Health and Social Care Bill (HL Bill 132)

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 physical and
mental 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
10accordance with this Act.

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

(4) The 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
15expressly 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 Duty as to improvement in quality of services

(1) The Secretary of State must exercise the functions of the Secretary of
20State 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) the prevention, diagnosis or treatment of illness, or

(b) the protection or improvement of public health.

(2) 25In 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
the services.

(3) The outcomes relevant for the purposes of subsection (2) include, in
30particular, outcomes which show—

(a) the effectiveness of the services,

(b) the safety of the services, and

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

(4) In discharging the duty under subsection (1), the Secretary of State
35must have regard to the quality standards prepared by NICE under
section 234 of the Health and Social Care Act 2012.”

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

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

“1B Duty as to the NHS Constitution

(1) 40In exercising functions in relation to the health service, the Secretary of
State must have regard to the NHS Constitution.

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

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

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

“1C 5Duty 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
the health service.”

5 10The Secretary of State’s duty as to promoting autonomy

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

“1D Duty as to promoting autonomy

(1) In exercising functions in relation to the health service, the Secretary of
State must have regard to the desirability of securing, so far as
15consistent with the interests of the health service—

(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
that it considers most appropriate, and

(b) 20that unnecessary burdens are not imposed on any such person.

(2) If, in the case of any exercise of functions, the Secretary of State
considers that there is a conflict between the matters mentioned in
subsection (1) and the discharge by the Secretary of State of the duties
under section 1, the Secretary of State must give priority to the duties
25under that section.”

6 The Secretary of State’s duty as to research

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

“1E Duty as to research

In exercising functions in relation to the health service, the Secretary of
30State must promote—

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

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

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

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

“1F 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
effective system for the planning and delivery of education and
40training 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) Any arrangements made with a person under this Act for the provision
of services as part of that health service must include arrangements for
5securing that the person co-operates with the Secretary of State in the
discharge of the duty under subsection (1) (or, where a Special Health
Authority is discharging that duty by virtue of a direction under section
7, with the Special Health Authority).

(3) In subsection (1), “relevant enactment” means—

(a) 10section 63 of the Health Services and Public Health Act 1968,

(b) this Act,

(c) the Health and Social Care Act 2008,

(d) the Health Act 2009, and

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

8 15Secretary of State’s duty as to promoting equality of provision

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

“1G 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
20providing services on behalf of the health service and shall within one
year 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.”

9 25The NHS Commissioning Board

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

“Role of the Board in the health service in England

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

(1) 30There is to be a body corporate known as the National Health Service
Commissioning Board (“the Board”).

(2) The 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
35Secretary of State or local authorities.

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

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

(b) 40must exercise the functions conferred on it by this Act in
relation to clinical commissioning groups so as to secure that
services are provided for those purposes in accordance with this
Act.

(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
State is a reference to the functions of the Secretary of State
5under 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
2B and 111 and paragraphs 1 to 7B and 13 of Schedule 1.”

(2) 10Before Schedule 1 to that Act, insert the Schedule set out in Schedule 1 to this
Act.

10 Clinical commissioning groups

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

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

1I 15Clinical 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
20in accordance with this Act.”

Arrangements for provision of health services

11 The 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 25Secretary of State’s duty as to protection of public health

(1) The Secretary of State must take such steps as the Secretary of State
considers 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) 30the conduct of research or such other steps as the Secretary of
State considers appropriate for advancing knowledge and
understanding;

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

(c) 35providing vaccination, immunisation or screening services;

(d) providing other services or facilities for the prevention,
diagnosis 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
which relates to—

(a) the protection of the public from ionising or non-ionising
5radiation, and

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

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

(a) consult the Health and Safety Executive, and

(b) 10have regard to its policies.”

12 Duties as to improvement of public health

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

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

(1) 15Each 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
considers appropriate for improving the health of the people of
England.

(3) 20The 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
that is detrimental to health or in any other way);

(c) 25providing services or facilities for the prevention, diagnosis or
treatment of illness;

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

(e) providing assistance (including financial assistance) to help
30individuals 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
improvement;

(g) 35making 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) In this section, “local authority” means—

(a) 40a 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) the Council of the Isles of Scilly;

(e) 45the Common Council of the City of London.”

13 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) In subsection (1)—

(a) 5for 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
responsibility”, and

(b) 10in 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
responsibility for—

(a) 15persons 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
clinical commissioning group.

(1B) 20Regulations 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
is or was a member of the group, or

(b) 25have 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
every person present in its area.

(1D) 30Regulations 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) in prescribed circumstances.

(1E) 35The 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) After subsection (1E) insert—

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

(a) 40the discharge by the Secretary of State and the Board of their
duty under section 1(1) (duty to promote a comprehensive
health service), and

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

(5) 45Omit subsections (2) and (3).

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

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

(8) 5In section 272 of that Act (orders, regulations, rules and directions), in
subsection (6) before paragraph (za) insert—

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

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

10After 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
15the 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) 20A 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.”

15 25Power 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
considers necessary to meet all reasonable requirements, for the
30provision 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) services or facilities for persons who are detained in a prison or
35in 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
Board (rather than clinical commissioning groups) to arrange for its
40provision 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
service or facility;

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

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

(d) 5the financial implications for clinical commissioning groups if
they were required to arrange for the provision of the service or
facility.

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

(a) 10obtain advice appropriate for that purpose, and

(b) consult the Board.

(5) The 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
152006, or

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

16 Secure psychiatric services

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

(2) 20In subsection (1) for the words from the beginning to “duty to provide”
substitute “The Board must arrange for the provision of”.

(3) In subsection (3)—

(a) after “may be provided” insert “—

(a)”, and

(b) 25after 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) The Secretary of State may—

(a) 30give 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
relation to high security psychiatric services.”

17 35Other 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) Schedule 1 to that Act is amended as follows.

(3) 40In 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”.