( ) Healthwatch England”

Page 83, line 12, at end insert—

“( ) In discharging the function under this section, the Secretary of State must publish an annual statement to Parliament of—

(a) the administrative cost of each body listed in subsection (2),

(b) the percentage of the health service budget these administrative costs represent, and

(c) the percentage increase of these administrative costs in relation to the previous year.”

Page 83, line 13, leave out “may” and insert “must”

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

Page 83, line 25, at end insert—

“( ) The Secretary of State must include in any report progress on tackling health inequalities for people with a disability.”

Page 294, line 33, after “Board,” insert—

“(hb) a subsidiary of a company which is formed under that section and wholly owned by the Secretary of State,”

Page 294, line 37, leave out “(ha)” and insert “(hb)”

Page 294, line 42, after “(ha)” insert “or (hb)”

Page 316, line 3, at end insert—

“ In section 216 (application of trust property: further provisions), in subsection (3), after “or 214” insert “of this Act or section 294 or 296 of the Health and Social Care Act 2011”.”

Page 316, line 21, at end insert—

“ In section 220 (trust property previously held for general hospital purposes), in subsection (2), after “or 214” insert “of this Act or section 294 or 296 of the Health and Social Care Act 2011”.”

Page 317, line 27, at end insert—

“In section 234(2)(1) for “Primary Care Trust” substitute “Clinical commissioning groups”.”

Page 317, line 27, at end insert—

“In section 234(2)(1)(a) for “Primary Care Trust” substitute “Clinical commissioning groups”.”

Page 317, line 27, at end insert—

“In section 234(2)(2) for “Primary Care Trust” substitute “Clinical commissioning groups”.”

Page 338, line 30, at end insert—

“( ) Section 77 of the Freedom of Information Act 2000 (offence of altering etc. records with intent to prevent disclosure) is amended as follows.

( ) In subsection (1), after the words “held by the public authority” insert “or by a service provider”.

( ) In subsection (2), after the words “public authority” in each place it appears insert “or service provider”.

( ) After subsection (4) insert—

“(5) “Service provider” means a person providing, or a person who has provided, services under a contract with the National Health Service Commissioning Board established under section 1E of the National Health Service Act 2006 or with a clinical commissioning group established under section 1F of that Act.””

Page 351, line 2, at beginning insert “In section 123 of”

Page 351, line 2, leave out from “2009” to “(partner” in line 18

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 or she 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.”

The above-named Lords give notice of their intention to oppose the Question that Clause 53 stand part of the Bill.

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.”

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.”

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.”

Insert the following new Clause—

“The Health Research Authority: approval functions

The following functions are transferred to the Health Research Authority—

(a) advising the Secretary of State on applications for support to process confidential patient information under section 251 of the NHS Act 2006,

(b) functions of the Human Tissue Authority in relation to the scheduled purpose of research in connection with disorders, or the functioning, of the human body,

(c) functions of the Human Fertilisation and Embryology Authority in relation to the provision of licences for research, and

(d) advising Health Ministers on the certification of doctors and dentists wishing to administer radioactive medicinal products to humans for research under the Medicines (Administration of Radioactive Substances) Regulations 1978.”

Insert the following new Clause—

“The Health Research Authority: duty of co-operation with MHRA

The Health Research Authority and the Medicines and Healthcare products Regulatory Agency (MHRA) must co-operate with each other in the exercise of their respective functions to develop a co-ordinated process for the approval of clinical trials of medicinal products and to deliver improvements to the regulation of these trials.”

Insert the following new Clause—

“The Health Research Authority: National Research Governance Service

(1) A component of the Health Research Authority, known as the National Research Governance Service, shall lead a streamlined common service 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”).

(2) The National Research Governance Service will have the following general functions—

(a) undertaking all study-wide NHS research governance checks, ensuring consistent national standards,

(b) recommending research projects as suitable for undertaking in the NHS, subject to local assessment of feasibility and delivery by NHS trusts,

(c) managing the process requiring NHS trusts to determine local feasibility within 20 working days,

(d) maintaining records on NHS staff to confirm their competence to conduct research, and

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

(3) The National Research Governance Service and NHS trusts must have regard to the National Institute of Health Research’s Research Support Services standard procedures, framework of good practice and benchmarks for performance.”

Insert the following new Clause—

The Secretary of State’s duty as to standards of adult social care

(1) In discharging the duty under sections 1 to 3, the Secretary of State shall, after appropriate consultation, make regulations governing the eligibility and assessment of individuals for adult social services on a consistent basis throughout England, including—

(a) portability of assessments between areas,

(b) the charging arrangements for services provided,

(c) the assessment of carers’ needs, and

(d) the integration of such assessments with those for continuing care under the NHS.

(2) Regulations made under subsection (1) shall be—

(a) made by statutory instrument subject to an affirmative resolution in both Houses of Parliament;

(b) laid within 3 years of this Act being given Royal Assent; and

(c) kept under review.

(3) 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.”

Page 87, line 12, leave out subsection (1) and insert—

“( ) The main duty of Monitor is to exercise its functions to support the duties of the Secretary of State as set out in section 1 of this Act as provided for in regulations.

( ) Monitor must exercise its functions to protect and preserve the interest of those who use, or may use, health care services, and to maintain or improve the quality of those services, and the outcomes achieved by those services.”

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

Page 87, line 16, at end insert—

“( ) The role of Monitor as the Independent Regulator of Foundation Trusts shall continue.”

Page 87, line 17, after “must” insert—

“(a) operate economically, efficiently and effectively, and

(b)”

Page 87, line 19, leave out subsection (3)

Page 87, line 19, leave out “anti-competitive”

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 benefiting from new or existing organisations providing new or extended NHS services that defined quality standards, together with their proposals for removing these barriers”

Page 87, line 31, leave out “enabling” and insert “promoting”

Page 88, line 12, after “from” insert “persons or organisations with expertise in the experience of patients and from”

Page 88, line 20, leave out subsection (10)

Page 88, line 26, at end insert—

“( ) Every annual report of Monitor must include a statement of the steps it has taken in the financial year to which the report relates to comply with the duty under subsection (7).”

Page 88, line 35, leave out subsection (2)

Page 89, line 25, leave out paragraphs (b) and (c)

Page 89, line 31, leave out from “that” to end of line 32 and insert “people who require health care services for those purposes are provided with fair access to them.”

Page 89, line 33, leave out paragraph (e)

Page 89, line 37, leave out from “for” to end of line and insert “operate economically, efficiently and effectively”

Page 89, line 38, leave out paragraph (g) and insert—

“(g) the need for commissioners and providers to cooperate to improve services and deliver seamless and sustainable care to patients”

Page 90, line 28, leave out paragraph (a)

Page 90, line 45, at end insert—

“(f) a matter likely to have a significant impact on the integration of services”

Page 92, line 13, leave out subsection (2)

Page 93, line 8, after “functions’ insert “other than the personal medical records of patients”

Page 93, line 20, leave out subsection (3)

Lord Whitty gives notice of his intention to oppose the Question that Clause 68 stand part of the Bill.

Lord Whitty gives notice of his intention to oppose the Question that Clause 69 stand part of the Bill.

Lord Whitty gives notice of his intention to oppose the Question that Clause 70 stand part of the Bill.

Page 95, line 41, after “treatment” insert “including integrated healthcare”

Page 95, line 43, leave out “anti-competitive”

Lord Whitty gives notice of his intention to oppose the Question that Clause 76 stand part of the Bill.

Lord Whitty gives notice of his intention to oppose the Question that Clause 77 stand part of the Bill.

Lord Whitty gives notice of his intention to oppose the Question that Clause 78 stand part of the Bill.

Page 101, line 29, after “service” insert “, including a primary medical service,”

Insert the following new Clause—

“Provision of health care to be public function

(1) A person (‘P’) who provides a health care service for the purposes of the NHS under arrangements made with P under the relevant statutory provisions is to be taken to be exercising a function of a public nature for the purposes of subsection (3)(b) of section 6 of the Human Rights Act 1998 (acts of public authorities) in doing so.

(2) The “relevant statutory provisions” are—

(a) section 3A of the National Health Service Act 2006 as amended;

(b) section 3B of the National Health Service Act 2006 as amended;

(c) section 4 of the National Health Service Act 2006 as amended;

(d) section 5 of the National Health Service Act 2006 as amended.”

Page 102, line 31, leave out “its Healthwatch England Committee” and insert—

“( ) Healthwatch England”

Page 103, line 33, leave out “its Healthwatch England Committee” and insert—

“( ) Healthwatch England”

Page 106, line 29, at end insert—

“( ) The standard conditions must set out—

(a) minimum standards for governance structures, including the management of conflicts of interests,

(b) minimum standards as regards meeting in public when decisions are taken and the disclosure of all relevant information,

(c) minimum standards as to employment conditions, workforce training and development,

(d) minimum standards around capitalisation debt ratios and other significant funding and financial factors,

(e) co-operate fully with the relevant local authority overview and scrutiny functions.”

Page 107, line 7, at end insert—

“( ) Requirement 3 is that the licensee must promote and engage in education and training of the health care workforce.”

Page 107, line 15, leave out “its Healthwatch England committee” and insert—

“( ) Healthwatch England”

Page 107, line 36, leave out “its Healthwatch England committee” and insert—

“( ) Healthwatch England”

Page 108, line 22, after second “of” insert “integrated”

Page 111, line 4, leave out “its Healthwatch England Committee” and insert—

“( ) “Healthwatch England”

The above-named Lords give notice of their intention to oppose the Question that Clause 110 stand part of the Bill.

The above-named Lords give notice of their intention to oppose the Question that Clause 111 stand part of the Bill.

The above-named Lords give notice of their intention to oppose the Question that Clause 112 stand part of the Bill.

Page 122, line 14, leave out “Monitor” and insert “The Secretary of State”

Page 122, line 19, at end insert—

“( ) 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,”

Page 122, line 19, at end insert—

“( ) that the national tariff reflects patient care pathways,”

Page 122, line 25, after “vary” insert “provided that this does not affect patient outcomes”

Page 123, line 41, at end insert—

“(d) specifying it by reference to clinical and social care pathways.”

Page 124, line 4, at end insert—

“( ) if it is specified in accordance with subsection (1)(d), specify a national price for the health and social care in its entirety.”

Page 132, line 21, at end insert—

“( ) protect the interests of patients,”

The above-named Lords give notice of their intention to oppose the Question that Clause 144 stand part of the Bill.

Page 148, line 11, leave out subsection (2) and insert—

“(2) For paragraph 9(3) of that Schedule (requirement for at least one member of council governors to be appointed by PCT) substitute—

(3) At least one member of the council of governors must be appointed by the NHS Commissioning Board.””

Page 149, line 20, after “whole” insert “for the purposes of the National Health Service”

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

Page 154, line 19, after “the” insert “national”

Page 160, line 32, after first “of” insert—

“(a)”

Page 160, line 33, at end insert “; and

(b) the Secretary of State”

Page 161, line 36, after first “of” insert—

“(a)”

Page 161, line 37, at end insert “; and

(b) the Secretary of State”

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, the regulator 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 or her 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 section 3(1) and (2), the Regulator shall incorporate the work of any such panel in any order or report made under section 5(5) and (6) as conditions to which the trust special administrator must have full regard in discharging his or her responsibilities.”

Page 175, leave out from line 16 to end of line 8 on page 178 and insert—

(1) There shall be a body corporate known as Healthwatch England.

(2) Healthwatch England shall have the following functions—

(a) to establish a Local Healthwatch organisation for each local authority area,

(b) to provide each Local Healthwatch organisation with such resources as may be agreed by Healthwatch England,

(c) to provide Local Healthwatch organisations with advice on and assistance in relation to their functions and on such other matters that Healthwatch England may determine,

(d) to provide relevant persons with information and advice on—

(i) the views of people who use health and social care services and of other members of the public on their needs for and experiences of health and social care services, and

(ii) the views of Local Healthwatch organisations and of other persons on the standard of provision of health and social care services and on whether or how the standard could or should be improved.

(3) Relevant persons referred to in subsection (2)(d) are—

(a) the Secretary of State;

(b) the National Health Service Commissioning Board;

(c) the Care Quality Commission;

(d) Monitor; and

(e) English local authorities.

(4) A person provided with advice under subsection (2)(d) must inform Healthwatch England in writing of its response or proposed response to the advice.

(5) Healthwatch England must publish details of arrangements it makes under this section, including details of payments of remuneration or other amounts.

(6) In performing functions under this section, Healthwatch England must have regard to such aspects of government policy as the Secretary of State may direct.

(7) As soon as possible after the end of each financial year, Healthwatch England must publish a report on the way in which it has exercised its functions during the year.

(8) Healthwatch England must—

(a) lay before Parliament a copy of each report made under subsection (7), and

(b) send a copy of each such report to the Secretary of State.

(9) Healthwatch England may publish other reports at such times, and on such matters relating to health or social care, as it deems appropriate.

(10) Before publishing a report under subsection (7) or (9), Healthwatch England must, so far as practicable, exclude any matter which relates to the private affairs of an individual, the publication of which, in its opinion, would or might seriously and prejudicially affect that individual’s interests.

(11) In this section, “financial year” means—

(a) the period beginning with the date on which Healthwatch England is appointed and ending with the following 31 March, and

(b) each successive period of 12 months ending with 31 March.

(12) The first Chair and members of Healthwatch England shall be appointed by the Secretary of State for a period that shall expire no more than twelve months after Local Healthwatch organisations have been established.

(13) Prior to appointing the first Chair and members of Healthwatch England, the Secretary of State shall consult, and must have regard to the views of, such organisations that seem to him or her to represent the interests of users of health and social care provision.

(14) The first Chair and members of Healthwatch England shall make arrangements for their successors to be elected by local Healthwatch organisations on such a basis as shall be determined by Healthwatch England.

Page 175, line 17, leave out subsections (2) and (3) and insert—

“(2) Healthwatch England is to be appointed in accordance with regulations made by the Secretary of State.”

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 10, after “people” insert “, including children,”

Page 176, line 11, after “public” insert “, including children,”

Page 176, line 20, at end insert—

“( ) Care Quality Commission,”

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

Page 176, line 23, leave out “committee”

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

Page 176, line 25, leave out subsection (6)

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 29, leave out “The Commission” and insert “Healthwatch England”

Page 176, line 34, leave out “committee”

Page 176, line 37, leave out second “the”

Page 176, line 38, leave out “committee”

Page 176, line 39, leave out “Commission” and insert “Secretary of State”

Page 176, line 44, leave out “The committee” and insert “Healthwatch England”

Page 176, line 47, at end insert—

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

Page 177, line 1, leave out “The committee” and insert “Healthwatch England”

Page 177, line 5, leave out “The committee’s” and insert “Healthwatch England’s”

Page 177, line 20, at end insert—

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

Page 177, line 21, leave out from beginning to end of line 8 on page 178

Leave out Clause 178 and insert the following new Clause—

“Healthwatch England

(1) There is to be established a body corporate called Healthwatch England.

(2) The primary duty of Healthwatch England shall be to represent the interests of patients and users of national health services and social care services (hereafter known as “patients and users”) in relation to providers and to regulators and the Secretary of State.

(3) Healthcare England shall be independent of any provider of national health or social care services or of any Regulator of health or social care or of any other body established by this Act or otherwise.

(4) The Board of Healthwatch England shall consist of a chair appointed by the Secretary of State and no more than sixteen members to be appointed by the Secretary of State of whom eight shall be chosen from nominations obtained from Local Healthwatch organisations as constituted under section 179 and terms and conditions of appointment of the chair and members of the Board of Healthwatch England shall be determined by the Secretary of State.

(5) The Chief Executive of Healthcare England shall be appointed in the first instance by the Secretary of State and thereafter by the Board of Healthwatch England and shall be an employee of the Board of Healthwatch England and of no other National Health Service provider or any body established under this Act and terms and conditions of the chief executive officer shall be determined by the Secretary of State.

(6) The Board of Healthwatch England shall appoint such other staff on terms and conditions as it considers appropriate and such staff shall be employees of the Board of Healthwatch England and no of other health service provider or of any body established under this Act.”

Insert the following new Clause—

“Powers of Healthwatch England

(1) Healthwatch England shall have powers of investigation as prescribed in subsection (2) and (3) and powers to require disclosure of information as prescribed in subsection (4).

(2) Healthwatch England may investigate—

(a) a complaint made by or on behalf of a patient or user or a local Healthwatch organisation which appears to the Board to raise one or more issues of general relevance; and

(b) any matter which appears to the Board of Healthwatch UK to be or be related to a problem which affects or may affect patients or users generally or patients or users of a particular description.

(3) For the purpose of subsection (3) a complaint raises an issue of general relevance if it raises—

(a) a novel issue which affects or may affect patients or users in general or patients or users of a particular description, or

(b) any other issue which has or may have an important effect on patients or users generally or patients or users of a particular description.

(4) Healthwatch England may by notice require a person within subsection (5) to supply it with such information as is specified or described in the notice within a reasonable period as is so specified and the information so specified or described must be information that Healthwatch England requires for the purpose of exercising its function.

(5) The persons referred to in subsection (4) are—

(a) any provider of health or social care services licensed by the Care Quality Commission and Monitor under the provisions of this Act;

(b) the National Health Service Commissioning Board;

(c) Monitor;

(d) Care Quality Commission;

(e) any other person specified or of a description specified by the Secretary of State.

(6) If a person within subsection (5) fails to comply with a notice under subsection (4) the person must if so required give notice to Healthwatch England of the reason for the failure and if that reason for failure is not acceptable to the Board of Healthwatch England then the Board of Healthwatch England may take steps to publish the notice and the reasons for failure provided or to seek enforcement of the said notice through the courts.”

Insert the following new Clause—

“Functions of Healthwatch England

(1) The Board of Healthwatch England shall take steps to ensure the organisation can perform the following functions—

(a) an information function to acquire information on matters of concern to patients and users,

(b) a research function to analyse such information and produce reports, and

(c) a representation function to where appropriate make representations to persons prescribed in subsection (2).

(2) Persons prescribed for the purposes of subsection (1)(c) are—

(a) any person supplying services to the National Health Service or Social Care services,

(b) Monitor,

(c) Care Quality Commission,

(d) any other person specified or of a description specified by the Secretary of State,

(e) the Secretary of State.”

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

Page 179, line 14, at end insert—

“(1A) In subsection (2)(a), (b) and (c) after “people” insert “, including children,””

Page 179, line 16, leave out “the”

Page 179, line 17, leave out “committee of the Care Quality Commission”

Page 179, line 23, leave out “the”

Page 179, line 24, leave out “committee of the Care Quality Commission”

Page 179, line 25, leave out “that committee” and insert “Healthwatch England”

Page 179, line 29, leave out “that committee” and insert “Healthwatch England”

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.”

Page 180, line 16, at end insert—

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

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

Page 181, line 5, at end insert “ensuring that there is no upper limit on the length and type of advocacy support that may be provided”

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, leave out subsection (4)

Page 183, line 7, at end insert—

“(4A) In section 224(2)(c) of the Local Government and Public Involvement Act for “Primary Care Trusts” substitute “Clinical Commissioning groups”.”

Page 190, line 44, at end insert—

“( ) The assessment must include an examination of the levels of hazardous, harmful and dependent alcohol use in the local population.”

Page 191, line 21, at end insert—

“( ) involve representatives from alcohol services”

Page 191, line 25, leave out “may” and insert “must”

Page 192, line 20, at end insert—

“( ) a representative of education providers for persons resident in the area of the local authority, including maintained schools, city technology colleges, city college for technology or the arts, and Academy schools”

Page 192, line 23, at end insert—

“( ) a representative from alcohol and drugs service”

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

Page 193, line 37, leave out “may” and insert “must”

Page 193, line 40, leave out “may” and insert “must”

Page 194, line 7, 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;”

Page 194, line 17, at end insert—

“( ) 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.”

Insert the following new Clause—

“Health Service Ombudsman for England and Health Service Ombudsman for Wales

All patients receiving care from an organisation that receives any funding from the NHS shall have the right of complaint to the relevant health service ombudsman.”

Insert the following new Clause—

“Power to regulate health care support workers in England

(1) The Nursing and Midwifery Order 2001 (S.I. 2002/253) shall be amended to provide that all health care support workers in England shall be registered by the Nursing and Midwifery Council and regulated in accordance with the terms of that order.

(2) For the purposes of subsection (1), a health care support worker shall be an individual whose work is routinely delegated to them by a registered nurse or midwife or has a qualification in health and social care at level one (or higher) of the Qualifications and Credit Framework, in England.”

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;

(l) where a statutory register for public health specialists from backgrounds other than medicine does not exist, such a register shall be established by the Health Professionals Council.”

(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.”

Page 224, line 46, leave out “voluntary”

Page 224, line 47, leave out “voluntary”

Page 225, line 26, leave out “voluntary”

Page 225, line 29, leave out “voluntary”

Page 226, line 14, leave out “Voluntary”

Page 226, line 25, leave out “voluntary”

Page 226, line 42, at end insert—

“(c) to which section 205A(2) does not apply”

Page 227, line 17, leave out “voluntary”

Page 227, line 39, leave out “voluntary”

Page 227, line 40, leave out “voluntary”

Page 228, line 9, leave out “voluntary”

Page 228, line 15, leave out “voluntary”

Page 228, line 24, leave out “Voluntary”

Page 228, line 25, leave out “voluntary”

Page 229, line 4, leave out “voluntary”

Page 229, line 9, leave out “voluntary”

Page 229, line 10, leave out “voluntary”

Page 229, line 13, leave out “voluntary”

Page 229, line 14, leave out “voluntary”

Page 229, line 17, leave out “voluntary”

Page 229, line 19, leave out “voluntary”

Page 229, line 20, leave out “voluntary”

Page 229, line 25, leave out “voluntary”

Page 229, line 27, leave out “voluntary”

Page 229, line 31, leave out “voluntary”

Page 229, line 37, leave out “voluntary”

Page 230, line 27, leave out “voluntary”

Page 231, line 36, leave out “the desirability of”

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”

Page 232, line 13, at end insert “including for patients with long term conditions,”

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.”

The above-named Lords give notice of their intention to oppose the Question that Clause 236 stand part of the Bill.

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

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”

Page 241, line 33, at end insert—

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

Page 244, line 31, at end insert—

“(c) require any person mentioned in subsection (2) to provide it with any information necessary for the national clinical audits”

Insert the following new Clause—

“Repeal of section 141 of the Mental Health Act 1983

Section 141 of the Mental Health Act 1983 (members of Parliament suffering from mental illness) is repealed.”

Page 259, line 42, after “duty” insert “or are otherwise in conflict with each other or at significant risk of being in conflict with each other”

Page 260, line 22, at end insert “or may require one or more of the bodies concerned to exercise specified functions in a specified manner”

Page 265, line 28, after “means” insert “—

(a) ”

Page 265, line 30, at end insert “, or

(b) a subsidiary of a company which is formed under that section and wholly owned by the Secretary of State.”

Page 272, line 1, leave out “voluntary”

Page 272, line 3, leave out “voluntary”

Insert the following new Clause—

“Review of the operation of the Act

(1) Annually, the Secretary of State shall review the operation of this Act, publish a report on the review and lay the report before Parliament.

(2) If required by a Committee of either House, the Secretary of State must make available to both Houses of Parliament information necessary for the operation of this Act to be scrutinised.”