Health and Care Bill (HL Bill 71)

Health and Care BillPage 30

(5)An integrated care partnership may include in a strategy under this
section a statement of its views on how arrangements for the provision
of health-related services in its area could be more closely integrated
with arrangements for the provision of health services and social care
5services in that area.

(6)Each time that an integrated care partnership receives an assessment of
relevant needs under section 116(5A) it must—

(a)consider whether the current integrated care strategy should be
revised, and

(b)10if so, prepare a revised integrated care strategy under
subsection (1).

(7)An integrated care partnership must—

(a)publish each integrated care strategy, and

(b)give a copy of each integrated care strategy to—

(i)15each responsible local authority whose area coincides
with or falls wholly or partly within its area, and

(ii)each partner integrated care board of those responsible
local authorities.

(8)In this section—

(a)20“assessed needs”, in relation to the area of an integrated care
partnership, means the needs assessed under section 116 in
relation to the areas of the responsible local authorities so far as
those needs relate to the integrated care partnership’s area;

(b)“partner integrated care board”, in relation to a responsible
25local authority, has the same meaning as in section 116;

(c)“health services”, “health-related services” and “social care
services” have the same meaning as in section 195 of the Health
and Social Care Act 2012.”

(5)In section 116A (health and social care: joint health and wellbeing strategies)—

(a)30in the heading, after “joint” insert “local”;

(b)for subsections (1) and (2) substitute—

(1)This section applies where a responsible local authority and
each of its partner integrated care boards receive an integrated
care strategy under section 116ZB(7)(b).

(2)35The responsible local authority and each of its partner
integrated care boards must prepare a strategy (“a joint local
health and wellbeing strategy”) setting out how the assessed
needs in relation to the responsible local authority’s area are to
be met by the exercise of functions of—

(a)40the responsible local authority,

(b)its partner integrated care boards, or

(c)NHS England.

(2A)But the responsible local authority and its partner integrated
care boards need not prepare a new joint local health and
45wellbeing strategy if, having considered the integrated care
strategy, they consider that the existing joint local health and
wellbeing strategy is sufficient.”;

(c)in subsection (3)—

Health and Care BillPage 31

(i)for “clinical commissioning groups” substitute “integrated care
boards”;

(ii)after “the extent to which the” insert “assessed”;

(d)in subsection (4)—

(i)5for “clinical commissioning groups” substitute “integrated care
boards”;

(ii)before paragraph (a) insert—

(za)the integrated care strategy prepared under
section 116ZB,”;

(e)10in subsections (5) and (7), for “clinical commissioning groups”
substitute “integrated care boards”;

(f)in subsection (8), for paragraph (a) (including the “and” at the end)
substitute—

(a)“partner integrated care board”, in relation to a
15responsible local authority, has the same meaning as in
section 116,

(aa)“assessed needs”, in relation to the area of a local
authority, means the needs assessed in relation to its
area under section 116, and”.

(6)20For section 116B substitute—

116B Duty to have regard to assessments and strategies

(1)A responsible local authority and each of its partner integrated care
boards must, in exercising any functions, have regard to the following
so far as relevant—

(a)25any assessment of relevant needs prepared under section 116 in
relation to the responsible local authority’s area,

(b)any integrated care strategy prepared under section 116ZB in
relation to an area that coincides with or includes the whole or
part of the responsible local authority’s area, and

(c)30any joint local health and wellbeing strategy prepared under
section 116A by the responsible local authority and its partner
integrated care boards.

(2)NHS England must, in exercising any functions in arranging for the
provision of health services in relation to the area of a responsible local
35authority, have regard to the following so far as relevant—

(a)any assessment of relevant needs prepared under section 116 in
relation to that area, and

(b)any integrated care strategy prepared under section 116ZB in
relation to an area that coincides with or includes the whole or
40part of that area,

(c)any joint local health and wellbeing strategy prepared under
section 116A by the responsible local authority and its partner
integrated care boards.”

(7)In the following provisions after “joint” insert “local”—

(a)45section 17(6)(g) and (h) of the National Health Service (Wales) Act 2006;

(b)sections 26(7) and 27(4) of the Children and Families Act 2014.

Health and Care BillPage 32

Integrated care system: financial controls

22 NHS England’s financial responsibilities

For sections 223C to 223E of the National Health Service Act 2006 substitute—

223C Financial duties of NHS England: expenditure

(1)5NHS England must exercise its functions with a view to ensuring that
expenditure incurred by the following bodies in a financial year (taken
together) does not exceed the aggregate of any sums received by them
in the year—

(a)NHS England;

(b)10integrated care boards.

(2)The Secretary of State may by direction—

(a)specify descriptions of expenditure that are, or are not, to be
treated for the purposes of this section as expenditure incurred
by a body, or expenditure incurred by it in a particular financial
15year;

(b)specify descriptions of sums that are, or are not, to be treated for
the purposes of this section as having been received by a body,
or as having been received by it in a particular financial year;

(c)provide for sums received by NHS England under section 223B
20in a year but not spent to be treated for the purposes of this
section as expenditure incurred by it in a particular financial
year;

(d)provide for sums received by an integrated care board under
section 223G in a year but not spent to be treated for the
25purposes of this section as expenditure incurred by it in a
particular financial year.

(3)For the purposes of this section any sum allotted to NHS England for a
year under section 223B is to be treated as received by it in that year
(subject to any direction under subsection (2)(b)).

223CA 30NHS England: banking facilities

The Secretary of State may by direction require NHS England to use
banking facilities specified in the direction for any purposes so
specified.

223D Financial duties of NHS England: controls on total resource use

(1)35NHS England must exercise its functions with a view to ensuring that,
in respect of each financial year—

(a)total capital resource use does not exceed the limit specified in
a direction by the Secretary of State;

(b)total revenue resource use does not exceed the limit specified in
40a direction by the Secretary of State

(2)In subsection (1) “total capital resource use” and “total revenue
resource use” means the use of capital resources or (as the case may be)
revenue resources by relevant NHS bodies, other than use that consists
of the transfer of resources between relevant NHS bodies.

(3)45In subsection (2) “relevant NHS bodies” means—

Health and Care BillPage 33

(a)NHS England,

(b)integrated care boards,

(c)NHS trusts established under section 25, and

(d)NHS foundation trusts.

(4)5A direction under subsection (1)(a) or (b) specifying a limit in relation
to a financial year may be varied by a subsequent direction only if—

(a)NHS England agrees to the change,

(b)a parliamentary general election takes place, or

(c)the Secretary of State considers that there are exceptional
10circumstances which make the variation necessary.

(5)The Secretary of State must publish and lay before Parliament any
directions under this section.

(6)Any reference in this Chapter to the use of capital resources or revenue
resources is a reference to their expenditure, consumption or reduction
15in value.

223E Financial duties of NHS England: additional controls on resource use

(1)The Secretary of State may direct NHS England to ensure—

(a)that relevant capital resource in a financial year which is
attributable to matters specified in the direction does not exceed
20an amount so specified;

(b)that relevant revenue resource use in a financial year which is
attributable to matters specified in the direction does not exceed
an amount so specified.

(2)In subsection (1) “relevant capital resource use” and “relevant revenue
25resource use” means the use of capital resources or (as the case may be)
revenue resources by NHS England and integrated care boards.

(3)The Secretary of State may direct NHS England to ensure that NHS
England’s use of revenue resources in a financial year which is
attributable to such matters relating to administration as are specified
30in the direction does not exceed an amount so specified.”

23 Expansion of NHS England’s duties in respect of expenditure

In section 223C of the National Health Service Act 2006 (as substituted by
section 22 of this Act), in subsection (1), after paragraph (b) insert—

(c)NHS trusts established under section 25;

(d)35NHS foundation trusts.”

24 Financial responsibilities of integrated care boards and their partners

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

Health and Care BillPage 34

(2)For the italic heading before section 223G substitute—

“Integrated care boards”.

(3)After section 223GA insert—

223GB Power to impose financial requirements on integrated care boards

(1)5NHS England may give integrated care boards directions about their
management or use of financial or other resources.

(2)The directions that may be given include a direction imposing limits on
expenditure or resource use by integrated care boards.

(3)NHS England must publish any directions under this section.

223GC 10 Financial duties of integrated care boards: expenditure limits

(1)An integrated care board must exercise its functions with a view to
ensuring that expenditure incurred by the board in a financial year
does not exceed the sums received by it in that year.

(2)NHS England may by direction—

(a)15specify descriptions of expenditure that are, or are not, to be
treated for the purposes of this section as expenditure incurred
by an integrated care board, or expenditure incurred by it in a
particular financial year;

(b)specify descriptions of sums that are, or are not, to be treated for
20the purposes of this section as having been received by an
integrated care board, or as having been received by it in a
particular financial year;

(c)provide for sums received by an integrated care board under
section 223G in a year but not spent to be treated for the
25purposes of this section as expenditure incurred by it in a
particular financial year.

(3)For the purposes of this section any sum allotted to an integrated care
board for a year under section 223G is to be treated as received by it in
that year (subject to any direction under subsection (2)(b)).

223GD 30 Integrated care boards: banking facilities

The Secretary of State may give integrated care boards directions
requiring them to use specified banking facilities for any specified
purposes.”

(4)Omit sections 223H to 223J (financial duties of clinical commissioning groups).

(5)35After section 223K insert—

“Joint duties of an integrated care board and its partner NHS trusts and NHS
foundation trusts
223L Joint financial objectives for integrated care boards etc

(1)NHS England may set joint financial objectives for integrated care
40boards and their partner NHS trusts and NHS foundation trusts.

Health and Care BillPage 35

An integrated care board and its partner NHS trusts and NHS
foundation trusts must seek to achieve any financial objectives set
under this section.
Financial objectives under this section may apply to—

(a)5integrated care boards and their partner NHS trusts and NHS
foundation trusts generally,

(b)a particular integrated care board and its partner NHS trusts
and NHS foundation trusts, or

(c)an integrated care board of a particular description and its
10partner NHS trusts and NHS foundation trusts.

223M Financial duties of integrated care boards etc: use of resources

(1)Each integrated care board and its partner NHS trusts and NHS
foundation trusts must exercise their functions with a view to ensuring
that, in respect of each financial year—

(a)15local capital resource use does not exceed the limit specified in
a direction by NHS England;

(b)local revenue resource use does not exceed the limit specified in
a direction by NHS England.

(2)In this section “local capital resource use” and “local revenue resource
20use” means the use of capital resources or (as the case may be) revenue
resources by the integrated care board and its partner NHS trusts and
NHS foundation trusts, other than use that consists of the transfer of
resources between those bodies.

(3)Where an NHS trust or NHS foundation trust is the partner of more
25than one integrated care board, its use of capital resources or revenue
resources is to be apportioned for the purposes of this section to one or
more of the integrated care boards in such manner as may be provided
for in a direction by NHS England.

(4)NHS England may by direction make provision for determining to
30which integrated care board, NHS trust or NHS foundation trust a use
of capital resources or revenue resources is to be attributed for the
purposes of this section.

223N Financial duties of integrated care boards etc: additional controls on
resource use

(1)35NHS England may direct an integrated care board and its partner NHS
trusts and NHS foundation trusts to exercise their functions with a
view to—

(a)ensuring that local capital resource use in a financial year which
is attributable to matters specified in the direction does not
40exceed an amount so specified;

(b)ensuring that local revenue resource use in a financial year
which is attributable to matters specified in the direction does
not exceed an amount so specified.

(2)A direction under subsection (1) may—

(a)45specify descriptions of resources which must, or must not, be
treated as local capital resources or local revenue resources for
the purposes of the direction;

Health and Care BillPage 36

(b)specify uses of local capital resources or local revenue resources
which must, or must not, be taken into account for the purposes
of the direction.

(3)Any directions given under section 223M(3) or (4) apply for the
5purposes of this section as they apply for the purposes of section 223M.

(4)In this section “local capital resource use” and “local revenue resource
use” have the meaning given by section 223M(2).

Directions about resources etc to be taken into account
223O Resources etc relevant to section 223D, 223E or 223M

10 The Secretary of State may give directions, in relation to a financial
year—

(a)specifying descriptions of resources which must, or must not,
be treated as capital resources or revenue resources for the
purposes of section 223D, 223E or 223M;

(b)15specifying uses of capital resources or revenue resources which
must, or must not, be taken into account for the purposes of
section 223D, 223E or 223M.”

25 Expansion of financial duties of integrated care boards and their partners

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

(2)20Omit section 223GC (inserted by section 24 of this Act).

(3)After section 223L (inserted by section 24 of this Act) insert—

223LA Financial duties of integrated care boards etc: expenditure limits

(1)An integrated care board and its partner NHS trusts and NHS
foundation trusts must exercise their functions with a view to ensuring
25that their expenditure in a financial year (taken together) does not
exceed the aggregate of any sums received by them in the year.

(2)Where an NHS trust or NHS foundation trust is the partner of more
than one integrated care board its receipts and expenditure are to be
apportioned for the purposes of this section to one or more of the
30integrated care boards in such manner as may be provided for in a
direction by NHS England.

(3)NHS England may by direction—

(a)specify descriptions of expenditure that are, or are not, to be
treated for the purposes of this section as expenditure incurred
35by a body, or expenditure incurred by it in a particular financial
year;

(b)specify descriptions of sums that are, or are not, to be treated for
the purposes of this section as having been received by a body,
or as having been received by it in a particular financial year;

(c)40provide for sums received by an integrated care board under
section 223G in a year but not spent to be treated for the
purposes of this section as expenditure by it in a particular
financial year.

Health and Care BillPage 37

(4)For the purposes of this section any sum allotted to an integrated care
board for a year under section 223G is to be treated as received by it in
that year (subject to any direction under subsection (3)(b)).”

Integrated care system: reviews and further amendments

26 5Care Quality Commission reviews etc of integrated care system

(1)Chapter 3 of Part 1 of the Health and Social Care Act 2008 (quality of health and
social care) is amended as follows.

(2)After section 46A (inserted by section 137 of this Act) insert—

46B Reviews and performance assessments: integrated care system

(1)10The Commission must, in accordance with this section—

(a)conduct reviews of—

(i)the provision of relevant health care, and adult social
care, within the area of each integrated care board, and

(ii)the exercise of the functions of the following in relation
15to the provision of that care within the area of each
integrated care board: the board; its partner local
authorities; and registered service providers,

(b)assess the functioning of the system for the provision of relevant
health care, and adult social care, within the area of each
20integrated care board (taking into account, in particular, how
those mentioned in paragraph (a)(ii) work together), and

(c)publish a report of its assessment.

(2)The Secretary of State—

(a)must set, and may from time to time revise, objectives and
25priorities for the Commission in relation to assessments under
this section, and

(b)must inform the Commission of the objectives and priorities.

(3)The priorities set by the Secretary of State under subsection (2)(a) must
include priorities relating to leadership, the integration of services and
30the quality and safety of services.

(4)The Commission—

(a)must determine, and may from time to time revise, indicators of
quality for the purposes of assessments under this section, and

(b)must obtain the approval of the Secretary of State in relation to
35the indicators.

(5)The Secretary of State may direct the Commission to revise the
indicators under subsection (4).

(6)Different objectives and priorities may be set, and different indicators
of quality may be determined, for different cases.

(7)40The Commission—

(a)must prepare, and may from time to time revise, a statement—

(i)setting out the frequency with which reviews under this
section are to be conducted and the period to which they
are to relate, and

Health and Care BillPage 38

(ii)describing the method that it proposes to use in
assessing and evaluating the functioning of the system
for the provision of relevant health care, and adult social
care, within the area of an integrated care board, and

(b)5must obtain the approval of the Secretary of State in relation to
the statement.

(8)The statement may—

(a)make different provision about frequency and period of
reviews for different cases, and

(b)10describe different methods for different cases.

(9)Before preparing or revising a statement under subsection (7) the
Commission must consult—

(a)NHS England, and

(b)any other persons it considers appropriate.

(10)15The Secretary of State may direct the Commission to revise the
statement under subsection (7).

(11)The Commission must publish—

(a)the objectives and priorities under subsection (2),

(b)the indicators of quality under subsection (4), and

(c)20the statement under subsection (7).

(12)For the purposes of this section—

  • “adult social care” means social care for individuals aged 18 or
    over;

  • “partner local authority”, in relation to an integrated care board,
    25means any English local authority whose area coincides with, or
    includes the whole or any part of, the area of the integrated care
    board;

  • “registered service provider” means a person registered under
    Chapter 2 as a service provider;

  • 30“relevant health care” means—

    (a)

    NHS care, or

    (b)

    the promotion and protection of public health.

(13)Regulations may amend the definition of “relevant health care” to
include health care which is provided or commissioned by a public
35authority (but which does not amount to NHS care).”

(3)In section 48 (special reviews and investigations), in subsection (2), after “46A”
(inserted by section 137 of this Act) insert “or 46B”.

(4)In section 50 (failings by English local authorities), in subsection (1), after “46A”
(inserted by section 137 of this Act) insert “or 46B”.

(5)40In section 162 (orders and regulations: parliamentary control), in subsection
(3), after paragraph (c) insert—

(c)regulations under section 46B(13) (amendment of definition of
relevant health care),”.

Health and Care BillPage 39

27 Integrated care system: further amendments

Schedule 4 contains minor and consequential amendments.

Merger of NHS bodies etc

28 Abolition of Monitor and transfer of functions to NHS England

(1)5Monitor is abolished.

(2)Schedule 5 contains amendments to transfer Monitor’s functions to NHS
England and related amendments.

29 Exercise by NHS England of new regulatory functions

(1)The National Heath Service Act 2006 is amended as follows.

(2)10After section 13S insert—

“Regulatory functions
13SA Minimising conflicts between regulatory and other functions

(1)NHS England must make arrangements for—

(a)minimising the risk of conflicts between the exercise of its
15regulatory functions and its other functions;

(b)managing any conflicts that arise.

(2)In this Act “regulatory functions”, in relation to NHS England, means—

(a)its functions under the provisions listed in subsection (3),

(b)its functions under Chapter 5A of Part 2 (trust special
20administrators) in relation to NHS foundation trusts, except for
any functions that are conferred on it under section 65DA, 65F
or 65G as a commissioner, and

(c)any other functions of NHS England so far as exercisable in
connection with functions within paragraph (a) or (b).

(3)25Those provisions are—

(a)in Part 2 of this Act, Chapter 5 (NHS foundation trusts);

(b)in Part 3 of the Health and Social Care Act 2012—

(i)Chapter 3 (licensing);

(ii)Chapter 4 (NHS payment scheme);

(iii)30Chapter 5 (health special administration);

(iv)Chapter 6 (financial assistance in special administration
cases).”

(3)In section 13U (annual report), after subsection (2) insert—

(2A)The annual report must also include a statement explaining what NHS
35England has done, during the financial year, to comply with its duties
under section 13SA.”

(4)In section 275 (interpretation), in subsection (1), at the appropriate place
insert—