Health and Social Care Bill

Page 2, line 6, after “of” insert “physical and mental”

Page 2, line 6, at end insert “, and

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

Page 2, leave out lines 7 to 9 and insert—

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

Page 2, line 8, after “to” insert “provide or”

Page 2, line 9, at end insert—

“( ) The Secretary of State retains ministerial responsibility to Parliament for the provision of the health service in England.”

Insert the following new Clause—

“The Secretary of State’s duty as to the NHS Constitution

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

“1AA Duty as to NHS Constitution

“(1) In exercising functions in relation to the health service, the Secretary of State must have regard to the NHS Constitution.

(2) In this Act, “NHS Constitution” has the same meaning as in Chapter 1 of Part 1 of the Health Act 2009 (see section 1 of that Act).””

Page 2, line 40, at end insert—

“, and

(b) the Secretary of State should by regulations set out a clear system of recourse for patients, or other concerned individuals, who do not believe that an equitable service is being commissioned either for their condition or in their locality, or both.”

Page 3, line 5, leave out from “must” to end of line 6 and insert “have regard to the desirability of securing, so far as consistent with the interests of the health service—”

Page 3, line 11, at end insert—

“( ) If, in the case of any exercise of functions, the Secretary of State considers that there is a conflict between the matters mentioned in subsection (1) and the discharge by the Secretary of State of the duties under section 1, the Secretary of State must give priority to the duties under that section.””

Leave out Clause 4

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

Page 3, line 28, at end insert—

“(1A) Any person who provides services for the purposes of that health service must co-operate with the Secretary of State (or a special health authority) in the discharge of the duty under subsection (1).”

Page 3, line 28, at end insert—

“(1A) Any arrangements made with a person under this Act for the provision of services as part of that health service must include arrangements for securing that the person co-operates with the Secretary of State in the discharge of the duty under subsection (1) (or, where a Special Health Authority is discharging that duty by virtue of a direction under section 7, with the Special Health Authority).”

Page 3, line 29, after “means” insert “—

( ) ”

Page 3, line 30, leave out from “and” to end of line 33 and insert—

“( ) this Act,

( ) the Health and Social Care Act 2008,

( ) the Health Act 2009, and

( ) the Health and Social Care Act 2012.””

Page 3, line 33, at end insert—

“( ) In discharging the duty the Secretary of State must establish a body known as Health Education England as a specialist health authority, with an independent chair and lay non-executive members accountable to the Secretary of State.

( ) Health Education England will be responsible for the oversight, supervision and maintenance of high standards of education and training of the NHS healthcare workforce.

( ) In discharging its function, Health Education England shall have due regard to—

(a) the statutory responsibilities and authority of the regulatory bodies education and training in health care,

(b) the responsibilities and authority of universities, institutions of higher education, Royal Colleges and faculties, involved in education and training,

(c) ensure that National Commissioning Board Commissioners and all providers of healthcare for NHS patients have regard to the requirement for education and training,

(d) ensure that local education training boards and post-graduate deans are held accountable to delivery of high standards of education training, research and continuous professional development,

(e) to be responsible for the whole of the NHS budget for education and training (the education levy) and appropriate distribution of the budget to LETBs; including statutory provisions for education and training,

( ) Health Education England should be responsible for national workforce planning of health care workers.”

Insert the following new Clause—

“The Secretary of State’s duty to ensure openness and transparency with patients when things go wrong

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

“1E Duty of candour when things go wrong

The Secretary of State must act with a view to securing that any organisation registered with the Care Quality Commission to provide healthcare is required to take all reasonable steps to ensure that a patient or, in the event of death or incapacity, their next of kin, is fully informed about incidents which occur as a consequence of providing the regulated healthcare to that patient where the incident has resulted in—

(a) any injury to a patient which, in the reasonable opinion of a health care professional, has resulted in—

(i) an impairment of the sensory, motor or intellectual functions of the patient which is not likely to be temporary,

(ii) changes to the structure of a patient’s body,

(iii) the patient experiencing prolonged pain or prolonged psychological harm, or

(iv) the significant shortening of the life expectancy of the patient; or

(b) any injury to a patient which, in the reasonable opinion of a health care professional, requires treatment by that, or another, health care professional in order to prevent—

(i) the death of the patient, or

(ii) an injury to the patient which, if left untreated, would lead to one or more of the outcomes mentioned in paragraph (a).””

Insert the following new Clause—

“The Secretary of State’s duty as to preventing bureaucracy

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

“1G Duty as to preventing bureaucracy

In exercising functions in relation to the health service, the Secretary of State must, so far as in consistent with the interests of the health service, act with a view to securing—

(a) that the NHS Commissioning Board shall exercise its functions in relation to the health service with a minimum level of management tiers, and

(b) that any other person exercising functions in relation to the health service must have regard to the need to curb bureaucracy.””

Page 4, leave out lines 10 to 21 and insert—

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

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

(3A) The Secretary of State may give a direction to the Board to discharge each of those functions, and in such manner and within such period or periods, as may be specified in the direction.”

Page 275, line 13, at end insert “with the consent of the Health Select Committee of the House of Commons”

Page 275, line 13, at end insert—

“( ) a vice-chair who will be the Senior Independent Director and who must be a non-executive member,”

Page 275, leave out lines 28 and 29

Page 5, line 3, at end insert—

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

Page 5, line 8, after “protection” insert “and promotion”

Page 5, line 11, at end insert “using the best scientific and other evidence available and without regard to special interests”

Page 5, line 12, leave out “may” and insert “must”

Page 5, line 38, at end insert “and shall, in doing so, take such steps as are appropriate to reduce health inequalities”

Page 5, line 39, leave out “may” and insert “must”

Page 6, line 16, 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 6, line 16, at end insert—

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

Page 6, line 19, at end insert—

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

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

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

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

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

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

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

Page 6, line 19, 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.”

Insert the following new Clause—

“Chief Environmental Health Officer for England

(1) The Secretary of State shall appoint a Chief Evironmental 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 7, line 17, at end insert—

“( ) After subsection (1E) insert—

“(1F) In exercising its functions under this section and section 3A, a clinical commissioning group must act consistently with—

(a) the discharge by the Secretary of State and the Board of their duty under section 1(1) (duty to promote a comprehensive health service), and

(b) the objectives and requirements for the time being specified in the mandate published under section 13A.””

Page 7, line 22, at end insert—

“( ) In section 272 of that Act (orders, regulations, rules and directions), in subsection (6) before paragraph (za) insert—

“(zza) regulations under section 3(1D),”.”

Leave out Clause 12

Page 8, line 12, at end insert “including for those with profound and multiple learning disabilities and people with complex needs whose behaviour challenges services”

Page 13, line 20, leave out “Regulations may” and insert “The Secretary of State must draft regulations not less than annually, and shall submit them to the relevant committee of the House of Commons not less than two months before the regulations are to be laid before Parliament.

(1A) Such regulations shall”

Page 15, line 10, at end insert—

“( ) Subsection (1) does not apply to any function of the Secretary of State of making an order or regulations.”

Page 15, line 22, at end insert—

“(6) In section 273 of that Act (further provision about orders and directions), in subsection (4)(b)—

(a) before paragraph (i) insert—

“(zi) section 7 about a function of a person other than the Secretary of State,” and

(b) in paragraph (i) after “a function” insert “of the Secretary of State”.”

Page 16, line 16, after “a” insert “draft”

Page 16, line 22, after “appropriate” insert—

“( ) the priority and scope for commissioning service redesign and reconfiguration in the light of the best clinical advice available,

( ) the priority and scope for transferring resources to adult social services to improve service integration and achieve best value for health services,”

Page 16, line 25, at end insert—

“( ) The Secretary of State must make a statement as to how the objectives and requirements specified in the mandate under subsection (2)(a) and (b) will further his discharge of each of his duties under sections 1 to 1F of this Act.”

Page 17, line 6, leave out “of the Care Quality Commission”

Page 17, line 9, at end insert—

“( ) Requirements included in the mandate have effect only if regulations so provide.”

Page 17, line 9, at end insert—

“( ) A mandate becomes finalised through an affirmative resolution of each House of Parliament.”

Page 17, line 21, at end insert—

“( ) Revisions to the mandate which consist of adding, omitting or modifying requirements have effect only if regulations so provide.”

Page 17, line 26, at end insert—

“13BA Mandate to Monitor and the Care Quality Commission

( ) Before the start of each financial year, the Secretary of State must publish and lay before Parliament additional documents in the form of the mandate as outlined in section 13A.

( ) These additional documents shall be—

(a) the mandate to Monitor, and

(b) the mandate to the Care Quality Commission.”

Page 17, line 38, at end insert—

“( ) In exercising this duty, the Board must, after consultation with the Secretary of State, specify for commissioners and providers of health services minimum standards for the production of annual audited management accounts that relate their expenditure to activities and performance so that comparisons of their relative efficiency are available publicly and a digest of these accounts should be published annually by the Board or Secretary of State.”

Page 18, line 15, at end insert “, and

(c) any evidence on the outcomes or any of them achieved from the provision of services as referred to its duty under subsection (1), derived from information and advice provided from time to time by Healthwatch England (within the meaning of section 45A of the Health and Social Care Act 2008).”

Page 18, line 15, at end insert “, and

(c) any evidence on the outcomes or any of them achieved from the provision of services as referred to its duty under subsection (1), derived from information and advice provided from time to time by Healthwatch England (within the meaning of section 45A of the Health and Social Care Act 2008).”

Page 18, leave out lines 16 to 23

Page 18, line 17, leave out from “must” to end of line 18 and insert “have regard to the desirability of securing, so far as consistent with the interests of the health service—”

Page 18, line 23, at end insert—

“( ) If, in the case of any exercise of functions, the Board considers that there is a conflict between the matters mentioned in subsection (1) and the discharge by the Board of its duties under sections 1(1) and 1G(3)(b), the Board must give priority to those duties.”

Page 18, line 30, at end insert—

“(c) 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 34, leave out from “decisions” to end of line and insert “which relate to—

(a) the prevention or diagnosis of illness in the patients, or

(b) their care or treatment.”

Page 18, line 39, at end insert—

“( ) The National Commissioning Board must have regard to advice from a range of healthcare practitioners from across the patient pathway, including local clinical specialists and allied health professionals.”

Page 18, line 40, leave out “advice appropriate” and insert “appropriate advice from a range of health professionals across the care pathway”

Page 18, line 41, after “from” insert “persons or organisations with expertise in the experience of patients and from”

Page 19, line 13, leave out “have regard to the need to”

Page 19, line 16, at end insert—

“13LA Duty as to promoting education and training

The Board must, in exercising its functions, have regard to the need to promote education and training for the persons mentioned in section 1E(1) so as to assist the Secretary of State in the discharge of the duty under that section.”

Page 19, line 16, at end insert—

“13LA Duty to provide education and training

The Board must, in exercising its functions, have regard to the need to provide—

(a) education and training of the healthcare workforce, and

(b) pay regard to the Health Education England reports.”

Page 19, line 16, at end insert—

“13LA Duty to provide training of clinical staff

The Board must, in the exercise of its functions, have regard to the need to promote adequate training of clinical staff in any provider from which it commissions services for NHS patients, whether that provider be NHS or private.”

Page 20, line 8, at end insert—

“( ) In this section and elsewhere in the Act “integration” means the integration of health and social care commissioning, assessment, service provision or payment arrangements with the primary purpose of improving the delivery of integrated care and treatment to individual patients or service users or groups of such individuals.”

Page 21, line 7, leave out “such persons as the Board considers appropriate” and insert—

“(a) clinical commissioning groups,

(b) all health care providers,

(c) the Care Quality Commission,

(d) Healthwatch England,

(e) local authorities with public health functions, and

(f) professional organisations in health care.”

Page 21, leave out lines 9 to 11

Page 21, line 42, after “13E” insert “, 13M”

Page 22, line 16, after “13E” insert “, 13G”

Page 22, line 16, after “13E” insert “, 13M”

Page 24, leave out lines 10 to 27 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) the NHS Commissioning Board, and

(b) clinical commissioning groups.”

Page 24, line 27, at end insert—

“( ) For the purposes of this section a failure to discharge a function properly includes a failure to discharge it consistently with what the Secretary of State considers to be the interests of the health service.”

Page 25, line 9, leave out “This section has” and insert “Paragraphs (a) to (c) and (h) of subsection (1) have”

Page 25, line 33, at end insert—

“section 13LA,”

Page 29, line 16, leave out “in writing by” and insert “by order of”

Page 29, line 23, at end insert—

“( ) The Board must exercise its functions under this Chapter so as to ensure that every person resident in England has access to all services provided by a clinical commissioning group.”

Page 35, line 9, at end insert—

“( ) provide for the chair and non-executive members of each governing body to be appointed using an independent process, the details of which are to be laid out in regulations;”

Page 35, line 9, at end insert—

“( ) provide that the members of governing bodies must include a majority of non-executive members;”

Page 35, line 15, at end insert—

“( ) that one of the non-executive members should be a member of the relevant local authority;”

Page 36, line 34, leave out “any guidance published under section 14Z6” and insert—

“(a) any guidance published under section 14Z6, and

(b) in relation to the outcomes or any of them achieved from the provision of services as referred to its duty under subsection (1)—

(i) any evidence from Local Healthwatch contained in such views, reports and recommendations (within the meaning of section 221(2)(d) of the Local Government and Public Involvement in Health Act 2007) as are published from time to time by a relevant Local Healthwatch; and

(ii) any evidence from Healthwatch England contained in such information and advice (within the meaning of section 45A of the Health and Social Care Act 2008) as may be provided from time to time by Healthwatch England.”

Page 281, line 8, after second “a” insert “valid”

Page 281, line 8, at end insert—

“( ) For the purposes of this Act, a valid constitution is one which has been approved by order of both Houses of Parliament in accordance with section 300 of the Health and Social Care Act 2012.”

Page 281, line 24, at end insert—

“(c) for the joint appointment, with local universities and other education providers, of committees with responsibilities for education and training.”

Page 281, line 33, after “interests of” insert “—

(a) ”

Page 281, line 34, at end insert “and shall apply the provisions of paragraphs 19A and 19C and the guidelines as established by paragraph 19C of this Schedule”

Page 281, line 34, at end insert “, or

(b) members of its committees or sub-committees.”

Page 281, line 34, at end insert—

“( ) Clinical commissioning groups 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 281, line 34, at end insert—

“( ) Clinical commissioning groups 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 282, line 34, after “members of” insert “—

(a) ”

Page 282, line 34, at end insert “and shall apply the provisions of paragraph 19B of this Schedule”

Page 282, line 34, at end insert—

“(b) its audit committee, and

(c) any committees or sub-committees appointed by virtue of paragraph 6(2)(b).”

Page 282, line 43, at end insert “provided that the public may not be excluded from any governing body meeting during a discussion involving a choice between potential providers”

Page 282, line 43, at end insert—

“(5) A record of the decisions made at any meeting or part of a meeting from which members of the public are excluded must be published not later than two weeks from the date when the meeting occurred.”

Page 288, line 12, at end insert—

19A (1) Every clinical commissioning group must keep a register of the relevant financial interests of all members of the Group.

(2) Within 28 days of a member joining a clinical commissioning group, the member must inform the group’s accountable officer of any relevant financial interests requiring registration.

(3) Within 28 days of any change to a member’s registered interests, the member must inform the group’s accountable officer of such change.

(4) The accountable officer shall ensure that the register of interests is freely available to inspection by the members of the public.

19B (1) A director of a healthcare provider organisation, or a general practitioner having a significant financial interest in a provider organisation, may not serve on the governing body of a clinical commissioning group if there is a contract between that clinical commissioning group and that organisation.

(2) If a clinical commissioning group enters into negotiations with a healthcare provider organisation and a member of the governing body of that clinical commissioning group is a director or has a significant financial interest in that provider organisation, that member shall take no part in the proceedings of the governing body until such negotiations are concluded and shall then stand down from membership of the governing body if a contract is entered into between the clinical commissioning group and the healthcare provider organisation.

19C The Guidelines on Conflict of Interest for Members of Clinical Commissioning Groups referred to in section 14Z8A (as inserted by section 25 of the Health and Social Care Act 2012) shall be drawn up by the Board.”

Page 36, line 18, at end insert—

“14PA Duty to provide services by a clinical commissioning group

Each clinical commissioning group must exercise its functions so as to ensure that every person resident in its area has access to all services provided by a clinical commissioning group.”

Page 36, line 34, leave out “any guidance published under section 14Z6” and insert—

“(a) any guidance published under section 14Z6, and

(b) in relation to the outcomes or any of them achieved from the provision of services as referred to its duty under subsection (1)—

(i) any evidence from Local Healthwatch contained in such views, reports and recommendations (within the meaning of section 221 2(d) of the Local Government and Public Involvement in Health Act 2007) as are published from time to time by a relevant Local Healthwatch; and

(ii) any evidence from Healthwatch England contained in such information and advice (within the meaning of section 45A of the Health and Social Care Act 2008) as may be provided from time to time by Healthwatch England.”

Page 37, line 4, at end insert—

“( ) ensure the provision of services for patients with less common conditions.”

Page 37, line 8, leave out from “decisions” to end of line 9 and insert “which relate to—

(a) the prevention or diagnosis of illness in the patients, or

(b) their care or treatment.”

Page 37, line 10, leave out “may” and insert “must”

Page 37, line 18, at end insert—

“( ) A clinical commissioning group must have regard to advice from a wide range of healthcare practitioners from across the patient pathway, including local clinical specialists and allied health professionals.”

Page 37, line 19, leave out “advice appropriate” and insert “appropriate advice from a range of health professionals across the care pathway”

Page 37, line 20, after “from” insert “persons or organisations with expertise in the experience of patients and from”

Page 37, line 23, at end insert—

“( ) Health professionals who sit on clinical commissioning group boards must be local to the area that the clinical commissioning group covers.”

Page 37, line 34, leave out “have regard to the need to”

Page 37, line 36, at end insert—

“14XA Duty as to promoting education and training

Each clinical commissioning group must, in exercising its functions, have regard to the need to promote education and training for the persons mentioned in section 1E(1) so as assist the Secretary of State in the discharge of the duty under that section.”

Page 37, line 36, at end insert—

“14XA Duty in respect of training

Each clinical commissioning group must, in the exercise of its functions, have regard to the need to promote adequate training of clinical staff in any provider from which it commissions services for NHS patients, whether that provider be NHS or private.”

Page 37, line 36, at end insert—

“14XA Duty in respect of training and education

Each clinical commissioning group must, in the exercise of its functions, have regard to the need to promote—

(a) training and education of the health care workforce, and

(b) ensure that commissioning of services has regard to the budgetary effects of training and education.”

Page 38, line 23, at end insert—

“14YA Duty as to addiction to benzodiazepines, selective serotonin reuptake inhibitors and Z-drugs

(1) Each clinical commissioning group shall have a duty to provide services to those suffering from addiction and withdrawal from benzodiazepines, selective serotonin reuptake inhibitors and Z-drugs.

(2) In fulfilling this duty, clinical commissioning groups must co-operate with and take account of the good practice of specialised agencies in this field.”

Page 38, line 45, at end insert—

“(d) pay due regard to Health Watch England and Local Healthwatch.”

Page 40, line 3, at end insert—

“14Z2A Joint exercise functions with local universities

Regulations must provide for functions relevant to education and training to be exercised jointly with local universities and other providers.”

Page 41, line 42, at end insert—

“14Z8A Duty of Board to refer to relevant professional body regarding conflicts of interest

The Board must refer to his or her relevant professional body any member of a clinical commissioning group whom it reasonably believes to have been in material breach of any of the provisions concerning conflict of interest set out in paragraphs 19A and 19B or the guidelines in paragraph 19C of Schedule 2 (as inserted by Schedule 2 to the Health and Social Care Act 2012).”

Page 43, line 9, after “Board” insert “and each relevant Local Healthwatch”

Page 44, line 17, after “14Q” insert “, 14S”

Page 45, leave out lines 24 and 25 and insert—

“( ) For the purposes of this section—

(a) a failure to discharge a function includes a failure to discharge it properly, and

(b) a failure to discharge a function properly includes a failure to discharge it consistently with what the Board considers to be the interests of the health service.”

Page 47, leave out lines 35 and 36 and insert—

“( ) For the purposes of this section—

(a) a failure to discharge a function includes a failure to discharge it properly, and

(b) a failure to discharge a function properly includes a failure to discharge it consistently with what the Board considers to be the interests of the health service.”

Page 48, line 39, leave out “This section has” and insert “Paragraphs (a) to (c) and (h) of subsection (1) have”

Page 48, line 40, at end insert—

“14Z21A Declaration of financial interests

A person who is a provider of primary medical services must declare any relevant 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 49, line 24, at end insert—

“section 14XA,”

Page 52, line 31, leave out from beginning to end of line 32 on page 53

Page 53, line 18, leave out from “(which” to end of line 20 and insert “shall include provision that Quality Payments—

(a) shall not be distributed to members of the clinical commissioning groups; and

(b) shall only be used for the improvement of services).”

Page 56, line 8, after “6C” insert “(1) or (3)”

Page 56, line 17, 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.”

Page 56, line 19, 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 post.”

Page 56, line 40, leave out “consult” and insert “have the consent of”

Page 56, line 40, at end insert—

“( ) A local authority must have regard to any guidance given by the Secretary of State in relation to its director of public health, including guidance as to appointment and termination of appointment, terms and conditions and management.”

Insert the following new Clause—

“Appointment of directors of public health

Any registered public health specialist or other person employed in the exercise of public health functions by a local authority or is 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.”

Page 57, line 7, at end insert—

“( ) A local authority shall have the function of ensuring an effective response is made to an 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 12, after “6C” insert “(1) or (3)”

Page 57, line 20, at end insert—

“( ) A document published under subsection (1), and guidance given under subsection (3), may include guidance as to the appointment of officers of the local authority to discharge any functions mentioned in subsection (2), and as to their terms and conditions, management and dismissal.”

Page 57, line 36, after “6C” insert “(1) or (3)”

Page 64, line 32, at end insert—

“(8) That the funds to meet the running costs of fluoridation schemes covered by legal agreements entered into before 1 April 2013 shall be:

(a) met from the identified fluoridation funds within the ring-fenced public health grants to be made by the Department of Health to local authorities with effect from 1 April 2013;

(b) held by Public Health England on behalf of the responsible local authorities in order to meet the costs incurred by water companies in operating those fluoridation schemes;

(c) accounted for by Public Health England to the responsible local authorities in annual reports on the expenditure incurred on behalf of those authorities.

(9) That the funds required to meet the running costs of new fluoridation schemes covered by legal agreements entered into after 1 April 2013 shall be:

(a) met from additional ring-fenced public health grants allocated by the Department of Health to the local authorities requesting fluoridation of all or part of their areas following a public consultation held under the provisions of this Act and its associated regulations;

(b) held by Public Health England on behalf of the responsible local authorities in order to meet the costs incurred by water companies in operating those fluoridation schemes;

(c) accounted for by Public Health England to the responsible local authorities in annual reports on the expenditure incurred on behalf of those authorities.

Page 66, line 11, at end insert—

“( ) The duty in subsection (3) does not apply in relation to the proposal if the Secretary of State so directs by an instrument in writing.”

Page 66, leave out lines 14 to 17

Page 66, line 39, at end insert—

“( ) The duty in subsection (2) does not apply in relation to the proposal if the Secretary of State so directs by an instrument in writing.”

Page 66, leave out lines 42 to 45

Page 67, line 34, at end insert—

“( ) The duty in subsection (2) does not apply in relation to the proposal if the Secretary of State so directs by an instrument in writing.”

Page 67, leave out lines 37 to 40

Page 80, line 10, at end insert—

“( ) Subsection (1) does not apply to any function of the Secretary of State of making an order or regulations.”

Page 81, line 6, at end insert—

“( ) Subsection (1) does not apply to any function of the Secretary of State of making an order or regulations.”

Page 81, line 16, at end insert—

“( ) Subsection (1) does not apply to any function of the Secretary of State of making an order or regulations.”

Page 82, line 10, at end insert—

“( ) Subsection (1) does not apply to any function of the Secretary of State of making an order or regulations.”

Page 83, line 26, at end insert “and its Healthwatch England committee”

Insert the following new Clause—

“Scope of patient and public involvement

(1) In this Act the arrangements for involvement of individuals shall include—

(a) the provision of information;

(b) the opportunity to comment on information provided; and

(c) participation in the monitoring of the impact on the manner in which services are delivered to the individuals or the range of services available to them of the implementation of any planning, proposals or decisions to which such arrangements relate in accordance with this Act.

(2) The involvement of individuals to whom the services are being or may be provided shall include involvement of those individuals and their carers, directly or through representatives.

(3) Services to which the arrangements for involvement required to be made under this Act by a body must include services provided or to be provided by another person to individuals—

(a) at that body’s direction;

(b) on its behalf; or

(c) in accordance with an agreement or arrangements made by that body with that other person.

(4) Where arrangements for the involvement of individuals are required for a body under this Act, such arrangements shall relate to any of the functions of such bodies under this Act which would or might have an impact on the manner in which services are delivered to individuals or the range of services available to them.”

Page 84, line 6, at end insert “and its integrated working with adult social care services”

Page 84, line 6, at end insert—

“( ) The report must include the Secretary of State’s assessment of the effectiveness of the discharge of the duties under sections 1A and 1B.”

Page 317, line 7, at end insert—

“( ) after paragraph (e) insert—

“(ea) paragraph 11 of Schedule A1,

(eb) paragraph 14 of Schedule 1A,”.”

Page 317, line 35, at end insert—

“( ) In subsection (9), for “section 224 or 226” substitute “section 225”.”

Page 318, line 24, at end insert—

“( ) In the heading to the section, omit “Strategic Health Authorities and”.”

Page 318, line 30, at end insert—

“( ) In the heading to the section, omit “Strategic Health Authorities and”.”

Page 321, line 18, at end insert “, and

(b) before paragraph (a) insert—

“(za) section 14A(1),”.”

Page 322, line 11, at end insert—

“( ) After the entry for “LPS scheme” insert—

Page 326, line 37, at end insert—

(1) Section 60 of the Health and Safety at Work etc. Act 1974 (supplementary provision about the Employment Medical Advisory Service) is amended as follows.

(2) In subsection (1) for “each Primary Care Trust and Local Health Board” substitute “the National Health Service Commissioning Board or each clinical commissioning group (in relation to England) and each Local Health Board (in relation to Wales)”.

(3) In subsection (2)—

(a) omit “for one of their”, and

(b) for ““each” to “its”” substitute ““the National” to “arranges””.”

Page 333, line 9, at end insert—

In section 2 of the Local Government and Housing Act 1989 (politically restricted posts), in subsection (6), after paragraph (za) insert—

“(zb) the director of public health appointed under section 73A(1) of the National Health Service Act 2006;”.”

Page 334, line 24, at end insert—

“( ) in that paragraph, after “or” (in the first place it occurs) insert “a”,

( ) in the words after paragraph (b) in that subsection, omit “authority or”,”

Page 334, line 33, at end insert “, and

( ) in the words after that paragraph, omit “Trust, Authority or.”

Page 334, line 34, leave out from beginning to end of line 6 on page 335

Page 342, line 1, leave out “Minister” substitute “the Welsh Ministers” and insert “Minister considers” substitute “the Welsh Ministers consider”

Page 342, line 6, at end insert—

“( ) The Licensing Act 2003 is amended as follows.

( ) In section 5(3) (statement of licensing policy)—

(a) in paragraph (ba) omit “Primary Care Trust or”, and

(b) after that paragraph insert—

“(bb) each local authority in England whose public health functions within the meaning of the National Health Service Act 2006 are exercisable in respect of an area any part of which is in the licensing authority’s area,”.

( ) In section 13(4) (authorised persons, interested parties and responsible authorities)—

(a) in paragraph (ba) omit “Primary Care Trust or”, and

(b) after that paragraph insert—

“(bb) the local authority in England whose public health functions within the meaning of the National Health Service Act 2006 are exercisable in respect of any area in which the premises are situated,”.”

Page 342, line 8, at end insert—

“( ) In section 69(4) (authorised persons, interested parties and responsible authorities)—

(a) in paragraph (ba) omit “Primary Care Trust or”, and

(b) after that paragraph insert—

“(bb) the local authority in England whose public health functions within the meaning of the National Health Service Act 2006 are exercisable in respect of any area in which the premises are situated,”.

( ) In section 172B(4) (procedural requirements for early morning alcohol restriction order)—

(a) in paragraph (d) omit “Primary Care Trust or”, and

(b) after that paragraph insert—

“(da) the local authority in England whose public health functions within the meaning of the National Health Service Act 2006 are exercisable in respect of an area any part of which is in the area specified in the order,”.”

Page 354, line 24, at end insert—

In section 149 of the Charities Act 2011 (audit or examination of English NHS charity accounts), in subsection (7)—

(a) omit paragraph (a),

(b) omit paragraph (b),

(c) before paragraph (c) insert—

“(ba) the National Health Service Commissioning Board,

(bb) a clinical commissioning group,

(bc) trustees for the National Health Service Commissioning Board appointed in pursuance of paragraph 11 of Schedule A1 to the National Health Service Act 2006, or

(bd) trustees for a clinical commissioning group appointed in pursuance of paragraph 14 of Schedule 1A to that Act,”, and

(d) omit paragraph (f).”

Page 356, line 13, at end insert—

“( ) The amendment made by section 20(6) does not affect—

(a) the validity of any direction made by an instrument in writing which continues to have effect by virtue of sub-paragraph (2),

(b) any power to vary such a direction otherwise than for the purpose of directing the Special Health Authority concerned to exercise an additional function, or

(c) any power to revoke such a direction.”

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 results;

(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;”.”

Insert the following new Clause—

“Public Health England

(1) Public Health England shall be an executive agency engaged in the exercise of public health functions accountable to the Secretary of State.

(2) Public Health England shall have a board chaired by an independent chair.

(3) The board shall have a majority of independent non-executive directors appointed by the Secretary of State.

(4) Any appointment of the independent chair or independent non-executive directors of Public Health England shall be made by the Secretary of State after consultation with the Faculty of Public Health and such other bodies as the Secretary of State considers appropriate.

(5) Public Health England shall be able to—

(a) undertake independent research;

(b) bid for funding for research from research councils, charities and national and international funding agencies;

(c) publish research findings;

(d) tender for contracts, including research for work related to the functions of The Agency.”

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.”

Page 88, line 3, after “to” insert “identifying and”

Page 88, line 5, at end insert—

“( ) Monitor must exercise its functions with a view to preventing anti-collaborative behaviour in the provision of health care services for the purposes of the NHS.”

Page 88, line 32, leave out subsection (7) and insert—

“(7) Monitor must make arrangements to secure that individuals to whom healthcare services are being or may be provided are involved in—

(a) decisions affecting the maintenance or improvement of the quality of services,

(b) determination of the interests of people who use healthcare services,

(c) considerations in relation to the integration of services as provided in subsections (4) and (5), and

(d) the exercise of any other of its functions which would have an impact on the manner in which the services are delivered to the individuals or the range of health services available to them.”

Page 89, line 33, at end insert—

“( ) Regulations under this section shall not limit the right of an adult with capacity to refuse medical diagnosis, testing and treatment of any kind.”

Page 90, leave out line 2 and insert—

“(1) In exercising its functions, Monitor must have regard, in particular, to—”

Page 90, line 3, at end insert—

“(2) Monitor must, in exercising its functions, also have regard to the following matters in so far as they are consistent with the matter referred to in subsection (1)—”

Page 90, line 5, at end insert “and in the efficiency of their provision”

Page 90, line 6, leave out paragraph (c)

Page 90, line 20, leave out paragraph (h)

Page 90, line 24, at end insert—

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

Page 90, line 39, leave out from “that” to end of line 40 and insert “action is taken to ensure that integrated working is promoted”

Page 93, line 38, after “Monitor’s” insert “, other than a function it has by virtue of section 70 or 71,”

Page 94, leave out lines 8 and 9 and insert—

“( ) For the purposes of this section—

(a) a failure to perform a function includes a failure to perform it properly, and

(b) a failure to perform a function properly includes a failure to perform it consistently with what the Secretary of State considers to be the interests of the health service in England or (as the case may be) with what otherwise appears to the Secretary of State to be the purpose for which it is conferred; and “the health service” has the same meaning as in the National Health Service Act 2006.”

Insert the following new Clause—

“Service of general economic interest

The provision of the health service is a service of general economic interest within the meaning of Article 106 of the Treaty of the Functioning of the European Union.”

Insert the following new Clause—

“Duty of co-operation

For section 72 of the National Health Service Act 2006 (co-operation between NHS bodies) substitute—

“72 Duty of co-operation

(1) It is the duty of each NHS provider of health care services to co-operate with—

(a) other such providers (whether providing the same or different types of health care services for the same or different areas),

(b) persons providing health-related services, or

(c) persons providing social care services.

(2) In carrying out their duty of co-operation, NHS providers of healthcare must have regard in particular to co-operating in the integration of health care services with health-related services or with social care services, as the case may be, where they consider this would—

(a) improve the quality of health services (including the outcomes that are achieved from the provision of those services) or the efficiency of 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 the provision of those services.

(3) For the purposes of this section—

(a) “NHS provider of health care services” means NHS Foundation Trusts and Care Trusts,

(b) “health-related services” and “social care services” have the same meaning as in section 61 of the Health and Social Care Act 2012.””

Page 98, line 26, after “(1)(a)” insert “or (b)”

Page 98, line 32, at end insert—

“( ) Before publishing guidance revised under subsection (4), Monitor must consult the persons mentioned in subsection (2).”

Page 98, line 34, leave out subsection (1) and insert—

“( ) For the purposes of Part 3 of the Enterprise Act 2002 (completed and anticipated mergers), each of the following cases is to be treated as being (in so far as it would not otherwise be) a case in which two or more enterprises cease to be distinct enterprises.”

Page 98, line 37, leave out “have ceased” and insert “cease”

Page 98, line 40, leave out “have ceased” and insert “cease”

Page 98, line 40, at end insert—

“(3A) Where the Office of Fair Trading decides to carry out an investigation under Part 3 of the Enterprise Act 2002 of a matter involving an NHS foundation trust, it must as soon as reasonably practicable notify Monitor.

(3B) As soon as reasonably practicable after receiving a notification under subsection (3A), Monitor must provide the Office of Fair Trading with advice on—

(a) the effect of the matter under investigation on benefits (in the form of those within section 30(1)(a) of the Enterprise Act 2002 (relevant customer benefits)) for people who use health care services provided for the purpose of the NHS, and

(b) such other matters relating to the matter under investigation as Monitor considers appropriate.”

Page 99, line 5, leave out paragraph (a) and insert—

“(a) the effectiveness of competition in the provision of health care services for the purposes of the NHS in promoting the interests of people who use such services,”

Leave out Clause 78

Leave out Clause 79

Leave out Clause 80

Leave out Clause 81

Page 104, line 36, leave out subsection (3) and insert—

“(3) Monitor may not set or revise the criteria unless the Secretary of State has by order approved the criteria or (as the case may be) revised criteria.”

Page 107, line 35, at end insert—

“( ) Local Healthwatch,

( ) the appropriate health and wellbeing board,”

Page 108, line 13, at end insert—

“(12) Monitor must consider education and training when setting its licence conditions.”

Page 109, line 13, at end insert—

“(da) for the purpose of enabling health care services provided for the purposes of the NHS to be provided in an integrated way where Monitor considers that this would achieve one or more of the objectives referred to in subsection (2A);

(db) for the purpose of enabling the provision of health care services provided for the purposes of the NHS to be integrated with the provision of health-related services or social care services where Monitor considers that this would achieve one or more of the objectives referred to in subsection (2A);

(dc) for the purpose of enabling co-operation between providers of health care services for the purposes of the NHS where Monitor considers that this would achieve one or more of the objectives referred to in subsection (2A);”

Page 109, line 22, at end insert—

“(2A) The objectives referred to in subsection (2)(da), (db) and (dc) are—

(a) improving the quality of health care services provided for the purposes of the NHS (including the outcomes that are achieved from their provision) or the efficiency of their provision,

(b) reducing inequalities between persons with respect to their ability to access those services, and

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

Page 109, line 29, at end insert—

“( ) In subsection (2)(db), “health-related services” and “social care services” each have the meaning given in section 61(11).”

Page 109, line 32, at end insert—

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

Page 119, line 24, leave out subsection (2)

Insert the following new Clause—

“Expiry of section 111

(1) Section 111 shall cease to have effect in relation to a NHS Foundation Trust after whichever is the later of—

(a) April 2016, or

(b) in the case of a Trust authorised on a date or after 1st April 2014, two years after that,

if the Secretary of State provides by order for that section to cease to have effect in relation to the Trust.

(2) An order under subsection (1) may not be made unless a draft of the order has been laid before and approved by a resolution of each House of Parliament.

(3) Where the Secretary of State proposes to make an order under this section, the Secretary of State must seek the advice of Monitor which must consult the Care Quality Commission and such other persons as Monitor considers appropriate.”

Leave out Clause 112

Leave out Clause 113

Leave out Clause 114

Page 125, line 18, leave out “licence holder” and insert “relevant provider”

Page 127, line 9, at end insert—

“(13A) In this section, a “relevant provider” is—

(a) a licence holder, or

(b) such other person, of such description as may be prescribed, as provides health care services for the purposes of the NHS.”

Page 127, line 10, leave out subsection (14)

Page 127, line 38, leave out “licence holders” and insert “relevant providers”

Page 128, line 1, leave out “licence holders” and insert “relevant providers”

Page 128, line 7, leave out “licence holders” and insert “relevant providers”

Page 128, line 10, leave out “licence holders” and insert “relevant providers”

Page 128, line 21, leave out “licence holder’s” and insert “relevant provider’s”

Page 128, line 22, at end insert—

“( ) In this section and section 121 and Schedule 12, “relevant provider” has the meaning given in section 118(13A).”

Page 128, line 23, leave out subsection (7)

Page 381, line 18, leave out “licence holder” and insert “relevant provider”

Page 128, line 32, leave out “licence holders” and insert “relevant providers”

Page 129, line 20, leave out “licence holders” and insert “relevant providers”

Page 132, line 16, leave out “licence holder” and insert “relevant provider”

Page 132, line 25, at end insert—

“( ) In this section, “relevant provider” has the meaning given in section 118(13A).”

Insert the following new Clause—

“Action prior to health special administration orders

(1) Monitor shall publish annually a report to the National Commissioning Board with evidence on any trusts that it considers are at serious risk of requiring a health special administration order and make this report available to the Secretary of State and the relevant clinical commission groups and health and wellbeing boards.

(2) It shall be for the Board and the relevant local organisations to establish an appropriate mechanism to review the services concerned and to produce within six months a report to Monitor indicating how those services can be made clinically and financially sustainable and the extent to which the proposed changes have been agreed by local interests.

(3) It shall be for Monitor to decide whether such responses are adequate to secure clinical and financial sustainability in the areas concerned and to inform the Secretary of State and interested parties of their decisions.

(4) It shall be for the Secretary of State either to endorse any report that achieves clinical and financial sustainability or to specify to the National Commissioning Board what further action should be taken to deliver such sustainability and the Secretary of State’s decisions and Monitor’s reports shall be made public.

(5) It shall be open to the National Commissioning Board in consultation with the Secretary of State to establish a panel of independent people with appropriate expertise to assist with securing local agreement on the reconfiguration of services required to secure clinical and financial sustainability.”

Page 148, line 26, at end insert—

“( ) Until section 8 comes into force, the references in this Part to the National Health Service Commissioning Board (other than the reference in section 95(11)(b)) are to be read as references to the NHS Commissioning Board Authority.

( ) Until the day specified by Secretary of State for the purposes of section 14A of the National Health Service Act 2006, the references in this Part to a clinical commissioning group (other than the reference in section 95(11)(a)) are to be read as references to a Primary Care Trust.

( ) Until section 180 comes into force, the following provisions in this Part are to be read as if the words “and its Healthwatch England committee” were omitted—

(a) section 84(4)(c);

(b) section 85(5)(a)(iii);

(c) section 96(2)(e);

(d) section 100(2)(e).”

Page 159, line 35, at end insert—

“(c) the promotion of education and training”

Page 159, line 35, at end insert—

“( ) NHS hospitals may provide private care as long as it is not detrimental to providing a public health service.”

Page 167, line 24, at end insert—

“( ) If, at any time before section 8 comes into force, Monitor obtains the approval of the NHS Commissioning Board Authority to publish guidance under section 65DA(4)(c) or (5) of the National Health Service Act 2006, that approval is to be treated for the purposes of subsection (6)(b) of that section as approval obtained from the National Health Service Commissioning Board.”

Page 392, line 20, leave out “section 78” and insert “sections 78 and 79”

Page 400, line 12, at end insert—

The Charities Act 2011 is amended as follows.

In section 149 (audit or examination of English NHS charity accounts), in subsection (7), omit paragraphs (c), (d) and (e).

In section 150 (audit or examination of Welsh NHS charity accounts), in subsection (4)—

(a) in paragraph (b), omit the words from “all or most” to the end,

(b) in paragraph (c), omit “falling within paragraph (b)”, and

(c) in paragraph (d), omit “such”.”

Page 176, line 25, at end insert—

“( ) The provision that must be made by virtue of sub-paragraph (1A) includes provision as to—

(a) the majority membership of Healthwatch England committee being elected from representatives of Local Healthwatch organisations, and

(b) the manner in which those representatives are elected, the term which they must serve and the role that they must fulfil.”

Page 176, leave out lines 26 to 29

Page 176, line 30, leave out subsection (3) and insert—

“(3) After sub-paragraph (5) insert—

“(5A) Regulations under sub-paragraph (1A) must make provision requiring a person who has power to appoint a member of the Healthwatch England committee to secure that a majority of the members of the committee are not members of the Commission.

(5B) Regulations under sub-paragraph (1A) may specify other results which a person who has power to appoint a member of the committee must secure.

(5C) Regulations under sub-paragraph (1A) may, in particular, make provision as to—

(a) eligibility for appointment;

(b) procedures for selecting or proposing persons for appointment.

(5D) Regulations under sub-paragraph (1A) may, in particular, make provision as to—

(a) the removal or suspension of members of the committee;

(b) the payment of remuneration and allowances to members.”.”

Page 177, line 10, leave out “people” and insert “adults and children”

Page 177, line 35, at end insert—

“45AA Conflicts of interest

(1) In making arrangements under section 45A(1), the Commission must have regard to any conflicts guidance issued by the Secretary of State.

(2) In exercising functions on behalf of the Commission, the Healthwatch England committee must have regard to any conflicts guidance issued by the Secretary of State.

(3) In this section, “conflicts guidance” means guidance about managing conflicts between—

(a) the exercise of functions by the Commission, and

(b) the exercise of functions by the Healthwatch England committee on the Commission’s behalf.”

Page 177, line 47, at end insert “and to every Local Healthwatch organisation”

Page 179, line 5, leave out subsection (14) and insert—

“(14) The Healthwatch England committee is to be treated for the purposes of section 2(1) of the Public Bodies (Admission to Meetings) Act 1960 as a body that includes all the members of the Care Quality Commission.”

Leave out Clause 180

Page 180, line 14, at end insert—

“(2) For subsection (1) substitute—

“(1) Unless a Local Healthwatch decides to make its own arrangements, A must make arrangements for securing that the Local Healthwatch for its area has the services, staff and accommodation (including such administration, maintenance, cleaning and other services as may be necessary for such accommodation) as may be necessary to enable it to perform its functions effectively.

(1A) A shall, in respect of each financial year, pay to the Local Healthwatch for its area sums equal to the amounts which it has approved as the amounts of expenditure which it considers may reasonably be incurred by Local Healthwatch in that year for the purpose of performing its functions.”

(3) In subsection (2) for “activities” substitute “functions of a Local Healthwatch”.”

Page 180, line 14, at end insert—

“( ) In subsection (2)(a), (b) and (c) for “people” substitute “adults and children”.”

Page 180, line 15, after “(2)” insert “—

(a) in each of paragraphs (a) to (c), before “people” insert “local”, and

(b) ”

Page 180, line 37, at end insert—

“( ) In subsection (6), after the definition of “local care services” insert—

““local people”, in relation to a local authority, means—

(a) people who live in the local authority’s area,

(b) people to whom care services are being or may be provided in that area,

(c) people from that area to whom care services are being provided in any place, and

(d) people who are (taken together) representative of the people mentioned in paragraphs (a) to (c);”.”

Page 181, line 4, leave out “activities” and insert “its functions”

Page 181, line 22, leave out subsection (9) and insert—

“(9) In subsection (1)—

(a) after “which” insert “include—

(i) prescribed provision relating to the way in which certain decisions of a local authority in relation to the arrangements are to be taken; and

(ii) provision that arrangements made under section 221(1) (“local authority arrangements”) must—

(a) include prescribed provision, or

(b) require prescribed provision to be included in Local Healthwatch arrangements; and

(c) ”

(b) for “local involvement network arrangements” substitute “Local Healthwatch organisation arrangements”.”

Page 182, 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 195, line 28, leave out “other functions of the authority” and insert “functions that are exercisable by the authority”

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.”

Leave out Clause 208

Leave out Clause 210

Leave out Clause 211

Leave out Clause 212

Page 211, line 36, after “and” insert “Social”

Leave out Clause 213

Leave out Clause 214

Leave out Clause 215

Insert the following new Clause—

“Public health specialists

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

“(k) those statutory bodies responsible for the regulation of public health specialists including those from backgrounds other than medicine, for whom a statutory register will be established by the Health Professions Council.”

(2) In this Act “registered public health specialist” 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.”

Leave out Clause 220

Leave out Clause 221

Leave out Clause 222

Insert the following new Clause—

“Power to regulate clinical physiologists in England

(1) Section 60 of the Health Act 1999 (regulation of health care professions) is amended as follows.

(2) In subsection (1), after paragraph (b) insert—

“(ba) regulating the clinical physiology professions in England,”.

(3) In that subsection, after paragraph (bb) insert—

“(bc) regulating clinical physiologists in England who appear to require regulation in pursuance of this section,”.”

Insert the following new Clause—

“Requirement for clinical physiologists in England to be registered

(1) The Health Professions Council is required to keep a register of clinical physiologists in England.

(2) A person may not practice as a clinical physiologist in England unless the person is registered in that part of the register maintained by the Health Professions Council.”

Insert the following new Clause—

“Statutory registration

(1) The Health Professions Council shall establish a statutory register of clinical perfusionists.

(2) In this Act “registered clinical perfusionists” means a person recognised as such on a register maintained by the statutory body responsible for the regulation of clinical perfusionists.”

Page 236, line 29, at end insert—

“( ) But provision made under subsection (8) may impose a requirement on a local authority, or a description of local authorities, only if the requirement relates to—

(a) the exercise by an authority of any of its functions under section 2B or 111 of, or paragraphs 1 to 7B or 13 of Schedule 1 to, the National Health Service Act 2006;

(b) the exercise by an authority of any of its functions by virtue of section 6C(1) or (3) of that Act;

(c) anything done by an authority in pursuance of arrangements under section 7A of that Act.”

Page 236, line 31, leave out “other than a local authority”

Page 239, line 29, at end insert—

“( ) For the purposes of this section, a failure to discharge a function properly includes a failure to discharge it consistently with what the Secretary of State considers to be the interests of the health service in England or (as the case may be) with what otherwise appears to the Secretary of State to be the purpose for which it is conferred.”

Page 243, line 26, leave out second “and” and insert “or”

Page 243, line 30, leave out from beginning to second “it” and insert “the Secretary of State considers that the information which could be obtained by complying with the direction is information which”

Page 243, line 38, leave out from “if” to “it” in line 39 and insert “the Board considers that the information which could be obtained by complying with the direction is information which”

Page 244, line 11, leave out second “and” and insert “or”

Page 244, line 13, leave out from beginning to “it” in line 14 and insert “A request may be made under subsection (1) by a person only if the person considers that the information which could be obtained by complying with the request is information which”

Page 244, line 20, leave out from “Chapter” to “it” in line 23 and insert “a request under subsection (1) is a mandatory request if—

(a) it is made by a principal body, and

(b) the body considers that the information which could be obtained by complying with the request is information which”

Page 244, line 41, leave out “relevant” and insert “principal”

Page 244, line 42, after “to” insert—

“(i) the code of practice prepared and published by the Centre under section (Code of practice on confidential information), and

(ii) ”

Page 244, line 44, leave out ““relevant” and insert ““principal”

Insert the following new Clause—

“Requests for collection under section 254: confidential information

(1) A request under section 254 is a confidential collection request if it is a request for the Information Centre to establish and operate a system for the collection of information which is in a form which—

(a) identifies any individual to whom the information relates who is not an individual who provides health care or adult social care, or

(b) enables the identity of such an individual to be ascertained.

(2) A person may make a confidential collection request under section 254 only if the request—

(a) is a mandatory request,

(b) relates to information which the person making the request (“R”) may require to be disclosed to R or to the Information Centre by the person holding it, or

(c) relates to information which may otherwise be lawfully disclosed to the Information Centre or to R by the person holding it.”

Page 245, line 32, leave out “that” and insert “any”

Page 245, line 36, leave out “collected pursuant to” and insert “obtained by complying with”

Page 245, line 37, leave out “or information derived from such information,”

Page 246, line 9, at end insert—

“(2A) But the Information Centre may not impose a requirement under subsection (1)(a) for the purpose of complying with a confidential collection request falling within section (Requests for collection under section 254: confidential information)(2)(c).

(2B) In such a case, the Information Centre may, however, request any person mentioned in subsection (2) to provide it with any information which the Centre considers it necessary or expedient for the Centre to have for the purpose of complying with the request.”

Page 246, line 16, at end insert—

“( ) If the Information Centre considers it appropriate to do so, the Centre may make a payment to any person mentioned in subsection (2)(b) who has provided information to the Centre pursuant to a request made under subsection (2B) in respect of the costs to that person of doing so.”

Page 246, line 18, leave out “subsection (1)” and insert “this section”

Page 246, line 32, leave out “collects pursuant to” and insert “obtains by complying with”

Page 247, line 9, leave out “collected pursuant to” and insert “obtained by complying with”

Page 247, line 10, leave out “collects pursuant to” and insert “obtains by complying with”

Page 247, line 18, leave out “collects pursuant to” and insert “obtains by complying with”

Page 247, line 39, leave out “collects pursuant to” and insert “obtains by complying with”

Page 247, line 46, after “and” insert “—

(i) the relevant person has consented to the dissemination, or

(ii) ”

Page 248, line 2, at end insert—

“( ) the information is in a form which identifies any individual to whom the information relates who is not a relevant person or enables the identity of such an individual to be ascertained and the individual has consented to the dissemination;”

Page 248, line 11, at end insert—

“(3A) The Information Centre may also disseminate, in such form and manner and at such times as it considers appropriate, any information which it collects pursuant to a direction under section 253 or a request under section 254 (whether or not it falls within subsection (2)) to any person to whom the information could have been lawfully disclosed by the person from whom the Centre collected the information.

(3B) The Information Centre may also disclose information which it obtains by complying with a direction under section 253 or a request under section 254 (whether or not it falls within subsection (2)) if—

(a) the information has previously been lawfully disclosed to the public,

(b) the disclosure is made in accordance with any court order,

(c) the disclosure is necessary or expedient for the purposes of protecting the welfare of any individual,

(d) the disclosure is made to any person in circumstances where it is necessary or expedient for the person to have the information for the purpose of exercising functions of that person conferred under or by virtue of any provision of this or any other Act,

(e) the disclosure is made in connection with the investigation of a criminal offence (whether or not in the United Kingdom), or

(f) the disclosure is made for the purpose of criminal proceedings (whether or not in the United Kingdom).

(3C) Paragraphs (a), (b) and (f) of subsection (3B) have effect notwithstanding any rule of common law which would otherwise prohibit or restrict the disclosure.”

Page 248, line 12, leave out subsections (4) and (5)

Page 248, line 22, after “section” insert “or section (Dissemination: directions under section 253 and requests under section 254)”

Page 248, line 23, leave out from “it)” to first “any” in line 24 and insert “under or by virtue of”

Page 248, line 25, leave out subsection (7)

Page 248, line 28, at end insert—

“( ) For the purposes of this section and section (Dissemination: directions under section 253 and requests under section 254) the provision by the Information Centre of information which it has obtained by complying with a direction under section 253 or a request under section 254 to the person who gave the direction or made the request is to be treated as dissemination by the Centre of that information to that person.”

Insert the following new Clause—

“Other dissemination: directions under section 253 and requests under section 254

(1) A direction under section 253 may require the Information Centre to disseminate information which it obtains by complying with the direction if the information falls within subsection (2).

(2) Information falls within this subsection if—

(a) the information is required to be published under section 258;

(b) the information is in a form which identifies any relevant person to whom the information relates or enables the identity of such a relevant person to be ascertained and—

(i) the relevant person has consented to the dissemination, or

(ii) the person giving the direction, after taking into account the public interest as well as the interests of the relevant person, considers that it is appropriate for the information to be disseminated;

(c) the information is in a form which identifies any individual to whom the information relates who is not a relevant person or enables the identity of such an individual to be ascertained and the individual has consented to the dissemination;

(d) the Centre is prohibited from publishing the information only by virtue of it falling within section 258(2)(c) and the person giving the direction considers it would be in the public interest for the information to be disseminated.

(3) A direction under section 253 may require the Information Centre to exercise—

(a) the power conferred by section 259(3A) in relation to information which it collects pursuant to the direction, or

(b) any other power it has under or by virtue of any other provision of this Act (other than section 259(1) or (3B)) or any other Act to disseminate information which it obtains by complying with the direction.

(4) A request under section 254 may request the Information Centre to exercise—

(a) the power conferred by section 259(1) or (3A) in relation to information which it obtains by complying with the request, or

(b) any other power it has to disseminate such information under or by virtue of any other provision of this or any other Act.

(5) A direction under section 253 may require, and a request under section 254 may request, the Information Centre not to exercise the power conferred by section 259(1) or (3A) in relation to information which it obtains by complying with the direction or request.

(6) Section 254(3) does not apply in relation to anything included in a mandatory request by virtue of subsection (4) or (5).

(7) A requirement imposed on, or a request made to, the Information Centre in accordance with this section to disseminate information may include a requirement or request about the persons to whom the information is to be disseminated and the form, manner and timing of dissemination.”

Insert the following new Clause—

“Code of practice on confidential information

(1) The Information Centre must prepare and publish a code in respect of the practice to be followed in relation to the collection, analysis, publication and other dissemination of confidential information concerning, or connected with, the provision of health services or of adult social care in England.

(2) For the purposes of this section “confidential information” is—

(a) information which is in a form which identifies any individual to whom the information relates or enables the identity of such an individual to be ascertained, or

(b) any other information in respect of which the person who holds it owes an obligation of confidence.

(3) Before publishing the code, the Information Centre must consult—

(a) the Secretary of State,

(b) the Board, and

(c) such other persons as the Centre considers appropriate.

(4) The Information Centre must not publish the code without the approval of—

(a) the Secretary of State, and

(b) the Board, so far as the code relates to information concerning, or connected with, the provision of NHS services.

(5) The Information Centre must keep the code under review and may revise it as it considers appropriate (and a reference in this section to the code includes a reference to any revised code).

(6) A health or social care body must have regard to the code in exercising functions in connection with the provision of health services or of adult social care in England.

(7) A person, other than a public body, who provides health services, or adult social care in England, pursuant to arrangements made with a public body exercising functions in connection with the provision of such services or care must, in providing those services or that care, have regard to the code.”

Page 248, line 31, leave out “collected” and insert “obtained”

Page 251, line 39, at end insert—

“( ) For the purposes of this section, a failure to discharge a function properly includes a failure to discharge it consistently with what the Secretary of State considers to be the interests of the health service in England or (as the case may be) with what otherwise appears to the Secretary of State to be the purpose for which it is conferred.”

Leave out Clause 277

Page 259, line 11, at end insert “, and both bodies must act in accordance with the mandate issued by the Secretary of State under section 13BA (mandate to Monitor and the Care Quality Commission) of the National Health Service Act 2006”

Page 261, line 16, after “duty” insert “or are otherwise in conflict with each other or at significant risk of being in conflict with each other”

Page 261, line 40, at end insert “or may require one or more of the bodies concerned to exercise specified functions in a specified manner”

Page 263, line 6, at end insert—

“( ) For the purposes of this section a failure to perform a function properly includes a failure to perform it consistently with what the Secretary of State considers to be the interests of the health service in England or (as the case may be) with what otherwise appears to the Secretary of State to be the purpose for which it is conferred; and “the health service” has the same meaning as in the National Health Service Act 2006.”

Insert the following new Clause—

“Contravention of section 64 of the Medicines Act 1968: due diligence defence

In section 67 of the Medicines Act 1968 (offences under Part 3), after subsection (2) insert—

“(2A) But it is a defence for a person charged with an offence under subsection (2) in respect of a contravention of section 64 to show that the person exercised all due diligence to avoid committing the offence.””

Page 269, line 22, at end insert—

“( ) an order under Schedule 2, Part 1 (Constitution of Clinical Commissioning Groups);”

Page 269, line 24, at end insert—

“( ) the first regulations under section 84 (licensing requirement: exemption regulations);”

Page 269, line 24, at end insert—

“( ) the first order under section 87 (approval by Secretary of State of licensing criteria);”

Page 271, line 47, at end insert—

“( ) Section (Contravention of section 64 of the Medicines Act 1968: due diligence defence) comes into force at the end of the period of two months beginning with the day on which this Act is passed.”