Health and Social Care Bill (HL Bill 92)

24 Financial arrangements for clinical commissioning groups

After section 223F of the National Health Service Act 2006 insert—

“Clinical commissioning groups

223<no value\>G Means of meeting expenditure of clinical commissioning groups out
5of public funds

(1) The Board must pay in respect of each financial year to each clinical
commissioning group sums not exceeding the amount allotted for that
year by the Board to the group towards meeting the expenditure of the
group which is attributable to the performance by it of its functions in
10that year.

(2) In determining the amount to be allotted to a clinical commissioning
group for any year, the Board may take into account—

(a) the expenditure of the clinical commissioning group during any
previous financial year, and

(b) 15the amount that it proposes to hold, during the year to which
the allotment relates, in any contingency fund established
under section 223F.

(3) An amount is allotted to a clinical commissioning group for a year
under this section when the group is notified in writing by the Board
20that the amount is allotted to it for that year.

(4) The Board may make a new allotment under this section increasing or
reducing an allotment previously so made.

(5) Where the Board allots an amount to a clinical commissioning group or
makes a new allotment under subsection (4), it must notify the
25Secretary of State.

(6) The Board may give directions to a clinical commissioning group with
respect to—

(a) the application of sums paid to it by virtue of a new allotment
increasing an allotment previously so made, and

(b) 30the payment of sums by it to the Board in respect of charges or
other sums referable to the valuation or disposal of assets.

(a)(a)the application of sums paid to it by virtue of a new allotment
increasing an allotment previously so made, and

(b) the payment of sums by it to the Board in respect of charges or
35other sums referable to the valuation or disposal of assets.

(7) Sums falling to be paid to clinical commissioning groups under this
section are payable subject to such conditions as to records, certificates
or otherwise as the Board may determine.

(8) In this section and sections 223H to 223K “financial year” includes the
40period which begins on the day the clinical commissioning group is
established and ends on the following 31 March.

223<no value\>H Financial duties of clinical commissioning groups: expenditure

(1) Each clinical commissioning group must, in respect of each financial
year, perform its functions so as to ensure that its expenditure which is
45attributable to the performance by it of its functions in that year does
not exceed the aggregate of—

(a) the amount allotted to it for that year under section 223G,

(b) any sums received by it in that year under any provision of this
Act (other than sums received by it under section 223G), and

(c) any sums received by it in that year otherwise than under this
Act for the purpose of enabling it to defray such expenditure.

(2) The Board may by directions determine—

(a) whether specified sums must, or must not, be treated for the
5purposes of this section as received by a specified clinical
commissioning group,

(b) whether specified expenditure must, or must not, be treated for
those purposes as expenditure within subsection (1) of a
specified clinical commissioning group, or

(c) 10the extent to which, and the circumstances in which, sums
received by a clinical commissioning group under section 223G
but not yet spent must be treated for the purposes of this section
as part of the expenditure of the group, and to which financial
year’s expenditure they must be attributed.

(b)(b)15whether specified expenditure must, or must not, be treated for
those purposes as expenditure within subsection (1) of a
specified clinical commissioning group, or

(c) the extent to which, and the circumstances in which, sums
received by a clinical commissioning group under section 223G
20but not yet spent must be treated for the purposes of this section
as part of the expenditure of the group, and to which financial
year’s expenditure they must be attributed.

(3) The Secretary of State may by directions require a clinical
commissioning group to use specified banking facilities for any
25specified purposes.

(4) In this section, “specified” means specified in the directions.

223<no value\>I Financial duties of clinical commissioning groups: use of resources

(1) For the purposes of this section and section 223J—

(a) a clinical commissioning group’s capital resource use, in
30relation to a financial year, means the group’s use of capital
resources in that year, and

(b) a clinical commissioning group’s revenue resource use, in
relation to a financial year, means the group’s use of revenue
resources in that year.

(2) 35A clinical commissioning group must ensure that its capital resource
use in a financial year does not exceed the amount specified by
direction of the Board.

(3) A clinical commissioning group must ensure that its revenue resource
use in a financial year does not exceed the amount specified by
40direction of the Board.

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

(5) The Board may by directions make provision for determining to which
45clinical commissioning group a use of capital resources or revenue
resources is to be attributed for the purposes of this section or section
223J.

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

223<no value\>J 50Financial duties of clinical commissioning groups: additional controls
on resource use

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

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

(3) The Board may direct a clinical commissioning group to ensure that its
5revenue resource use in a financial year which is attributable to
prescribed matters relating to administration does not exceed an
amount specified in the direction.

(4) The Board may give directions, in relation to a financial year, specifying
uses of capital resources or revenue resources which must, or must not,
10be taken into account for the purposes of subsection (1) or (as the case
may be) subsection (2) or (3).

(5) The Board may not exercise the power conferred by subsection (1) or (2)
in relation to particular matters unless the Secretary of State has given
a direction in relation to those matters under subsection (1) of section
15 223E or (as the case may be) subsection (2) of that section.

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

223<no value\>K 20Payments in respect of quality

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

(2) For the purpose of determining whether to make a payment under
subsection (1) and (if so) the amount of the payment, the Board must
25take into account at least one of the following factors—

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

(b) any improvement in the quality of relevant services provided
during that year (in comparison to the quality of relevant
30services provided during previous financial years);

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

(d) any improvement in the outcomes identified during that
35financial year as having been so achieved (in comparison to the
outcomes identified during previous financial years as having
been so achieved).

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

(a) 40relevant inequalities identified during that year;

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

(4) Regulations may make provision as to the principles or other matters
45that the Board must or may take into account in assessing any factor
mentioned in subsection (2) or (3).

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

(a) not make a payment that would otherwise be made to a clinical
commissioning group under subsection (1), or

(b) 5reduce the amount of such a payment.

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

(7) 10A clinical commissioning group must publish an explanation of how
the group has spent any payment made to it under subsection (1).

(8) In this section—

• “relevant services” means services provided in pursuance of
  arrangements made by the clinical commissioning group—

  (a)

  15under section 3 or 3A or Schedule 1, or

  (b)

  by virtue of section 7A;

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

  (a)

  20their ability to access the services, or

  (b)

  the outcomes achieved for them by their provision.”

25 Requirement for primary medical services provider to belong to clinical
commissioning group

(1) In section 89 of the National Health Service Act 2006 (general medical services
25contracts: required terms), after subsection (1) insert—

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

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

(b) 30as to arrangements for securing that a relevant contractor
appoints one individual to act on its behalf in the dealings
between it and the clinical commissioning group to which it
belongs;

(c) for imposing requirements with respect to those dealings on the
35individual appointed for the purposes of paragraph (b);

(d) for requiring a relevant contractor, in doing anything pursuant
to the contract, to act with a view to enabling the clinical
commissioning group to which it belongs to discharge its
functions (including its obligation to act in accordance with its
40constitution).

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

(1C) In the case of a contract entered into by two or more individuals
45practising in partnership—

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

(b) regulations making provision under subsection (1A)(b) may
5make provision as to arrangements for securing that the
partners make the appointment;

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

(1D) 10Regulations making provision under subsection (1A) for the case of a
contract entered into by two or more individuals practising in
partnership may make provision as to the effect of a change in the
membership of the partnership.

(1E) The regulations may require an individual appointed for the purposes
15of subsection (1A)(b)—

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

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

(2) 20In section 94 of that Act (regulations about arrangements under section 92 of
that Act for provision of primary medical services), after subsection (3) insert—

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

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

(b) make provision as to arrangements for securing that a relevant
provider appoints one individual to act on its behalf in dealings
between it and the clinical commissioning group to which it
30belongs;

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

(d) require a relevant provider, in doing anything pursuant to
section 92 arrangements, to act with a view to enabling the
35clinical commissioning group to which it belongs to discharge
its functions (including its obligation to act in accordance with
its constitution).

(3B) Provision by virtue of subsection (3A)(a) may in particular describe
services by reference to the manner or circumstances in which they are
40performed.

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

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

(b) 45regulations making provision under subsection (3A)(b) may
make provision as to arrangements for securing that the
persons collectively make the appointment;

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

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

(3E) 5The regulations may require an individual appointed for the purposes
of subsection (3A)(b)—

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

(b) 10to meet such other conditions as may be prescribed.”

Further provision about local authorities’ role in the health service

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

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

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

(a) 15in subsection (1) for “A Primary Care Trust” substitute “A local
authority”,

(b) in subsection (2)—

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

(ii) 20in paragraph (b) for “other Primary Care Trusts” substitute
“other local authorities”, and

(c) after subsection (2) insert—

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

(3) 25In section 249 (joint working with the prison service) after subsection (4)
insert—

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

27 Appointment of directors of public health

30In Part 3 of the National Health Service Act 2006 (local authorities and the
NHS) before section 74 insert—

“73A Appointment of directors of public health

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

(a) 35the exercise by the authority of its functions under section 2B,
111 or 249 or Schedule 1,

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

(c) anything done by the authority in pursuance of arrangements
40under section 7A,

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

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

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

(2) 5The individual so appointed is to be an officer of the local authority and
is to be known as its director of public health.

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

(a) considers that the director has failed or might have failed to
discharge (or to discharge properly) the responsibilities of the
10director under—

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

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

(b) has consulted the local authority.

(4) 15The Secretary of State may direct the local authority to—

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

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

(c) 20consider taking any steps specified in the direction;

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

(5) A local authority may terminate the appointment of its director of
25public health.

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

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

28 Exercise of public health functions of local authorities

30In Part 3 of the National Health Service Act 2006 after section 73A insert—

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

(1) A local authority must, in the exercise of any functions mentioned in
subsection (2), have regard to any document published by the Secretary
35of State for the purposes of this section.

(2) The functions mentioned in this subsection are—

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

(b) the exercise by the authority of its functions by virtue of section
406C,

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

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

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

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

(4) 5The director of public health for a local authority must prepare an
annual report on the health of the people in the area of the local
authority.

(5) The local authority must publish the report.

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

29 10Complaints about exercise of public health functions by local authorities

In Part 3 of the National Health Service Act 2006 (local authorities and the
NHS) after section 73B insert—

“73C Complaints about exercise of public health functions by local
authorities

(1) 15Regulations may make provision about the handling and consideration
of complaints made under the regulations about —

(a) the exercise by a local authority of any of its public health
functions;

(b) the exercise by a local authority of its functions by virtue of
20section 6C;

(c) anything done by a local authority in pursuance of
arrangements made under section 7A;

(d) the exercise by a local authority of any of its other functions—

(i) which relate to public health, and

(ii) 25for which its director of public health has responsibility;

(e) the provision of services by another person in pursuance of
arrangements made by a local authority in the exercise of any
function mentioned in paragraphs (a) to (d).

(2) The regulations may provide for a complaint to be considered by one
30or more of the following—

(a) the local authority in respect of whose functions the complaint
is made;

(b) an independent panel established under the regulations;

(c) any other person or body.

(3) 35The regulations may provide for a complaint or any matter raised by a
complaint—

(a) to be referred to a Local Commissioner under Part 3 of the Local
Government Act 1974 for the Commissioner to consider
whether to investigate the complaint or matter under that Part;

(b) 40to be referred to any other person or body for that person or
body to consider whether to take any action otherwise than
under the regulations.

(4) Where the regulations make provision under subsection (3)(a) they
may also provide for the complaint to be treated as satisfying sections
4526A and 26B of the Act of 1974.

(5) Section 115 of the Health and Social Care (Community Health and
Standards) Act 2003 (health care and social services complaints
regulations: supplementary) applies in relation to regulations under
this section as it applies in relation to regulations under subsection (1)
5of section 113 of that Act.

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

Abolition of Strategic Health Authorities and Primary Care Trusts

30 Abolition of Strategic Health Authorities

(1) The Strategic Health Authorities continued in existence or established under
10section 13 of the National Health Service Act 2006 are abolished.

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

31 Abolition of Primary Care Trusts

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

(2) 15Chapter 2 of Part 2 of that Act (Primary Care Trusts) is repealed.

Functions relating to fluoridation of water

32 Fluoridation of water supplies

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

(2) 20In section 87 (fluoridation of water supplies at request of relevant authorities),
in subsection (3)(a) for sub-paragraph (i) substitute—

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

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

“(3A) 25The Secretary of State may make a request under subsection (1) only if
the Secretary of State is required to do so by section 88G(2) (following
the making of a fluoridation proposal in accordance with section 88B).”

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

“(a) in relation to England, such area as the Secretary of State
30considers appropriate for the purpose of complying with
section 88G(2);”.

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

“(7A) The Secretary of State must, in relation to the terms to be included in
any arrangements under this section, consult any local authority whose
35area includes, coincides with or is wholly or partly within the specified
area.

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

(a) a county council in England;

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

(c) a London borough council;

(d) 5the Common Council of the City of London.”

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

“(7C) If the Secretary of State and the Welsh Ministers request a particular
water undertaker to enter into arrangements in respect of adjoining
10areas—

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

(b) if suitable terms are not agreed for all the arrangements, a
combined reference may be made by them under section 87B
15below to enable the terms of each set of arrangements to be
determined so that they are consistent.

(7D) If the Secretary of State requests a water undertaker to vary
arrangements for an area which adjoins an area in respect of which the
Welsh Ministers have made arrangements with the same water
20undertaker, the Secretary of State must co-operate with the Welsh
Ministers so as to secure that following the variation the arrangements
(taken together) will be operable and efficient.

(7E) If the Welsh Ministers request a water undertaker to vary arrangements
for an area which adjoins an area in respect of which the Secretary of
25State has made arrangements with the same water undertaker, the
Welsh Ministers must co-operate with the Secretary of State so as to
secure that following the variation the arrangements (taken together)
will be operable and efficient.

(7F) If suitable terms are not agreed for a variation to which subsection (7D)
30or (7E) applies, a combined reference may be made by the Secretary of
State and the Welsh Ministers under section 87B below so that
(following the variation) both sets of arrangements are consistent.”

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

(8) In subsection (11) of that section for “a relevant authority” substitute “the
35Welsh Ministers”.

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

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

(a) make arrangements which provide for the concentration in the
40specified area (or any part of it) to be lower than the general
target concentration, or

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

the Secretary of State shall consult any local authority whose area
includes, coincides with or is wholly or partly within the specified
45area.”

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