Health and Social Care Bill

Page 4, line 18, at end insert—

“( ) Each clinical commissioning group has the function of safeguarding the comprehensive provision of NHS services.”

Page 4, line 23, after “protection” insert “and promotion”

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 37, at end insert “in particular, public information and advice campaigns, especially those aimed at improving the levels of early diagnosis of serious conditions”

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 4, line 38, at end insert—

“( ) The Secretary of State shall commission and publish annually a report on the public health impacts of budget changes on the duty prescribed under this section.”

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 11, after “health” insert “and reduction of health inequalities”

Page 5, line 13, after first “the” insert “physical and mental”

Page 5, line 13, after “people” insert “and reducing health inequalities between people and between communities”

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

Page 5, line 13, at end insert “and shall, in doing so, take such steps as are appropriate to reduce health inequalities”

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

Page 5, line 15, after first “the”insert “physical and mental”

Page 5, line 15, after “people” insert “and reducing health inequalities between people and between communities”

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 18, at end insert “in particular, public information and advice campaigns, especially those aimed at improving the levels of early diagnosis of serious conditions”

Page 5, line 21, at end insert—

“( ) providing training and support for parents or prospective parents who are or who are likely to be caring for a young child under the age of 5;”

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 23, at end insert—

“( ) providing services to improve communication skills in children and adults;”

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 32, at end insert—

“( ) Such steps shall include, but not be restricted to, the following public health issues—

(a) sexual health;

(b) obesity;

(c) nutrition;

(d) alcohol and substance abuse;

(e) air and water quality;

(f) adequate housing standards;

(g) fuel poverty;

(h) occupational health.”

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 5, line 35, at end insert—

“( ) The Secretary of State shall commission and publish annually a report on the public health impacts of budget changes on the duty prescribed under this section.”

Page 5, line 38, leave out from “England” to end of line 39

Page 5, line 42, at end insert—

“( ) Nothing in this section shall relieve district councils from the duty required by statute to discharge responsibilities pertaining to or impacting upon public health.”

Insert the following new Clause—

“Chief Environmental Health Officer for England

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

(2) 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 section 2A of the National Health Service Act 2006 and the duties referred to in section 2B of that Act.

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

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 12, at end insert—

“( ) In making arrangements in accordance with subsection (1), each commissioning consortium may arrange for the provision of such services or facilities as it considers appropriate for the purposes of the health service that relate to providing—

(a) housing or housing related support,

(b) education and employment,

(c) transport and leisure services, and

(d) other health-related services.”

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 28, at end insert—

“( ) the assessment of pre-school age children’s communication skills;”

Page 7, line 29, at end insert—

“( ) specialist services for rare conditions”

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)””

Page 9, line 38, after “group” insert “or local authority”

Page 10, line 10, after “group” insert “or local authority”

Page 10, line 20, after “group” insert “or local authority”

Page 10, line 22, after “group” insert “or local authority”

Page 10, line 31, leave out subsection (13)

Page 11, line 16, after “authority” insert “or two or more authorities acting jointly”

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”

[Withdrawn]

Page 13, line 6, at end insert—

“(d) for integrated care partnership with local authorities.”

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 32, at end insert—

“(5A) Regulations must also secure procedures for the Board to require clinical commissioning groups not to appoint to the Board or a sub-committee of a clinical commissioning group any person who is an employee or a share-holder of a commissioning support organisation.”

Page 13, line 33, leave out “may” and insert “shall”

[Withdrawn]

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—

“( ) 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.”

Insert the following new Clause—

“Public Health England

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

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

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 5, at end insert “and the objectives specified under paragraph (a) include objectives relating to preparation and support for parents caring for one or more children under 5”

Page 16, line 5, at end insert—

“( ) The Secretary of State must consider, in drawing up the mandate, the desirability of public health information and advice campaigns, especially those aimed at improving the levels of early diagnosis of those serious conditions whose treatment is likely to benefit significantly from such improved early diagnosis.”

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 28, at end insert—

“( ) the Secretary of State for Education”

Page 16, line 30, at end insert—

“and must publish the results of such consultation”

Page 16, line 30, at end insert—

“( ) If, within 60 parliamentary days of the mandate having been laid—

(a) either House of Parliament makes a recommendation with regard to the proposal, or

(b) a committee of either House of Parliament makes recommendations with regard to the proposal,

the Secretary of State must lay before Parliament a statement setting out the Secretary of State’s response to the resolution or recommendations.”

Page 17, line 9, at end insert—

“( ) consult Healthwatch England.”

Page 17, line 11, at end insert—

“13C1 Duty as to representation

The Board must ensure that the governing bodies of all clinical commissioning groups comply with the minimum requirements for the representation of clinical and non-clinical persons including nurses and secondary care doctors.”

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 14, at end insert—

“13DA Duty as to commissioning of services

In carrying out its duties in respect of the commissioning of services, the Board must, in the exercise of its functions, have regard to the interdependency of services and the impact that the arrangements for the provision of one service may have on the financial and clinical sustainability of other services.”

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, leave out lines 33 and 34 and insert—

“(5) In discharging its duty under subsection (1), the Board must publish guidance for clinical commissioning groups that includes the option to opt out and explains the extent of compliance with—

(a) the quality standards prepared by NICE under section 231 of the Health and Social Care Act 2011;

(b) indicators included within the NHS Outcomes Framework; and

(c) minimum standards set by the Board on patient related outcomes measures.”

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

Page 17, line 34, at end insert—

“( ) In discharging its duty under subsection (1), in relation to specialised services, the Board must exercise its functions in accordance with current NICE guidance.”

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 7, at end insert—

“( ) reduce inequalities in health status, outcomes and experience between people and between communities in England”

Page 18, line 7, at end insert—

“( ) In having regard to inequalities, the Board 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 and belief;

(h) gender;

(i) sexual orientation;

(j) geographical variation;

(k) socio-economic variation.”

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 “, including the commissioning decisions of clinical commissioning groups”

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 18, after “persons” insert “from all relevant healthcare providers”

Page 18, line 21, at end insert—

“( ) medicine, nursing, dentistry, pharmacy, ophthalmology, and allied health professional work”

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 24, after “provision” insert “and commissioning”

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

Page 18, line 26, after “may” insert “establish an innovation fund as part of its direct commissioning responsibilities and”

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”

[Withdrawn]

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, after “services” insert “including any public information and advice campaigns”

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 4, at end insert—

“( ) The local presence of the Board must be sufficient to support such integration.”

Page 19, line 19, after “health” insert “and social care”

Page 19, line 25, at end insert—

“( ) The Board must report bi-annually to the Secretary of State on how the Board has discharged its duty to promote integration.”

Page 19, line 25, at end insert—

“( ) Under its duty to encourage integrated working, the Board may encourage the establishment of pilot integrated care pathways for persons who experience the worst inequalities in access to health care.”

Page 19, line 33, at end insert—

“13M1 Duty to promote collaboration

The Board must, in the exercise of its functions, promote collaboration between those regulating and commissioning health and social care services.”

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 1, at end insert—

“( ) The Board must ensure that in relation to its duties under sections 13C to 13N, those persons in the private sector contracted to provide health services must contribute in the same way as public providers towards the achievements of those duties.”

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 “with” insert “accessible”

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 23, at end insert—

“13O1 Duty to monitor and publish information on NHS complaints

(1) The Board must establish and operate systems for collecting and analysing information relating to complaints about services provided by the health service in England.

(2) The Board must make information collected by virtue of subsection (1) and any other information obtained by analysing it, available to the general public.

(3) The Board must establish and operate systems for collecting and analysing information relating to complaints about commissioning decisions made by the Board and clinical commissioning groups.

(4) The Board must make information collected by virtue of subsection (3) and any other information obtained by analysing it, available to the general public.”

Page 20, line 24, leave out from beginning to end of line 2 on page 21

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 17, at end insert “draft”

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

Page 21, line 20, after first “The” insert “draft”

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

Page 21, line 24, after first “The” insert “draft”

Page 21, line 26, at end insert—

“( ) The Board must—

(a) lay the business plan before Parliament, and

(b) once it has done so, send a copy to the Secretary of State.”

Page 21, line 26, at end insert—

“( ) The Board must lay the draft business plan before Parliament.”

Page 21, line 27, at end insert “following public consultation”

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 “, 13K”

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

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

Page 21, line 39, at end insert—

“( ) how effectively the NHS services meet the needs of the older population”

Page 21, line 39, at end insert—

“( ) how it discharged its functions under sections 13H, 13I and 13J and empowered patients”

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 24, line 19, at end insert “and is made with the agreement of that individual or of a person having legal responsibility for that individual’s care”

Page 24, leave out lines 24 and 25

Page 24, line 31, at end insert—

13Z2A Duty to reduce bureaucracy

(1) The Board must exercise its functions so as to reduce administrative costs in the NHS.

(2) For that purpose the Board must exercise its functions under sections 14A and 14C so as to ensure that at no time there exists more clinical commissioning groups than there were primary care trusts on 1 April 2011.”

Page 27, leave out line 35

Page 28, line 19, at end insert—

“223EA Financial duties of the Board: administrative costs

(1) The Board must direct clinical commissioning groups to ensure that their expenditure on administrative costs does not exceed a prescribed percentage of their resource.

(2) The Board must ensure that the total national expenditure by clinical commissioning groups on administrative costs in any financial year from April 2014 does not exceed 55 per cent of total expenditure on administrative costs by primary care trusts in the financial year 2009-2010.”

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 36, leave out “or wishes to be”

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

Page 29, line 45, at end insert—

“( ) Before the Board considers any application, it must have been subject to consultation with—

(a) the general public;

(b) the relevant local authority;

(c) the relevant Health and Wellbeing Board;

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

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 31, at end insert—

“( ) Before granting an application, the Board must have consulted—

(a) the general public;

(b) the relevant local authority;

(c) the relevant Health and Wellbeing Board;

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

Page 30, line 37, at end insert—

“( ) Regulations made under this section may not be made unless a draft of the instrument had been laid before, and approved by a resolution of, each House of Parliament.”

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 31, leave out line 8 and insert—

“(3) The Board must, after consultation, determine and publish criteria—”

Page 31, line 14, at end insert—

“( ) Regulations made under this section may not be made unless a draft of the instrument had been laid before, and approved by a resolution of, each House of Parliament.”

Page 31, line 31, at end insert—

“( ) the general public;

( ) the relevant local authority;

( ) the relevant Health and Wellbeing Board; and

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

Page 31, line 37, at end insert—

“( ) Regulations made under this section may not be made unless a draft of the instrument had been laid before, and approved by a resolution of, each House of Parliament.”

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 32, line 12, at end insert—

“( ) Before the Board considers any application, it must have been subject to consultation with—

( ) the general public;

( ) the relevant local authority;

( ) the relevant Health and Wellbeing Board;

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

Page 32, line 17, at end insert—

“( ) No dissolution can be made before consultation has taken place with—

( ) the general public;

( ) the relevant local authority;

( ) the relevant Health and Wellbeing Board;

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

Page 32, leave out line 18 and insert—

“(2) The Board must, after consultation, determine and publish criteria—”

Page 32, line 24, at end insert—

“( ) Regulations made under this section may not be made unless a draft of the instrument had been laid before, and approved by a resolution of, each House of Parliament.”

Page 32, line 27, after “may” insert “after consultation”

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”

[Withdrawn]

Page 33, leave out lines 16 to 44 and insert—

“( ) Schedule (Clinical Commissioning Group governance arrangements) has effect.”

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”

Page 34, line 30, at end insert—

“( ) individuals from specialist services from the areas covered by the clinical commissioning group;”

Page 34, line 30, at end insert—

“( ) individuals who are qualified public health specialists;”

Page 34, line 31, after “persons” insert “, including how such lay persons are recruited and remunerated”

Page 34, line 41, at end insert—

“( ) Regulations must specify the arrangements whereby the governing body of a clinical commissioning group must include—

(a) a representative of district councils in two-tier areas;

(b) the Director of Public Health, or his or her representative.”

Page 34, line 41, at end insert—

“( ) Regulations must specify the arrangements whereby the governing body of a clinical commissioning group must include—

(a) a lay chair appointed by the NHS Commissioning Board;

(b) a lay vice-chair appointed by the NHS Commissioning Board;

(c) a lay member appointed by the relevant local authority;

(d) other lay members appointed by the NHS Commissioning Board.

( ) The total number of lay members must be more than the number of other members.”

Page 35, line 20, at end insert—

“( ) Regulations may make provision as to how clinical commissioning groups will deal with conflicts of interests of members or employees of the clinical commissioning group.

( ) In particular, a clinical commissioning group cannot commission services from a member of the clinical commissioning group nor promote the services of private sector.”

Insert the following new Schedule—

1 The persons who may become or continue as patient members of a clinical commissioning group are individuals who are on the medical list of providers of primary medical services who are encompassed within a clinical commissioning group.

2 An individual who is eligible to be a patient member may do so on application to the clinical commissioning group.

3 The constitution may provide for an individual to become a member of the clinical commissioning group, unless he or she informed the clinical commissioning group that he or she does not wish to do so.

4 A clinical commissioning group has a board of governors.

5 The members of the board of governors other than appointed members must be chosen by election.

6 Regulations may make provision as to the term of office and eligibility for re-election for elected members of the board of governors.

7 The constitution must provide for the chairman of the clinical commissioning group or (in his or her absence) another person to preside at meetings of the board of governors.

8 The constitution must provide for meetings of the board of governors to be open to members of the public.

9 The constitution may provide for members of the public to be excluded from a meeting for special reasons.

10 The constitution may make further provisions.

11 A clinical commissioning group shall have a board of directors.

12 The constitution must provide for all the powers of the clinical commissioning group to be exercisable by the board of directors on its behalf.

13 But the constitution may provide for any of those powers to be delegated to a committee of directors or to an executive director.

14 (1) The board consists of—

(a) executive directors, one of whom is the chief executive (and accounting officer) and another the finance director,

(b) non-executive directors, one of whom is chairman.

(2) One of the executive directors must be a registered medical director and another must be a registered nurse or registered midwife.

(3) One of the non-executive directors must be appointed from the relevant local authority.

15 It is for the board of governors at a general meeting to appoint or remove the chairman and other non-executive directors of the clinical commissioning group board.

16 Removal of a non-executive director under paragraph 4(1) requires the approval of three-quarters of the board of governors.

17 It is for the non-executive directors to appoint or remove the chief executive.

18 It is for a committee consisting of the chairman, the chief executive and other non-executive directors to appoint or remove the executive directors.

19 The appointment of a chief executive requires the approval of the board of governors.”

[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 35, line 41, at end insert—

“( ) promote awareness of the NHS Constitution amongst providers of primary medical services within the clinical commissioning group”

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 3, at end insert—

“( ) Each clinical commissioning group must assist and support the NHS Commissioning Board in discharging its responsibilities under section 13D for securing effectiveness, efficiency and economy in the provision of primary medical services.”

Page 36, line 3, at end insert—

“14PA Duty as to commissioning services

In carrying out its duties in respect of the commissioning of services, each commissioning consortium must, in the exercise of its functions, have regard to the interdependency of services and the impact that the arrangements for the provision of one service may have on the financial and clinical sustainability of other services.”

[Withdrawn]

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 19, at end insert—

“( ) In discharging its duty, each clinical commissioning group must ensure that primary medical services comply with NICE guidance.”

Page 36, line 22, after “to” insert—

“( ) promoting integration between primary and secondary care;

( ) defining the core clinical duties of primary medical services, particularly in public health, in the diagnosis and management of disease and in the management of long-term conditions;

( ) defining the responsibilities of primary medical services to provide or ensure promotion of integrated health services that are available at all times;”

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 30, at end insert—

“( ) reduce inequalities in health status, outcomes and experience between people and between communities in their area, and in England”

Page 36, line 30, at end insert—

“( ) In having regard to inequalities, each clinical commissioning group 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 and belief;

(h) gender;

(i) sexual orientation;

(j) geographical variation;

(k) socio-economic variation.”

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 36, leave out “may” and insert “must”

Page 36, line 38, leave out “have regard to” and insert “implement”

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 36, line 43, at end insert “including primary medical services”

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

Page 37, line 3, after “persons” insert “from all relevant healthcare providers”

Page 37, line 6, at end insert—

“( ) A clinical commissioning group must consult each local Health and Wellbeing Board for the area it serves on the exercise of its functions, and must provide each such Board with any information it requests excluding any personal data.”

Page 37, line 6, at end insert—

“( ) In so doing, the clinical commissioning group must—

(a) seek views of all appropriate clinical groups through the commissioning process,

(b) establish a procedure for reconciling different professional perspectives, and

(c) seek agreement of non-GP professional groups in case of significant service changes.”

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 17, leave out “have regard to the need to”

Page 37, line 19, at end insert—

“( ) the use of information derived from patients for research purposes while taking full account of the confidentiality of such information”

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 29, at end insert—

“( ) improve communication skills in children and young people”

Page 37, line 29, at end insert—

“( ) reduce duplication and increase collaboration between primary and secondary care”

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

Page 37, line 32, after second “services” insert “or education or children’s services”

Page 37, line 40, at end insert—

“( ) reduce duplication and promote collaboration between care providers.”

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 patients and 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 patients and 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 2, at end insert—

“14Y1 Duty to ensure the priorities of local Health and Wellbeing strategies

Each clinical commissioning group must ensure their commissioning plans address the priorities of the joint Health and Wellbeing strategies of the relevant local authorities.”

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 12, after “with” insert “accessible”

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 24, at end insert—

“( ) in decisions of the groups effecting the operation of primary medical services”

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 4, at end insert—

“( ) Payments to voluntary organisations should be equal to or exceed the overall level of payments made by predecessor Primary Care Trusts.”

Page 40, line 32, at end insert “subject to section 13E”

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, leave out lines 12 to 26

Page 41, line 13, leave out “or” and insert “and”

Page 41, line 16, after “assistance,” insert—

“(aa) building and supporting capabilities,”

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 42, line 34, at end insert—

“( ) The clinical commissioning group must also consult—

(a) the general public,

(b) the relevant local authority, and

(c) patients on the list of primary medical service providers within the clinical commissioning group.”

Page 42, line 35, leave out “involve” and insert “obtain the agreement of”

Page 42, line 36, at end insert—

“( ) The clinical commissioning group must involve each relevant Health and Wellbeing Board in preparing or revising the plan.”

Page 43, leave out lines 1 to 10

Page 43, line 38, at end insert—

“( ) No commissioning plan can be agreed or revised by a clinical commissioning group without the consent of the relevant Health and Wellbeing Board.

( ) If the clinical commissioning group and the Health and Wellbeing Board fail to agree, the NHS Commissioning Board will decide whether to publish or vary the plan.”

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 24, after “14V” insert “, 14Y”

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 46, leave out line 7 and insert—

“14Z19 Power on failure or potential failure of clinical commissioning groups”

Page 47, line 28, at end insert—

“( ) the relevant Health and Wellbeing Boards,”

Page 47, line 28, at end insert—

“( ) patients receiving medical primary services from providers within the clinical commissioning group,”

Page 48, line 29, at end insert—

“14Z21A Declaration of financial interests

A person who is a provider of primary medical services must declare any financial interest that person may have in a commissioning decision by a clinical commissioning group of which he or she is a member and must absent him or herself from the making of any such decision.”

Page 50, line 17, at end insert—

“( ) relevant inequalities”

Page 50, line 37, at end insert—

“( ) The Board must publish each year details of the methodology used to determine allocations to clinical commissioning groups.”

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 7, leave out from “spent” to end of line 9 and insert “(which must be for the benefit of patients served by the relevant clinical commissioning group)”

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.”

Insert the following new Clause—

“Clinical senates

(1) There are to be bodies corporate known as clinical senates.

(2) Each clinical senate has the function of supporting the better integration of services in each area of the country.

(3) Each clinical senate has the function of establishing and maintaining a system of the re-validation of doctors within their area.

(4) Each clinical senate must appoint a proper officer.

(5) Each clinical senate has the function of maintaining a system of clinical governance within clinical commissioning groups.

(6) Each clinical senate has the function of establishing and maintaining a system of clinical networks in their area.

(7) No clinical commissioning group can be authorised without the consent of the relevant clinical senate.

(8) No commissioning plan of a clinical commissioning group can be agreed without the consent of the relevant clinical senate.”

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 6, at end insert—

“( ) The individual so appointed must—

(a) be appointed according to the statutory process for appointments of directors of public health within the NHS,

(b) be a member of an appropriate professional register, and

(c) report directly to the council chief executive.”

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

Page 56, line 27, leave out “consult” and insert “receive the agreement 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.”

Page 57, line 9, at end insert—

“( ) A local authority must consult relevant voluntary aid societies when discharging its functions under section 73A(4)(d).”

Page 58, line 11, at end insert—

“(3) This section comes into force on a date to be specified by order by the Secretary of State.

(4) The time specified in subsection (3) must be after such time as the Secretary of State is satisfied that all duties and functions of Strategic Health Authorities are being fulfilled by another body.”

The above-named Lords give notice of their intention to oppose the Question that Clause 30 stand part of the Bill.

The above-named Lords give notice of their intention to oppose the Question that Clause 31 stand part of the Bill.

Leave out Clause 37 and insert the following new Clause—

“After-care

(1) Section 117 of the Mental Health Act 1983 (after-care) is amended as follows.

(2) In subsection (2)—

(a) after “duty of the” insert “clinical commissioning group or”,

(b) omit “Primary Care Trust or” in each place it appears,

(c) for “such time as the” substitute “such time as (in relation to England) the clinical commissioning group or”.

(3) After subsection (2C) insert—

“(2D) Subsection (2) above, in its application to the clinical commissioning group, has effect as if for “to provide” there were substituted “to arrange for the provision of”.

(2E) The Secretary of State may by regulations provide that the duty imposed on the clinical commissioning group by subsection (2) above is, in the circumstances or to the extent prescribed by the regulations, to be imposed instead on another clinical commissioning group or the National Health Service Commissioning Board.

(2F) Where regulations under subsection (2E) above provide that the duty imposed by subsection (2) above is to be imposed on the National Health Service Commissioning Board, subsections (2D) and (2E) above have effect as if references to the clinical commissioning group were references to the National Health Service Commissioning Board.

(2G) Section 272(7) and (8) of the National Health Service Act 2006 applies to the power to make regulations under subsection (2E) above as it applies to a power to make regulations under that Act.”

(4) In subsection (3)—

(a) after “section “the” insert “clinical commissioning group or”,

(b) omit “Primary Care Trust or” in each place it appears, and

(c) after “means the”, in the first place it appears, insert “clinical commissioning group or”.

(5) In consequence of the repeals made by subsections (2)(b) and (4)(b), omit paragraph 47 of the Schedule 2 to the National Health Service Reform and Health Care Professions Act 2002.”

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;”.”

Insert the following new Clause—

“Criteria of impaired decision-making for supervised community treatment

In section 17A of the Mental Health Act 1983 (community treatment orders) after subsection (5)(a) insert—

“( ) that because of his mental disorder, his ability to make decisions about the provision of medical treatment is significantly impaired;”.”

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.”

[Withdrawn]

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 289, line 35, at end insert—

“( ) This general power does not affect Chapter 1 of Part 7 (pharmaceutical services).”

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 299, line 21, at end insert—

“(2B) Prior to the Board concluding any arrangements for the provision of primary medical services by any person under subsection (2), including any contractual arrangements with any person other than a general medical services contract under section 84 of this Act, the Board shall—

(a) disclose the nature of the proposed arrangements for the provision of primary medical services to each of the Health and Wellbeing Boards for the area in which the primary medical services are due to be provided under the proposed arrangements (referred in this section as a “relevant Health and Wellbeing Board”);

(b) provide any further information in relation to the proposed arrangements which is sought in writing by each relevant Health and Wellbeing Board;

(c) obtain the written consent from each relevant Health and Wellbeing Board to the proposed arrangements;

(2C) In the event that the Secretary of State certifies that in his or her opinion consent for the arrangements is being unreasonably withheld or refused by any relevant Health and Wellbeing Board, the Secretary of State shall be entitled to give a direction to the Board to enter into arrangements notwithstanding the absence of consent by the relevant Health and Wellbeing Board.

(2D) The direction making power under subsection (2C) shall not be delegated by the Secretary of State to any person apart from a Minister of State.

(2E) Unless the Board considers that it is necessary to make interim arrangements to provide short term emergency primary medical services in a particular area or the Secretary of State has given a direction under subsection (2C), no primary care medical services shall be provided by any person under subsection (2) until each relevant Health and Wellbeing Board has provided its consent to the proposed arrangements.”

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

[Withdrawn]

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 with a management board with an independent chairman and at least three non-Executive Directors with expertise in its functions selected by the Department’s Chief Scientific Adviser.

( ) In allocating these functions the Secretary of State shall ensure that staff of the Executive Agency should have freedom to secure and discharge external research contracts.”

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

Page 85, line 2, at end insert—

“( ) Any function conferred on the appropriate authority by this section may be performed by either the Secretary of State or the Department of Health, Social Services and Public Safety in Northern Ireland acting alone or both of them acting jointly (and references in this section to the appropriate authority are to be construed accordingly).”

Page 85, leave out lines 4 to 6

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—

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

(1) 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.”

Insert the following new Clause—

“Charges to overseas visitors

(1) The National Health Service (Charges to Overseas Visitors) Regulations 2011 (S.I. 2011/1556) is amended as follows.

(2) In regulation 6 (services exempted from charges) for paragraph (e) substitute—

“(e) the diagnostic test for evidence of infection with the Human Immunodeficiency Virus (HIV) and counselling associated with that test and its result;

(ea) all other services for the treatment of HIV provided to an overseas visitor who has been present in the United Kingdom for a period of not less than six months preceding the time when services are provided;

(eb) treatment for sexually transmitted infections other than HIV;”.”

Page 361, line 24, at end insert—

“( ) The first Chief Executive of Monitor is to be appointed by the Secretary of State.”

Page 361, line 25, leave out “The chief executive and”

Page 364, line 26, at end insert—

(1) The Secretary of State may require Monitor to provide the Secretary of State with such information as the Secretary of State considers it necessary to have.

(2) The information must be provided in such form, and at such time or within such period, as the Secretary of State may require.”

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 13, after “services” insert “and adult social care services”

Page 87, line 14, after “services” insert “and adult social care 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 18, at end insert “and adult social care services”

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

Page 87, line 19, after “to” insert “promoting collaboration and”

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

Page 87, line 20, after “services” insert “and adult social care services”

Page 87, line 20, leave out from “services” to end of line 22 and insert “where it considers that preventing such behaviour would—

(a) improve—

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

(ii) the efficacy of the provision of those services;

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

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

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 22, at end insert “and adult social care services”

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

Page 87, line 32, after “services” insert “and adult social care services”

Page 87, line 35, after “services” insert “and adult social care services”

Page 87, line 39, after “services” insert “and adult social care services”

Page 87, line 41, at end insert “and adult social care services”

Page 88, line 7, after “services” insert “and adult social care services”

Page 88, line 10, at end insert “and Monitor must obtain advice from Healthwatch England for enabling if effectively to discharge that function”

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

Page 88, line 15, after “2006),” insert—

“(aa) public and patient involvement,”

Page 88, line 16, at end insert—

“( ) the management of a wide range of complex clinical conditions”

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

Page 88, line 21, after “services” insert “and adult social care services”

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 26, at end insert—

“( ) Monitor must report annually to the Secretary of State on how it has discharged its duty to promote integration.”

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

Page 89, line 21, at end insert—

“(5) The regulations under this section must not be made unless a draft of the statutory instrument containing them has been laid before Parliament and approved by a resolution of each House of Parliament.”

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

Page 89, line 26, after “services” insert “provided”

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 89, line 45, at end insert—

“( ) the need to secure and protect the education and training of the future healthcare workforce,”

Page 90, line 16, at end insert “with a paramount duty towards the safety of people who use health care services”

Page 90, line 16, at end insert “and imposes the least burden on providers”

Page 90, line 26, leave out subsection (3)

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

Page 90, line 35, at end insert—

“(4A) Where Monitor concludes that it is unable to secure the resolution of a conflict it must publish a statement setting out—

(a) the nature of the conflict;

(b) the matters which it considers to be significant to its resolution; and

(c) the reasons why it has been unable to resolve the conflict.”

Page 90, line 45, at end insert—

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

Page 90, line 45, at end insert—

“( ) a matter likely to have significant impact on the need to secure and protect the education and training of the future healthcare workforce or the need for high standards in the education and training of healthcare professionals who provide services for the purposes of the NHS”

Page 90, line 46, after “(4)” insert “or (4A)”

Page 91, line 1, after “(4)” insert “or (4A)”

Page 91, line 2, at end insert—

“(7A) Where Monitor is required to publish a statement under subsection (4A), it must submit the statement to the Secretary of State for resolution of the conflict.

(7B) Where the Secretary of State has received a statement under subsection (7A), the Secretary of State must direct Monitor as to how to resolve the conflict and must publish a statement giving notice of his or her direction as soon as is reasonably practicable.”

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”

Page 95, line 44, at end insert—

“(d) ensure that health services are integrated where that is in the interests of people who use such services.”

Page 95, line 44, at end insert—

“(d) ensure consistent healthcare provision through the quality assurance of education and training, a requirement to follow the NHS Outcomes Framework, utilisation and support of medical research and innovation and the adoption of professional guidelines in the event of complications following treatment.”

Page 96, line 19, at end insert “or (d)”

Page 368, line 12, leave out from “contains” to the end of line 14 and insert “information which it is satisfied is—

(a) commercial information the disclosure of which would, or might, significantly harm the legitimate business interests of the person to whom it relates;

(b) information relating to the private affairs of an individual the disclosure of which would, or might, significantly harm that person’s interests.”

Page 98, line 7, after “(1)(a)” insert “, (1)(b) or revised guidance under subsection (4)”

Page 98, line 10, after “(b)” insert “or revised guidance under subsection (4)”

Page 98, line 25, at end insert—

“( ) The cases referred to in subsections (2) and (3) shall be (in so far they would not otherwise be) “relevant merger situations” for the purposes of Part 3 of the Enterprise Act 2002.”

Insert the following new Clause—

“Public interest consideration

In section 58 of the Enterprise Act 2002 (specified considerations), after subsection (2C) insert—

“(2D) The interest of the promotion in the United Kingdom of a comprehensive health service is specified in this section.

(2E) For the purposes of subsection (2D) a “comprehensive health service” means a health service—

(a) designed to secure the improvements set out in section 1(1) of the National Health Service Act 2006; and

(b) that is free of charge at the point of delivery except as specified in section 1(3) of that Act.””

Page 98, line 28, leave out “development” and insert “occurrence”

Page 99, line 2, at end insert—

“( ) Healthwatch England.”

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.

Page 101, line 10, after “considers” insert “would or”

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 102, line 39, leave out “28” and insert “90”

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 13, leave out “National Health Service Commissioning Board” and insert “NHS Commissioning Board Authority”

Page 107, line 14, leave out “clinical commissioning group” and insert “Primary Care Trust”

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

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

“( ) Healthwatch England”

Page 107, line 20, at end insert “which must—

“( ) state services to be provided by primary medical services,

( ) include a duty of collaboration across all health and social care providers,

( ) facilitate staff involvement in local and national work for the wider benefit of healthcare services and patients,

( ) promote education and training, at undergraduate and postgraduate level, relevant to the service provided”

Page 107, line 22, at end insert—

“( ) If, at the time Monitor discharges the function under subsection (7), the day specified by the Secretary of State for the purposes of section 14A of the National Health Service Act 2006 has passed or section 6 or 178 has come into force—

(a) in the case of section 14A of the National Health Service Act 2006, the reference in subsection (8)(c) to every Primary Care Trust is to be read as a reference to every clinical commissioning group;

(b) in the case of section 6, the reference in subsection (8)(b) to the NHS Commissioning Board Authority is to be read as a reference to the National Health Service Commissioning Board;

(c) in the case of section 178, the reference in subsection (8)(d) to the Care Quality Commission is to be read as including a reference to its Healthwatch England committee.”

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

“( ) Healthwatch England”

Page 108, line 16, at end insert—

“( ) for the purpose of encouraging the integration of services where such integration is in the interest of people who use such services;”

Page 108, line 21, at end insert “provided for the purposes of the NHS”

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

Page 108, line 42, at end insert—

“( ) requiring the licence holder to abide by the seven general principles of public life set out in the First Report of the Committee on Standards in Public Life (Cm 2850),

( ) requiring the declaration of any financial interest the licence holder may have in a commissioning decision by a clinical commissioning group,”

Page 108, line 42, at end insert—

“( ) requiring the licence holder to hold indemnity, for the services provided, which will remain valid for the lifetime of patients treated,

( ) requiring the licence holder to have registered competencies in the service being provided,”

Page 109, line 9, at end insert “ orfor the purposes of encouraging the integration of services in the interest of people who use such services”

Page 109, line 38, after “NHS” insert “in order to ensure the continued provision of one or more of the health care services that the licence holder provides for those purposes”

Page 109, line 40, at end insert “in order to ensure the continued provision of one or more of the health care services that the licence holder provides for those purposes”

Page 109, line 42, leave out subsection (3)

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

“( ) “Healthwatch England”

Page 111, line 12, leave out “28” and insert “90”

The above-named Lords give notice of their intention to oppose the Question that Clause 99 stand part of the Bill.

Page 372, line 26, after “are” insert “not”

Page 373, line 26, after “considers” insert “would or”

Page 373, line 29, after “considers” insert “would or”

Page 115, line 10, at end insert “or the conditions of a particular licence”

Page 378, line 35, leave out from “contains” to the end of line 37 and insert “information which it is satisfied is—

(a) commercial information the disclosure of which would, or might, significantly harm the legitimate business interests of the person to whom it relates;

(b) information relating to the private affairs of an individual the disclosure of which would, or might, significantly harm that person’s interests.”

Page 118, line 5, leave out from “include” to the end of line 7 and insert “information which it is satisfied is—

(a) commercial information the disclosure of which would, or might, significantly harm the legitimate business interests of the person to whom it relates;

(b) information relating to the private affairs of an individual the disclosure of which would, or might, significantly harm that person’s interests.”

Page 118, line 31, leave out subsection (2)

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 8, at end insert—

“( ) If a health care service is awaiting inclusion in the national tariff, the provider of the health care service can apply to the National Commissioning Board for the service to be included within the innovation tariff in accordance with section 114(1)(e).”

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 22, at end insert—

“(e) the method of deciding whether a health care service can be included within the innovation tariff.”

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

Page 122, line 27, at end insert—

“( ) The national tariff must also—

( ) specify variations to the national price for a service by reference to the circumstances relating to individuals who experience disadvantage or who have complex needs,

( ) specify variations to the national price for a service by reference to circumstances in which the service is provided or other factors relevant to the provision of the service,

( ) provide for rules for determining the price payable for the provision for the purposes of the NHS of health care services and health-related services which are not specified under subsection (1)(a).”

Page 122, line 33, at end insert—

“( ) In exercising its functions under this Chapter, Monitor and the National Commissioning Board must have regard to the latter’s Board’s duties under section 13M of the National Health Service Act 2006 and clinical commissioning groups’ duties under section 14Y of that Act.”

Page 123, line 24, leave out subsection (11)

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 124, line 14, leave out subsection (4)

Page 124, line 38, after “holder,” insert—

“( ) relevant clinical groups,”

Page 125, line 26, leave out “guidance” and insert “such guidance as Monitor proposes to provide for in the national tariff”

Page 127, line 15, leave out “Competition Commission” and insert “Secretary of State”

Page 127, line 28, after “holders” insert “undertaking work of comparable complexity”

Page 127, line 31, leave out “Competition Commission” and insert “Secretary of State”

Page 127, line 34, leave out subsection (5)

Page 380, line 5, leave out from “each” to end of line 6 and insert “objector”

Page 380, line 7, at end insert—

“( ) In this Schedule, “objector” means—

(a) in relation to a reference made where the condition in section 118(2)(a) is not met, each clinical commissioning group who objected to the proposed method to which the reference relates, and

(b) in relation to a reference made where the condition in section 118(2)(b) or (c) is not met, each licence holder who objected to that proposed method.”

Page 382, line 8, at end insert—

“( ) The Competition Commission must give notice to each objector who has made representations in accordance with paragraph 2 of the time and place at which an oral hearing is to be held.”

Page 382, line 22, leave out “entitled to give evidence at the hearing” and insert “present at the hearing and comes within sub-paragraph (5)”

Page 382, line 24, leave out second “is not” and insert “cannot be”

Page 382, line 26, leave out from “not” to “, and” in line 27 and insert “obliged to require the person to attend the hearing”

Page 128, line 4, after “by” insert “clinical commissioning groups or”

Page 128, line 38, after “such” insert “clinical commissioning groups or”

The above-named Lords give notice of their intention to oppose the Question that Clause 119 stand part of the Bill.

The above-named Lords give notice of their intention to oppose the Question that Clause 120 stand part of the Bill.

Page 129, line 28, after “are” insert “not”

The above-named Lords give notice of their intention to oppose the Question that Clause 121 stand part of the Bill.

Page 130, line 23, at end insert “and ensure that all providers licensed under Chapter 3 and operating in relevant clinical commissioning groups are paid the same price for the provision of the service”

Page 132, line 21, at end insert—

“( ) protect the interests of patients,”

Page 134, line 46, at end insert “or (b)”

Page 136, line 40, after “provider” insert “of health care services for the purposes of the NHS (referred to in this Chapter as “a provider”)”

Page 139, line 44, at end insert “(but for this not to affect any other method of recovery)”

Page 141, line 6, leave out second “that” and insert “the current financial year”

Page 141, line 25, leave out “the rate of levy” and insert “those factors”

Page 143, line 38, at end insert “(but this does not affect any other method of recovery)”

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 159, line 16, at end insert—

“( ) before “purpose” insert “exclusive”,

( ) at the end insert “as detailed in an annual plan presented to and approved by its council of governors””

Page 159, line 33, at end insert—

“( ) An NHS Foundation Trust may provide private health treatment and care but not so that its provision is to any significant extent detrimental to that provided for the purposes of the health service save that that shall not restrict accommodation and services not available within the health service nor restrict treatment or care where that is not a clinical priority.”

Page 159, line 35, at end insert—

“( ) NHS services must not use NHS business to recruit private patient business.

( ) NHS services must ensure that the availability of NICE approved treatments is not decreased by private service provision.”

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 12, after “services” insert “including services directly commissioned by the NHS Commissioning Board at a regional or national level”

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 subsections (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 19, at end insert—

“( ) involve allied health professionals who work in that area;”

Page 190, line 20, at end insert—

“( ) consult and work with education or children’s services;”

Page 190, line 24, leave out from “group” to end of line 25 and insert “must consult with persons with experience of delivering relevant health services giving particular regard to health professionals who work with children or vulnerable adults”

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 20, after “authority,” insert—

“( ) involve allied health professionals who work in that area,”

Page 191, line 20, after “authority,” insert—

“(aa) have regard to the assessment of housing needs undertaken by the local planning authority,”

Page 191, line 21, at end insert—

“( ) involve representatives from alcohol services”

Page 191, line 21, at end insert—

“( ) consult and work with education or children’s services”

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

Page 191, line 29, at end insert “, including how such integration could be supported by the involvement of allied health professionals”

Page 191, line 44, after “functions,” insert—

“( ) an assessment of the needs of areas of disadvantage and of inequalities which exist,”

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 21, at end insert—

“( ) a representative of community pharmacy”

Page 192, line 21, at end insert—

“( ) a representative of the probation service,

( ) a representative of the police,”

Page 192, line 21, at end insert—

“( ) a representative of an allied health professional organisation,”

Page 192, line 23, at end insert—

“( ) a representative from alcohol and drugs service”

Page 192, line 23, at end insert—

“( ) in the case of two-tier local government areas, a representative of district councils”

Page 193, line 31, after “services” insert “, including allied health professionals,”

Page 193, line 31, after “services” insert “and education or children’s services”

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 38, after “services” insert “, including allied health professionals,”

Page 193, line 38, after “services” insert “or education or children’s services”

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

Page 193, line 41, after “services” insert “, including allied health professionals,”

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.”

Page 194, line 22, at end insert—

“(5) A Health and Wellbeing Board shall be entitled to make a referral for investigation relating to any services which have been provided as part of the health service under this Act related to any who is or has been person in the area for which a Health and Wellbeing Board functions or which services, in the opinion of the Health and Wellbeing Board ought to be provided as part of the health service under this Act.

(6) A referral for investigation shall be made by a Health and Wellbeing Board to the body that they understand is the commissioner of the relevant services or would commission the services if provided as part of the health service under this Act.

(7) Where a commissioner of health services receives a referral under subsection (5), the commissioner shall undertake a prompt and comprehensive investigation into all matters which are relevant to the referral and shall report its findings in writing to the relevant Health and Wellbeing Board within 28 days or within such longer period as shall be agreed by the Health and Wellbeing Board.

(8) In the event that the commissioner of health services to whom a referral has been made under subsection (5) hereof is not the commissioner of all or part of the services relevant to the referral, the commissioner of health services to whom the referral has been made shall pass all relevant details of the referral to such other commissioner of health services as it considers is the appropriate commissioner of health services, whereupon that commissioner of health services shall be obliged to investigate and report to the Health and Wellbeing Board within 28 days of receiving the referral or within such longer period as shall be agreed by the Health and Wellbeing Board.

(9) In this section “commissioner of services” shall mean the Board, Clinical Commissioning Group or other body under this Act which has made or would make arrangements for the relevant services to be provided or, if there is no such body which has made arrangements, is the body which will meet all or part of the cost of the provision of the said services.

(10) Subject to subsection (11), all reports provided under subsection (7) shall be published by the Health and Wellbeing Board in such a manner as the Health and Wellbeing Board consider appropriate.

(11) All publicly available copies of reports provided under subsection (7) hereof shall have details of individual patients anonymised in such a way as the commissioner of services considers appropriate to protect the confidentiality of any patient who desires to maintain confidentiality, and shall also have the details of any other person anonymised where this is necessary to protect a legal right to confidentiality.”

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 Professions 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”

Page 245, line 14, at end insert—

“(9) The powers under this section do not apply to information which falls within Section 256(2)(b).”

Page 252, line 20, at end insert—

“( ) The National Information Governance Committee shall appoint a chairman from within its membership who shall report to the Information Commissioner.”

The above named Lords give notice of their intention to oppose the Question that Clause 275 stand part of the Bill.

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”

Baroness Finlay of Llandaff gives notice of her intention to oppose the Question that Clause 285 stand part of the Bill.

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 270, line 34, at end insert—

“( ) Section 30 comes into force in accordance with section 30(3).”

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.”