Health and Social Care Bill (HL Bill 119)

Part 1 The health service in England

The health service: overview

1 Secretary of State’s duty to promote comprehensive health service

5For section 1 of the National Health Service Act 2006 (Secretary of State’s duty

to promote health service) substitute—

“1 Secretary of State’s duty to promote comprehensive health service

(1) The Secretary of State must continue the promotion in England of a
comprehensive health service designed to secure improvement—

(a) 5in the physical and mental health of the people of England, and

(b) in the prevention, diagnosis and treatment of illness.

(2) For that purpose, the Secretary of State must exercise the functions
conferred by this Act so as to secure that services are provided in
accordance with this Act.

(3) 10The services provided as part of the health service in England must be
free of charge except in so far as the making and recovery of charges is
expressly provided for by or under any enactment, whenever passed.”

2 The Secretary of State’s duty as to improvement in quality of services

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

“1A 15Duty as to improvement in quality of services

(1) The Secretary of State must exercise the functions of the Secretary of
State in relation to the health service with a view to securing continuous
improvement in the quality of services provided to individuals for or in
connection with—

(a) 20the prevention, diagnosis or treatment of illness, or

(b) the protection or improvement of public health.

(2) In discharging the duty under subsection (1) the Secretary of State
must, in particular, act with a view to securing continuous
improvement in the outcomes that are achieved from the provision of
25the services.

(3) The outcomes relevant for the purposes of subsection (2) include, in
particular, outcomes which show—

(a) the effectiveness of the services,

(b) the safety of the services, and

(c) 30the quality of the experience undergone by patients.

(4) In discharging the duty under subsection (1), the Secretary of State
must have regard to the quality standards prepared by NICE under
section 233 of the Health and Social Care Act 2012.”

3 The Secretary of State’s duty as to reducing inequalities

35After section 1A of the National Health Service Act 2006 insert—

“1B Duty as to reducing inequalities

In exercising functions in relation to the health service, the Secretary of
State must have regard to the need to reduce inequalities between the
people of England with respect to the benefits that they can obtain from
40the health service.”

4 The Secretary of State’s duty as to promoting autonomy

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

“1C Duty as to promoting autonomy

In exercising functions in relation to the health service, the Secretary of
5State must, so far as is consistent with the interests of the health service,
act with a view to securing—

(a) that any other person exercising functions in relation to the
health service or providing services for its purposes is free to
exercise those functions or provide those services in the manner
10that it considers most appropriate, and

(b) that unnecessary burdens are not imposed on any such person.”

5 The Secretary of State’s duty as to research

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

“1D Duty as to research

15In exercising functions in relation to the health service, the Secretary of
State must have regard to the need to promote—

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

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

6 20The Secretary of State’s duty as to education and training

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

“1E Duty as to education and training

(1) The Secretary of State must exercise the functions of the Secretary of
State under any relevant enactment so as to secure that there is an
25effective system for the planning and delivery of education and
training to persons who are employed, or who are considering
becoming employed, in an activity which involves or is connected with
the provision of services as part of the health service in England.

(2) In subsection (1), “relevant enactment” means section 63 of the Health
30Services and Public Health Act 1968 and any other enactment under
which the Secretary of State has functions which could be exercised for
the purpose of securing that there is such an effective system as is
mentioned in that subsection.”

7 Secretary of State’s duty as to promoting equality of provision

35After section 1E of the National Health Service Act 2006 insert—

“1F Duty as to promoting equality of provision

In exercising functions in relation to the Health Service, the Secretary of
State must have regard to the need to promote equality for those
providing services on behalf of the health service and shall within one
40year of passing this Act, lay a report before Parliament on the treatment
for Value Added Tax of supplies by charities to bodies exercising

functions on behalf of a Minister of the Crown of healthcare services or
associated goods.”

8 The NHS Commissioning Board

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

5“Role of the Board in the health service in England

1G The National Health Service Commissioning Board and its general
functions

(1) There is to be a body corporate known as the National Health Service
Commissioning Board (“the Board”).

(2) 10The Board is subject to the duty under section 1(1) concurrently with
the Secretary of State except in relation to the part of the health service
that is provided in pursuance of the public health functions of the
Secretary of State or local authorities.

(3) For the purpose of discharging that duty, the Board—

(a) 15has the function of arranging for the provision of services for the
purposes of the health service in England in accordance with
this Act, and

(b) must exercise the functions conferred on it by this Act in
relation to clinical commissioning groups so as to secure that
20services are provided for those purposes in accordance with this
Act.

(4) Schedule A1 makes further provision about the Board.

(5) In this Act—

(a) any reference to the public health functions of the Secretary of
25State is a reference to the functions of the Secretary of State
under sections 2A and 2B and paragraphs 7C, 8 and 12 of
Schedule 1, and

(b) any reference to the public health functions of local authorities
is a reference to the functions of local authorities under sections
302B and 111 and paragraphs 1 to 7B and 13 of Schedule 1.”

(2) Before Schedule 1 to that Act, insert the Schedule set out in Schedule 1 to this
Act.

9 Clinical commissioning groups

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

35“Role of clinical commissioning groups in the health service in England

1H Clinical commissioning groups and their general functions

(1) There are to be bodies corporate known as clinical commissioning
groups established in accordance with Chapter A2 of Part 2.

(2) Each clinical commissioning group has the function of arranging for the
provision of services for the purposes of the health service in England
in accordance with this Act.”

Arrangements for provision of health services

10 5The Secretary of State’s duty as to protection of public health

After section 2 of the National Health Service Act 2006 insert—

“Provision for protection or improvement of public health

2A Secretary of State’s duty as to protection of public health

(1) The Secretary of State must take such steps as the Secretary of State
10considers appropriate for the purpose of protecting the public in
England from disease or other dangers to health.

(2) The steps that may be taken under subsection (1) include—

(a) the conduct of research or such other steps as the Secretary of
State considers appropriate for advancing knowledge and
15understanding;

(b) providing microbiological or other technical services (whether
in laboratories or otherwise);

(c) providing vaccination, immunisation or screening services;

(d) providing other services or facilities for the prevention,
20diagnosis or treatment of illness;

(e) providing training;

(f) providing information and advice;

(g) making available the services of any person or any facilities.

(3) Subsection (4) applies in relation to any function under this section
25which relates to—

(a) the protection of the public from ionising or non-ionising
radiation, and

(b) a matter in respect of which the Health and Safety Executive has
a function.

(4) 30In exercising the function, the Secretary of State must—

(a) consult the Health and Safety Executive, and

(b) have regard to its policies.”

11 Duties as to improvement of public health

After section 2A of the National Health Service Act 2006 insert—

“2B 35Functions of local authorities and Secretary of State as to improvement
of public health

(1) Each local authority must take such steps as it considers appropriate for
improving the health of the people in its area.

(2) The Secretary of State may take such steps as the Secretary of State
40considers appropriate for improving the health of the people of
England.

(3) The steps that may be taken under subsection (1) or (2) include—

(a) providing information and advice;

(b) providing services or facilities designed to promote healthy
living (whether by helping individuals to address behaviour
5that is detrimental to health or in any other way);

(c) providing services or facilities for the prevention, diagnosis or
treatment of illness;

(d) providing financial incentives to encourage individuals to
adopt healthier lifestyles;

(e) 10providing assistance (including financial assistance) to help
individuals to minimise any risks to health arising from their
accommodation or environment;

(f) providing or participating in the provision of training for
persons working or seeking to work in the field of health
15improvement;

(g) making available the services of any person or any facilities.

(4) The steps that may be taken under subsection (1) also include
providing grants or loans (on such terms as the local authority
considers appropriate).

(5) 20In this section, “local authority” means—

(a) a county council in England;

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

(c) a London borough council;

(d) 25the Council of the Isles of Scilly;

(e) the Common Council of the City of London.”

12 Duties of clinical commissioning groups as to commissioning certain health
services

(1) Section 3 of the National Health Service Act 2006 is amended as follows.

(2) 30In subsection (1)—

(a) for the words from the beginning to “reasonable requirements”
substitute “A clinical commissioning group must arrange for the
provision of the following to such extent as it considers necessary to
meet the reasonable requirements of the persons for whom it has
35responsibility”, and

(b) in each of paragraphs (d) and (e) for the words “as he considers”
substitute “as the group considers”.

(3) After that subsection insert—

“(1A) For the purposes of this section, a clinical commissioning group has
40responsibility for—

(a) persons who are provided with primary medical services by a
member of the group, and

(b) persons who usually reside in the group’s area and are not
provided with primary medical services by a member of any
45clinical commissioning group.

(1B) Regulations may provide that for the purposes of this section a clinical
commissioning group also has responsibility (whether generally or in
relation to a prescribed service or facility) for persons who—

(a) were provided with primary medical services by a person who
5is or was a member of the group, or

(b) have a prescribed connection with the group’s area.

(1C) The power conferred by subsection (1B)(b) must be exercised so as to
provide that, in relation to the provision of services or facilities for
emergency care, a clinical commissioning group has responsibility for
10every person present in its area.

(1D) Regulations may provide that subsection (1A) does not apply—

(a) in relation to persons of a prescribed description (which may
include a description framed by reference to the primary
medical services with which the persons are provided);

(b) 15in prescribed circumstances.

(1E) The duty in subsection (1) does not apply in relation to a service or
facility if the Board has a duty to arrange for its provision.”

(4) Omit subsections (2) and (3).

(5) For the heading to section 3 substitute “Duties of clinical commissioning
20groups as to commissioning certain health services”.

(6) For the cross-heading preceding section 3 substitute “Arrangements for the
provision of certain health services”.

13 Power of clinical commissioning groups as to commissioning certain health
services

25After section 3 of the National Health Service Act 2006 insert—

“3A Power of clinical commissioning groups to commission certain health
services

(1) Each clinical commissioning group may arrange for the provision of
such services or facilities as it considers appropriate for the purposes of
30the health service that relate to securing improvement—

(a) in the physical and mental health of the persons for whom it has
responsibility, or

(b) in the prevention, diagnosis and treatment of illness in those
persons.

(2) 35A clinical commissioning group may not arrange for the provision of a
service or facility under subsection (1) if the Board has a duty to arrange
for its provision by virtue of section 3B or 4.

(3) Subsections (1A), (1B) and (1D) of section 3 apply for the purposes of
this section as they apply for the purposes of that section.”

14 Power to require Board to commission certain health services

After section 3A of the National Health Service Act 2006 insert—

“3B Secretary of State’s power to require Board to commission services

(1) Regulations may require the Board to arrange, to such extent as it
5considers necessary to meet all reasonable requirements, for the
provision as part of the health service of—

(a) dental services of a prescribed description;

(b) services or facilities for members of the armed forces or their
families;

(c) 10services or facilities for persons who are detained in a prison or
in other accommodation of a prescribed description;

(d) such other services or facilities as may be prescribed.

(2) A service or facility may be prescribed under subsection (1)(d) only if
the Secretary of State considers that it would be appropriate for the
15Board (rather than clinical commissioning groups) to arrange for its
provision as part of the health service.

(3) In deciding whether it would be so appropriate, the Secretary of State
must have regard to—

(a) the number of individuals who require the provision of the
20service or facility;

(b) the cost of providing the service or facility;

(c) the number of persons able to provide the service or facility;

(d) the financial implications for clinical commissioning groups if
they were required to arrange for the provision of the service or
25facility.

(4) Before deciding whether to make regulations under this section, the
Secretary of State must—

(a) obtain advice appropriate for that purpose, and

(b) consult the Board.

(5) 30The reference in subsection (1)(b) to members of the armed forces is a
reference to persons who are members of—

(a) the regular forces within the meaning of the Armed Forces Act
2006, or

(b) the reserve forces within the meaning of that Act.”

15 35Secure psychiatric services

(1) Section 4 of the National Health Service Act 2006 (high security psychiatric
services) is amended as follows.

(2) In subsection (1) for the words from the beginning to “duty to provide”
substitute “The Board must arrange for the provision of”.

(3) 40In subsection (3)—

(a) after “may be provided” insert “—

(a)”, and

(b) after paragraph (a) insert “, and

(b) only by a person approved by the Secretary of State for
the purposes of this subsection.”

(4) After subsection (3) insert—

“(3A) 5The Secretary of State may—

(a) give directions to a person who provides high security
psychiatric services about the provision by that person of those
services;

(b) give directions to the Board about the exercise of its functions in
10relation to high security psychiatric services.”

16 Other services etc. provided as part of the health service

(1) In section 5 of the National Health Service Act 2006 (other services) for “about
the Secretary of State and services under this Act” substitute “about the
provision of services for the purposes of the health service in England”.

(2) 15Schedule 1 to that Act is amended as follows.

(3) In paragraph 1 (medical inspection of pupils)—

(a) for “The Secretary of State” substitute “A local authority”, and

(b) for “local authorities” substitute “the local authority”.

(4) In paragraph 2—

(a) 20in sub-paragraph (1)—

(i) for “The Secretary of State” substitute “A local authority”, and

(ii) omit “, by arrangement with any local authority,”,

(b) in sub-paragraph (2)—

(i) for “The Secretary of State” substitute “A local authority”,

(ii) 25after “educational establishment” insert “in its area”, and

(iii) for “a local authority” substitute “the local authority”, and

(c) omit sub-paragraph (3).

(5) In paragraph 4—

(a) for “A local authority may not make an arrangement” substitute “A
30local authority may not provide for any medical inspection or
treatment”, and

(b) for “the arrangement” substitute “the inspection or (as the case may be)
treatment”.

(6) In paragraph 5—

(a) 35omit sub-paragraph (1)(a) and the word “and” immediately following
it,

(b) in sub-paragraph (2) omit “local authority or”,

(c) for “the Secretary of State” substitute “a local authority”, and

(d) for “him” substitute “it”.

(7) 40In paragraph 7A (weighing and measuring of children)—

(a) for “The Secretary of State” (in each place it occurs) substitute “A local
authority”,

(b) in sub-paragraph (1) omit “, by arrangement with any local authority,”,
and