Health and Social Care Bill

Page 14, line 9, at end insert—

“( ) The regulations must require the Board to include in terms and conditions prepared by virtue of subsection (5)(a) provision for a requirement to be placed upon any organisation that enters into a commissioning contract to provide healthcare with the Board or with a clinical commissioning group 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 contracted 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).”

Page 14, line 32, at end insert—

“(8A) The standing rules under subsection (1) shall make provision as to how clinical commissioning groups are required to register, manage and report upon conflicts of interests of both members and employees of a clinical commissioning group, or any individual engaged by a clinical commissioning group to be involved in any part of the process of commissioning NHS services (“the Conflict and Financial Interests Rules”).

(8B) The Secretary of State shall consult upon and then publish a Code of Conduct for members of clinical commissioning groups concerning the registration of pecuniary and non-pecuniary interests by members of a clinical commissioning group, and setting out how clinical commissioning groups shall manage actual or potential conflicts of interests amongst its members, which shall include provisions concerning the provision of services (other than NHS services) to NHS patients.

(8C) The Conflict and Financial Interests Rules shall include the following provisions—

(a) a duty on members of a clinical commissioning group to abide by the terms of the Code of Conduct to be published by the Secretary of State under subsection (8B) hereof;

(b) that each clinical commissioning group shall maintain a register of pecuniary and non-pecuniary interests of members of the clinical commissioning group;

(c) a requirement that each member of a clinical commissioning group shall register all of his pecuniary and non-pecuniary interests in the Register unless the said interest shall be within a de minimis classification set out in the Regulations, and shall keep the said register up to date;

(d) a requirement that the register of interests of each clinical commissioning group shall be published and made available for public inspection;

(e) a requirement that, unless approved by the Board, a clinical commissioning group shall not be entitled to enter into any arrangements to commission healthcare or other services with any person where any member of the clinical commissioning group has a financial interest or link to that person of a type set out in Regulations (“a Conflicted Arrangement”);

(f) a procedure (“the Exemption Procedure”) under which a clinical commissioning group shall be entitled to request an exemption from the Board so as to permit the clinical commissioning group to enter into any a Conflicted Arrangement;

(g) that the Exemption Procedure shall require the clinical commissioning group to publicise the application for the exemption and to permit any objections thereto to be considered by the Board;

(h) that the Exemption Procedure shall provide that, after considering the merits of the individual application, the Board shall be entitled to approve the arrangement if but only if the Board is satisfied that the proposal to enter into any such arrangement has been the subject of an open and transparent procurement process, that it provides the best value for money for the clinical commissioning group and that there are appropriate safeguards proposed by the clinical commissioning group to manage any conflict of interest in the management of the said arrangement;

(i) that no member of a clinical commissioning group shall be permitted to take any part in any discussion of or decision making process concerning any arrangement or proposed arrangement with a provider of services with whom that person has a registerable interest;

(j) a procedure for complaints to be made to the Secretary of State by any person who alleges that a member of a clinical commissioning group has acted in breach of the Code of Conduct or in breach of the Conflict and Financial Interests Regulations;

(k) a procedure for the Secretary of State to appoint an adjudicator to investigate and to rule upon any such complaint; and

(l) for the adjudicator to be able to impose sanctions on any member of a clinical commissioning group has been found by an adjudicator to have acted in breach of the Code of Conduct or in breach of the Conflict and Financial Interests Rules including—

(i) such financial sanctions as the Secretary of State shall consider appropriate;

(ii) suspension of such a person from being a member of a clinical commissioning group;

(iii) removal of such a person from current membership of a clinical commissioning group;

(iv) a bar on such a person being a member of a clinical commissioning group for a period of up to 10 years;

(v) the referral to the Board for action to be taken against any individual who is a performer under the National Health Service (Performers List) Regulations 2004; and

(vi) the suspension or termination of any contract or arrangement for the provision of NHS services that may exist between the Board or any clinical commissioning group and that person or any partnership, company or other organisation with whom that person shall have a registerable interest.

(8D) Where any contract or other arrangement is suspended or terminated by the action of an adjudicator following an adjudication under sub-section (8C)(I), no other person shall be entitled to assert any legal right or make any claim for damages or financial compensation on any other basis whatsoever against the Board or any clinical commissioning group as a result of the said adjudication.”

Insert the following new Clause—

“Integration of services

(1) In discharging any duties under this Act, or any related regulations or guidance, “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.

(2) Annual reports produced in accordance with this Act by the National Commissioning Board; and a clinical commissioning group shall report progress made by that body on improving the delivery of integrated care and treatment in accordance with this definition.

(3) The National Commissioning Board’s annual business plan must explain how it proposes to improve integration of services in accordance with this definition.

(4) In developing tariffs, both the National Commissioning Board and Monitor shall have regard to improving integrated care and treatment in accordance with this definition.”

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 16, line 25, at end insert—

“( ) The mandate shall also require performance monitoring in primary care by the Board.”

Page 17, line 1, at end insert—

“(aa) monitor the progress made in primary care in relation to the standards specified in the mandate,”

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 17, line 38, at end insert—

“Patients’ interests to be treated as paramount

The Board must, so far as resources allow, exercise its functions on the basis that the interests of patients are paramount.”

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—

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

[Withdrawn]

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 “, and

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

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—

(a) provide 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 19, line 26, at end insert—

“( ) When granting authorisation and when renewing authorisation annually of a clinical commissioning group, the commissioning board must ascertain that the clinical commissioning group is—

(a) commissioning for less common conditions; and

(b) collaborating with other relevant clinical commissioning groups over commissioning for less common conditions.”

[Withdrawn]

Page 20, line 8, at end insert—

“Duty in respect of emergency and unscheduled care services

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

(a) ensure that emergency health services are adequate for the population served,

(b) recognise the importance of integration between emergency care and specialised networks and associated specialities,

(c) ensure that primary care provision in-hours and out-of-hours has integrated care pathways with emergency departments.”

Page 20, line 24, at end insert—

“13OA Duty to have regard to the voluntary and social enterprise sector

(1) In exercising its functions, the Board must, so far as it is consistent with the interests of the health service, act with a view to ensuring that competition does not disadvantage the voluntary and social enterprise sectors.

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

(3) Any action the Board takes in subsection (2) shall only be such that a level playing field between providers is achieved and maintained, meaning that one sector of provision is not more disadvantaged than another and the relative benefits of each form of organisation can be taken into account.”

Page 20, line 24, at end insert—

“13OB Duty to promote inclusion of weightings

The Board may promote the inclusion of weightings in the pre-commencement and procurement stages for services, which reflect wider social, economic and health outcomes for each local health area.”

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 “, 13C”

[Withdrawn]

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

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

[Withdrawn]

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;”

[Withdrawn]

Page 36, line 1, at end insert—

“14NA Registers of interests and management of conflicts of interest

(1) Each clinical commissioning group must maintain one or more registers of the interests of—

(a) the members of the group,

(b) the members of its governing body,

(c) the members of its committees or sub-committees or of committees or sub-committees of its governing body, and

(d) its employees.

(2) Each clinical commissioning group must publish the registers maintained under subsection (1) or make arrangements to ensure that members of the public have access to the registers on request.

(3) Each clinical commissioning group must make arrangements to ensure—

(a) that a person mentioned in subsection (1) declares any conflict or potential conflict of interest that the person has in relation to a decision to be made in the exercise of the commissioning functions of the group,

(b) that any such declaration is made as soon as practicable after the person becomes aware of the conflict or potential conflict and, in any event, within 28 days, and

(c) that any such declaration is included in the registers maintained under subsection (1).

(4) Each clinical commissioning group must make arrangements for managing conflicts and potential conflicts of interest in such a way as to ensure that they do not, and do not appear to, affect the integrity of the group’s decision-making processes.

(5) The Board must publish guidance for clinical commissioning groups on the discharge of their functions under this section.

(6) Each clinical commissioning group must have regard to guidance published under subsection (5).

(7) For the purposes of this section, the commissioning functions of a clinical commissioning group are the functions of the group in arranging for the provision of services as part of the health service.”

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, leave out lines 32 to 34

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 38, at end insert—

“( ) The constitution must specify the arrangements made by the clinical commissioning group for discharging its duties under section 14NA(1) to (4).”

Page 282, leave out lines 33 to 34

[Withdrawn]

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—

(1) The application of a clinical commissioning group’s seal must be authenticated by the signature of any person who has been authorised (generally or specially) for that purpose.

(2) Any instrument which, if executed by an individual, would not need to be under seal may be executed on behalf of a clinical commissioning group by any person who has been authorised (generally or specially) for that purpose.

(3) A document purporting to be duly executed under a clinical commissioning group’s seal or to be signed on its behalf must be received in evidence and, unless the contrary is proven, taken to be so executed or signed.”

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 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.

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 18, at end insert—

“14PA Patients’ interests to be treated as paramount

Each clinical commissioning Group must, so far as resources allow, exercise its functions on the basis that the interests of patients are paramount.”

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 36, line 38, at end insert “and provide the Board with the information necessary to assist and support the Board in discharging its functions under section 13A(7)”

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 to 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—

“and must 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 44, line 17, after “14Q” insert “, 14Y”

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 who is 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

Leave out Clause 39 and insert the following new Clause—

“After-care

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

(2) In subsection (2)—

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

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

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

(3) After subsection (2C) insert—

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

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

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

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

(4) In subsection (3)—

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

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

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

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

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 319, line 33, at end insert—

“After section 254 insert—

254A Support functions of the Secretary of State

(1) The Secretary of State may, for the purpose of assisting any person exercising functions in relation to the health service or providing services for its purposes—

(a) provide (or otherwise make available) to the person goods, materials or other facilities;

(b) facilitate the recruitment and management of the person’s staff;

(c) develop or operate information or communication systems;

(d) do such other things to facilitate or support the carrying out of the person’s functions or other activities as the Secretary of State considers appropriate;

(e) arrange for any other person to do anything mentioned in paragraphs (a) to (d) or to assist the Secretary of State in doing any such thing.

(2) The power conferred by subsection (1)(a) includes power to purchase goods and materials for the purpose of providing them or making them available.

(3) The Secretary of State may, in connection with anything done under subsection (1), make available the services of any person employed by the Secretary of State.

(4) The powers conferred by this section may be exercised on such terms, including terms as to the making of payments to or by the Secretary of State, as may be agreed.

(5) In this section, “the health service” does not include that part of the health service that is provided in pursuance of the public health functions of the Secretary of State or local authorities.””

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—

Secretary of State duty as to the standards of adult social care

(1) The Secretary of State shall have a duty to secure the improvement in the quality of adult social care services through local social services authorities and qualified service providers registered with the Care Quality Commission.

(2) In discharging this duty, the Secretary of State must ensure—

(a) the establishment of a fair and resilient partnership between individuals and the state for funding adult social care that—

(i) secures adequate funding to deliver safe and sustainable services,

(ii) provides access to these services for those of limited means,

(iii) caps the financial liability to pay for services for those with unusually high lifetime care costs,

(iv) minimises the impact on the demand for health services,

(b) that the assessment of the needs of individuals and their carers for services is undertaken on the basis of published criteria for eligibility to and charging for services that applies consistently throughout England,

(c) that continuing efforts are made to reduce barriers to the delivery of integrated health and adult social care to individuals and through the conduct of commissioners and providers of both health and social care services.

(3) The Secretary of State may, after appropriate consultations, make regulations governing the discharge of his duties under subsections (1) and (2), subject to affirmative resolutions in both Houses of Parliament.”

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.”

Line 3, leave out from “be” to end of line 4 and insert “established as a Special Health Authority”

Line 18, leave out “Agency” and insert “Authority”

Insert the following new Clause—

“Employment conditions for public health specialists

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

Insert the following new Clause—

“Health premium

(1) The Secretary of State may allocate additional financial resources to local authorities by way of a health premium to reflect achievements in promoting public health or narrowing health inequalities.

(2) Regulations shall set out the criteria by which a health premium is to be determined and allocated.

(3) These regulations are to be approved annually by affirmative resolution of both Houses of Parliament.

(4) The health premium scheme shall lapse four years after coming into effect with the passing of this Act, unless it is renewed by affirmative resolution of both Houses of Parliament.”

Page 87, line 31, at end insert—

“(c) is to continue as regulator of NHS Foundation Trusts as set out in Chapter 5 of Part 2 of the National Health Service Act 2006.

(d) is to take on the further duties as set out in this Act in relation to authorising through licensing any person who provides health care services for the purposes of the NHS as set out in Chapter 3 of this Act.”

Page 368, line 17, after “functions” insert—

“(b) include a statement of what it did to comply with the duty under section (Secretary of State’s guidance on duty under section 61(9))(2) (duty to have regard to Secretary of State’s guidance on duty under section 61(9)), and

(c) include a statement of what it did to comply with the duty under section 64(1)(ja) (duty to have regard to Secretary of State’s guidance on relevant parts of document on improving quality of services).”

Page 87, line 37, after “effective,” insert—

“( ) is based on the principles of universality and social solidarity,”

Page 87, line 38, after “effective,” insert—

“(1A) The role of Monitor as the Independent Regulator of Foundation Trusts shall continue.”

Page 88, line 3, leave out subsection (3) and insert—

“( ) Monitor shall be under a duty (known as the “duty of cooperation”) to ensure that any provider organisation which is regulated by it shall both plan to provide and shall provide its services in ways that promote efficient and effective cooperation between providers of health care services as part of health services provided under this Act, and in particular shall both plan and provide services that further the objectives of—

(a) improving the quality of services for patients from all providers under subsection (1A);

(b) reducing inequalities between persons with respect to their ability to access those health care services;

(c) reducing inequalities between persons with respect to of health outcomes.

( ) The Secretary of State shall publish guidance to Monitor and providers if NHS services regarding the exercise of the duty of cooperation, and where such guidance is published, NHS providers and Monitor shall pay due regard to the guidance in the discharge of their functions.

( ) Regulations may require NHS providers to take such steps as are prescribed as part of the duty of cooperation.”

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 88, line 45, leave out subsection (10)

Insert the following new Clause—

“Secretary of State’s guidance on duty under section 61(9)

(1) The Secretary of State may, for the purpose of assisting Monitor to comply with its duty under section 61(9), publish guidance on—

(a) the objectives specified in the mandate published under section 13A of the National Health Service Act 2006 which the Secretary of State considers to be relevant to Monitor’s exercise of its functions, and

(b) the Secretary of State’s reasons for considering those objectives to be relevant to Monitor’s exercise of its functions.

(2) In exercising its functions, Monitor must have regard to guidance under subsection (1).

(3) Where the Secretary of State publishes guidance under subsection (1), the Secretary of State must lay a copy of the published guidance before Parliament.

(4) The Secretary of State—

(a) may revise guidance under subsection (1), and

(b) if the Secretary of State does so, must publish the guidance as revised and lay it before Parliament.”

Page 89, line 12, leave out subsection (2)

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 89, line 34, at end insert—

“( ) Regulations may provide for Monitor to make the granting of a licence conditional upon performance in relation to matters set out as in section 64.”

Leave out Clause 63

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 8, at end insert—

“(d) the desirability of a full transfer of information from authorities responsible for a child’s social care to the authority responsible for that person’s adult social care at the time the transfer takes place; and where no other date has been agreed, the date for transfer shall be the date on which the patient reaches the age of eighteen,

(e) the desirability of an assessment at, or about, the time they transfer from child social care services to adult social care services, of a patient’s ongoing care needs and of the quality of care and treatment, if any, he or she has received as a child,”

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 27, at end insert—

“(ja) where the Secretary of State publishes a document for the purposes of section 13E of the National Health Service Act 2006 (improvement of quality of services), any guidance published by the Secretary of State on the parts of that document which the Secretary of State considers to be particularly relevant to Monitor’s exercise of its functions,”

Page 90, line 28, leave out paragraphs (k) to (m)

Page 90, line 36, at end insert—

“( ) Where the Secretary of State publishes guidance referred to in subsection (2)(ja), the Secretary of State must lay a copy of the published guidance before Parliament.

( ) The Secretary of State—

(a) may revise the guidance, and

(b) if the Secretary of State does so, must publish the guidance as revised and lay it before Parliament.”

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 90, line 41, leave out from “act” to end of line 49 and insert “through appropriate organisational arrangements to separate its functions in paragraphs (c) and (d) of section 64.”

Page 91, line 20, at end insert—

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

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 96, line 30, at end insert—

“(5) An NHS commissioner shall be entitled to undertake a review (“a Commissioning Review”) of all or any part of the health services that the NHS commissioner considers are reasonably required in order to discharge its functions under this Act, and, upon completion of such a Commissioning Review, an NHS Commissioner shall be entitled to determine that the most appropriate way to deliver all or any part of such services shall be through the conclusion of arrangements with one or more health services bodies or one or more NHS Foundation Trusts.

(6) NHS Commissioners shall, when conducting a Commissioning Review, have regard to the following factors—

(a) the need for NHS services to be provided in a way that is economic, efficient and effective;

(b) the need to commission services in a way that maintains or improves the quality of the services;

(c) the need to commission health services in a way that promotes the integration of health and social care services;

(d) the need for health care services provided for the purposes of the NHS to be provided in an integrated way where this will—

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

(ii) reduce inequalities between persons with respect to their ability to access those services, and

(iii) reduce inequalities between persons with respect to the outcomes achieved for them by the provision of those services;

(e) the likely future demand for health care services;

(f) the desirability of patient choice.

(7) An NHS commissioner shall be entitled, as part of any Commissioning Review, to seek expressions of interest from health services bodies or from NHS Foundation Trusts which may have an interest in providing such services, and shall be entitled to undertake such processes as it shall consider appropriate to determine which of such bodies is able most appropriately to provide any such services.

(8) A Commissioning Review and decisions made following a Commissioning Review to make arrangements with one or more health services bodies or NHS Foundation Trusts shall not constitute anti-competitive behaviour for the purposes of this or any other Act.

(9) The Public Contracts Regulations 2006 shall not impose any obligations on an NHS commissioner which undertakes a Commissioning Review or makes decisions to make arrangements with one or more health services bodies or NHS Foundation Trusts following a Commissioning Review.

(10) Regulations under this section shall not impose obligations on an NHS commissioner undertaking a Commissioning Review.

(11) The NHS Commissioning Board may, after consultation with Monitor, publish guidance to NHS Commissioners concerning Commissioning Reviews.

(12) The National Health Service Act 2006 shall be amended by adding the following after section 9(4)(r)—

“(s) An NHS Foundation Trust”.”

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.”

Leave out Clause 77

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

[Withdrawn]

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,”

Leave out Clause 101

Leave out Clause 102

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 123, line 6, leave out “Monitor” and insert “Regulations must provide and the Secretary of State”

Page 123, line 14, at end insert—

“( ) The regulations must be accompanied by a full statement of how the various prices and methods were determined.

( ) Regulations must also set out how any proposal for a change to any national price of for a method to be used will be subject to proper evaluation and testing, with the results being published, prior to any implementation.

( ) Before publishing any regulations under this section, the Secretary of State must consult with Monitor, and publish his response.”

Page 124, line 5, leave out subsections (9) and (10)

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)

Leave out Clause 118

Leave out Clause 119

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)

Leave out Clause 120

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”

Leave out Clause 121

Leave out Clause 122

Leave out Clause 123

Page 130, line 34, at end insert—

“( ) Regulations must provide guidance on the circumstances in which there can be any agreement to a local variation in the price payable as set out in the national tariff to the provider of health care service.”

Page 130, line 44, at end insert “and the Board”

Page 131, line 9, at end insert “Health and Wellbeing Boards,”

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).”

Leave out Clause 127

Leave out Clause 128

Leave out Clause 129

Leave out Clause 130

Leave out Clause 131

Leave out Clause 132

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.”

Leave out Clause 133

Leave out Clause 134

Leave out Clause 135

Leave out Clause 136

Leave out Clause 137

Leave out Clause 138

Leave out Clause 139

Leave out Clause 140

Leave out Clause 141

Leave out Clause 142

Leave out Clause 143

Leave out Clause 144

Leave out Clause 145

Insert the following new Clause—

“Human Rights Act 1988: provision of certain personal care and health care services to be public function

(1) A person who is commissioned to provide—

(a) personal care to an individual living in their own home, or

(b) a health care service,

shall be taken to be exercising a function of a public nature in providing such a service.

(2) In subsection (1)(a) “personal care” in relation to England has the same meaning as in paragraph 2 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and in relation to Scotland has the same meaning as “personal care and personal support” as defined in section 2(28) of the Regulation of Care (Scotland) Act 2001 and section 1(1)(c) and Schedule 1 to the Community Care and Health (Scotland) Act 2001.

(3) In subsection (1)(a) and (b) “functions of a public nature” has the same meaning as in section 6(3) of the Human Rights Act 1998 (acts of public authorities).”

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 151, line 32, at end insert—

“(1B) Annual proper accounts and proper records must be separately prepared and kept which separately detail the income and expenditure derived—

(a) from private charges, and

(b) in relation to the provision of services to NHS patients.

(1C) “Private charges” means charges imposed in respect of goods and services provided to patients other than patients being provided with goods and services for the purposes of the health service in England.”

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 159, leave out lines 36 to 40

Page 159, leave out lines 39 and 40 and insert—

“such proportion of its income from the provision of goods and services for all purposes as the NHS foundation trust may agree with Monitor, provided that any such agreed proportion shall in no circumstances be more than one half.

(2B) In the event that an NHS foundation trust fails to agree with Monitor such proportion as is mentioned in (2A) above, the question of the appropriate proportion shall be referred to arbitration by an arbitrator appointed by the Secretary of State for the purpose.”

Leave out Clause 164 and insert the following new Clause—

“Private health care

In section 44 of the National Health Service Act 2006 (private health care) after subsection (3) insert—

“(3A) The proportion of income specified in subsection (2) may be varied subject to the approval of—

(a) the members of the NHS foundation trust by a majority vote after a formal consultation process,

(b) the governors of the NHS foundation trust by a majority vote, and

(c) the Board.

(3B) The basis for any such consultation, which must also include the views of the relevant Health and Well-being Boards and Clinical Commissioning Groups, is to be set out in regulations made under this section.

(3C) Where the proportion of income is varied in line with subsection (3A) above, this may not exceed 5% of the total income of the NHS foundation trust or mental health foundation trust in any financial year without the additional approval of Monitor.

(3D) In carrying out its duty under subsection (3C) Monitor must have regard to matters set out in regulations made under this section, including ensuring that benefits to NHS patients can be demonstrated, and that proper consultation has been conducted, as well as having regard to the matters outlined in section 64 of the Health and Social Care Act 2012.””

Leave out Clause 172

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.”

Leave out Clause 178

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 7, at end insert—

“(3) A Local Healthwatch organisation must have due regard to any advice or assistance provided by Healthwatch England under subsection (2).”

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

Insert the following new Clause—

“Healthwatch England’s Commissioner for Older People

(1) The Health and Social Care Act 2008 is amended as follows.

(2) In Chapter 3 of Part 1 (quality of health and social care), before section 46 and the preceding cross-heading insert—

Healthwatch England’s Commissioner for Older People

(1) A member of Healthwatch England shall be designated as the Commissioner for Older People in England.

(2) The Commissioner shall exercise their functions independent of their role as a member of Healthwatch England.

(3) The general functions of the Commissioner shall be to consult with and garner the opinions of older people, and to represent those opinions in all arenas of public discourse including Parliament.

(4) The Commissioner shall be free to set its own parameters within the broad context of monitoring institutions.

(5) The Commissioner must encourage the involvement of older people in the work of the Commissioner.

(6) The Commissioner must, in a particular, take reasonable steps to listen to and consult with older people on the work to be undertaken by the Commissioner.””

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 191, line 32, leave out “may consult any” and insert “must consult relevant health professionals and any other”

Page 193, line 24, leave out from beginning to “of” and insert “at least three elected representatives”

Page 193, line 31, at end insert—

“( ) an allied health professional.”

Page 193, line 38, leave out subsection (4) and insert—

“(4) In subsection (2)(a), an elected representative means—

(a) in the case of a local authority operating executive arrangements, the elected mayor or the executive leader of the local authority, or a councillor of the local authority;

(b) in any other case, a councillor of the local authority.”

Page 194, line 40, after “services” insert “and education or children’s services”

Page 195, line 4, after “services” insert “or education or children’s services”

Page 195, line 7, after “services” insert “and education or children’s services”

Page 195, line 9, at end insert—

“( ) A Health and Wellbeing Board must encourage persons who arrange for the provision of any services to people with communication needs in that area to work closely together in an integrated manner.

( ) A Health and Wellbeing Board must encourage people who arrange for the identification of communication needs to work closely together to screen all at risk children.”

Page 195, line 9, at end insert—

“( ) The Health and Welfare Board must ensure collaboration between all relevant providers at the time of transfer of a patient from one provider to another in order to avoid confusion or distress for the patient.

( ) The Health and Welfare Board must ensure that the case history and other records of each patient are transferred with the patient when patients transfer from one provider to another.

( ) The Health and Welfare Board must ensure that an account of a patient’s ongoing social care needs is made each time a patient is transferred from one provider to another.”

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 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

Insert the following new Clause—

“Protection of the functions of “social workers” etc

(1) Section 61 of the Care Standards Act 2000 (use of title “social worker” etc.) is amended as follows.

(2) After subsection (1), insert—

“(1A) Any organisation which employs individuals to undertake the functions and roles of a social worker in their employment must ensure that any individuals occupying such posts are appropriately qualified and registered as a social worker.””

Insert the following new Clause—

“The Office of Chief Social Worker for England

(1) The Secretary of State shall appoint a Chief Social Worker for England.

(2) In carrying out their role, the Chief Social Worker for England shall consult and liaise as necessary with professional organisations which promote social work which shall include, but not limited to—

(a) the British Association of Social Workers,

(b) the College of Social Work,

(c) the Health Professions Council,

(d) the Professional Standards Authority for Health and Social Care,

(e) the National Institute for Health and Clinical Excellence, Inspectors and Employers,

and any successor organisation of the above.

(3) The Chief Social Worker for England shall lay an annual report before Parliament on social work in England.”

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 233, line 32, at end insert—

“( ) In exercising its functions under subsection (1) the relevant commissioner must maintain a publicly available report on the progress towards publishing each statement of standards.”

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 35, at end insert—

“(A1) Part 3 of this Act shall come into force, by order, on a date to be determined by Parliament, which shall not be before April 2016.

(A2) Before bringing forward any order to bring Part 3 of this Act into force the Secretary of State shall consult the NHS Commissioning Board, the Independent Regulator of Foundation Trusts, the Care Quality Commission, patients or their representatives, and staff delivering NHS services or their representatives, and shall report to Parliament on the outcomes of the consultation.

(A3) Any such order must be laid in draft and approved by a resolution of each House of Parliament.”

Page 271, line 44, at beginning insert “subject to subsections (A1) to (A3),”

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.”