National Health Service (Wales) Bill [HL]

House of Commons

Session 2005 - 06
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Other Bills before Parliament

National Health Service (Wales) Bill [HL]

National Health Service (Wales) Bill [HL]
Part 9 — Charging
85

Exemptions, etc
130
Remission and repayment of charges
Regulations may provide in relation to prescribed descriptions of person for
the remission or repayment of the whole or any part of any charges which
would otherwise be payable in pursuance of section 121, 125 or 128.
5
131
Payment of travelling expenses
Regulations may provide in relation to prescribed descriptions of persons—
(a)
for the payment by the Welsh Ministers, a Local Health Board or an
NHS trust, in such cases as may be prescribed, of travelling expenses
(including the travelling expenses of a companion) incurred or to be
10
incurred for the purpose of their obtaining any services provided under
this Act,
(b)
for the reimbursement by a Local Health Board to an NHS trust and, in
such cases as may be prescribed, to another Local Health Board, of such
payments,
15
(c)
for the reimbursement by a Local Health Board to an NHS trust or an
NHS foundation trust and, in such cases as may be prescribed, to a
Primary Care Trust, of payments made by virtue of section 183(a) of the
National Health Service Act 2006 (c. 00).
132
Sections 130 and 131: supplementary
20
(1)
Descriptions of persons may be prescribed for the purposes of section 130 or
section 131 by reference to any criterion and, without prejudice to the
generality of this subsection, by reference to any of the following criteria—
(a)
their age,
(b)
the fact that a prescribed person or a prescribed body accepts them as
25
suffering from a prescribed medical condition,
(c)
the fact that a prescribed person or a prescribed body accepts that a
prescribed medical condition from which they suffer arose in
prescribed circumstances,
(d)
their receipt of benefit in money or in kind under any enactment or
30
their entitlement to receive any such benefit,
(e)
the receipt of any such benefit by other persons satisfying prescribed
conditions or the entitlement of other persons satisfying prescribed
conditions to receive such benefits, and
(f)
the relationship, as calculated in accordance with the regulations by a
35
prescribed person, between their resources and their requirements.
(2)
Regulations under section 130 or 131 may direct how a person’s resources and
requirements are to be calculated and, without prejudice to the generality of
this subsection, may direct that they are to be calculated—
(a)
by a method set out in the regulations,
40
(b)
by a method described by reference to a method of calculating or
estimating income or capital specified in an enactment other than this
section or in an instrument made under an Act of Parliament or by
reference to such a method but subject to prescribed modifications,

National Health Service (Wales) Bill [HL]
Part 9 — Charging
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(c)
by reference to an amount applicable for the purposes of a payment
under an Act of Parliament or an instrument made under an Act of
Parliament, or
(d)
by reference to the person’s being or having been entitled to
payment under an Act of Parliament or an instrument made under an
5
Act of Parliament.
(3)
Regulations under section 130 or 131 which refer to an Act of Parliament or an
instrument made under an Act of Parliament may direct that the reference is to
be construed as a reference to that Act or instrument—
(a)
as it has effect at the time when the regulations are made, or
10
(b)
both as it has effect at that time and as amended subsequently.
Other provisions relating to charging
133
Charges for more expensive supplies
(1)
Regulations may provide for the making and recovery of such charges falling
within subsection (2) as may be prescribed.
15
(2)
The charges are charges by the Welsh Ministers or an NHS trust—
(a)
in respect of the supply of any appliance or vehicle which is, at the
request of the person supplied, of a more expensive type than the
prescribed type, or
(b)
in respect of the repair or replacement of any such appliance, or the
20
replacement of any such vehicle, or the taking of any such action in
relation to the vehicle as is mentioned in paragraph 10(2) of Schedule 1.
134
Charges for repairs and replacements in certain cases
(1)
Regulations may provide for the making and recovery of such charges falling
within subsection (2) as may be prescribed.
25
(2)
The charges are charges by the Welsh Ministers or an NHS trust in respect of
the repair or replacement of any appliance or vehicle, where it is determined in
the prescribed manner—
(a)
in any case, that the repair or replacement was necessitated by an act or
omission of the person supplied, or
30
(b)
in a case where the person supplied was under the age of 16, that the
repair or replacement was necessitated by an act or omission, occurring
while that person was under that age, of a person having charge of him.
135
Charges for designated services or facilities
Regulations may provide for the making and recovery of charges in respect of
35
services or facilities designated by the regulations as services or facilities
provided in pursuance of section 3(1)(d) or (e).
136
Sums otherwise payable to those providing services
(1)
Subsection (2) applies to regulations under—
(a)
section 121 (charges for drugs, medicines or appliances, or
40
pharmaceutical service),

National Health Service (Wales) Bill [HL]
Part 9 — Charging
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(b)
section 128 (charges for optical appliances),
(c)
section 133 (charges for more expensive supplies), or
(d)
section 134 (charges for repairs and replacements in certain cases),

which provide for the making and recovery of charges in respect of any
services.
5
(2)
The regulations may provide for the sums which would otherwise be payable
by a Local Health Board or Special Health Authority to the persons by whom
the services are provided, to be reduced by the amount of the charges
authorised by the regulations in respect of the services.
137
Hospital accommodation on part payment
10
(1)
The Welsh Ministers—
(a)
may authorise accommodation to be made available for patients to
such extent as they may determine, and
(b)
may recover such charges as they may determine in respect of such
accommodation and calculate them on any basis that they consider to
15
be the appropriate commercial basis.
(2)
Accommodation means—
(a)
accommodation in single rooms or small wards which is not needed by
any patient on medical grounds,
(b)
accommodation at any health service hospital or group of hospitals, or
20
a hospital in which patients are treated under arrangements made by
virtue of section 10, or at the health service hospitals in a particular area
or a hospital in which patients are so treated.
(3)
References in subsection (2) to a health service hospital include references to
such a hospital within the meaning of section 275 of the National Health
25
Service Act 2006 (c. 00), but do not include references to a hospital vested in an
NHS trust or an NHS foundation trust.
138
Expenses payable by employed patients
(1)
The Welsh Ministers may require any person—
(a)
who is a resident patient for whom the Welsh Ministers provide
30
services under this Act, and
(b)
who is absent during the day from the hospital where he is a patient for
the purpose of engaging in remunerative employment,

to pay such part of the cost of his maintenance in the hospital and any
incidental cost as may seem reasonable to the Welsh Ministers having regard
35
to the amount of that person’s remuneration.
(2)
The Welsh Ministers may recover the amount required under subsection (1).
Recovery, etc
139
Recovery of charges
(1)
All charges recoverable under this Act by—
40
(a)
the Welsh Ministers,
(b)
a local social services authority, or

National Health Service (Wales) Bill [HL]
Part 9 — Charging
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(c)
any body established under this Act,

may be recovered summarily as a civil debt (but this does not affect any other
method of recovery).
(2)
If any person, for the purpose of evading the payment of any charge under this
Act, or of reducing the amount of any such charge—
5
(a)
knowingly makes any false statement or false representation, or
(b)
produces or furnishes, or causes or knowingly allows to be produced
or furnished, any document or information which he knows to be false
in a material particular,

the charge or the balance of the charge, may be recovered from him by the
10
person by whom the cost of the service in question was defrayed.
140
Recovery of charges and payments in relation to goods and services
(1)
Where goods or services to which this section applies are provided and—
(a)
any charge payable by any person under this Act in respect of the
provision of the goods or services is reduced, remitted or repaid, but
15
that person is not entitled to the reduction, remission or repayment, or
(b)
any payment under this Act is made to, or for the benefit of, any
person in respect of the cost of obtaining the goods or services, but that
person is not entitled to, or to the benefit of, the payment,

the amount mentioned in subsection (2) is recoverable summarily as a civil
20
debt from the person in question by the responsible authority.
(2)
That amount—
(a)
in a case within subsection (1)(a), is the amount of the charge or (where
it has been reduced) reduction,
(b)
in a case within subsection (1)(b), is the amount of the payment.
25
(3)
Where two or more persons are liable under section 139(1) or this section to pay
an amount in respect of the same charge or payment, those persons are jointly
and severally liable.
(4)
For the purposes of this section, the circumstances in which a person is to be
treated as not entitled to a reduction, remission or repayment of a charge, or to
30
(or to the benefit of) a payment, include in particular those in which it is
received (wholly or partly)—
(a)
on the ground that he or another is a person of a particular
description, where the person in question is not of that description,
(b)
on the ground that he or another holds a particular certificate, when the
35
person in question does not hold such a certificate or does hold such a
certificate but is not entitled to it,
(c)
on the ground that he or another has made a particular statement, when
the person in question has not made such a statement or the statement
made by him is false.
40
(5)
In this section and section 141, “responsible authority” means—
(a)
in relation to the recovery of any charge under section 139(1) in respect
of the provision of goods or services to which this section applies, the
person by whom the charge is recoverable,
(b)
in relation to the recovery by virtue of this section of the whole or part
45
of the amount of any such charge, the person by whom the charge
would have been recoverable,

National Health Service (Wales) Bill [HL]
Part 9 — Charging
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(c)
in a case within subsection (1)(b), the person who made the payment.
(6)
But the Welsh Ministers may by directions provide for—
(a)
the functions of any responsible authority of recovering any charges
under this Act in respect of the provision of goods or services to which
this section applies,
5
(b)
the functions of any responsible authority under this section and
section 141,

to be exercised on behalf of the authority by another health service body.
(7)
This section applies to the following goods and services—
(a)
dental treatment and appliances provided in pursuance of this Act,
10
(b)
drugs and medicines provided in pursuance of this Act,
(c)
sight tests,
(d)
optical appliances,
(e)
any other appliances provided in pursuance of this Act.
141
Penalties relating to charges
15
(1)
Regulations may provide that, where a person fails to pay—
(a)
any amount recoverable from him under section 139(1) in respect of the
provision of goods or services to which section 140 applies, or
(b)
any amount recoverable from him under section 140,

a notice (referred to in this section as a penalty notice) may be served on the
20
person by the responsible authority.
(2)
A penalty notice is a notice requiring the person on whom it is served to pay
the amount to the authority within a prescribed period, together with a charge
(referred to in this section as a penalty charge) of an amount determined in
accordance with the regulations.
25
(3)
The regulations may not provide for the amount of the penalty charge to
exceed whichever is the smaller of—
(a)
£100,
(b)
the amount referred to in subsection (1)(a) or (b) multiplied by 5.
(4)
The Welsh Ministers may by order provide for subsection (3) to have effect as
30
if, for the sum specified in paragraph (a) or the multiplier specified in
paragraph (b) (including that sum or multiplier as substituted by a previous
order), there were substituted a sum or multiplier specified in the order.
(5)
Regulations may provide that, if a person fails to pay the amount he is required
to pay under a penalty notice within the period in question, he must also pay
35
to the responsible authority by way of penalty a further sum determined in
accordance with the regulations.
(6)
The further sum must not exceed 50 per cent of the amount of the penalty
charge.
(7)
Any sum payable under the regulations (including the amount referred to in
40
subsection (1)(a) or (b)) may be recovered by the responsible authority
summarily as a civil debt.
(8)
But a person is not liable by virtue of a penalty notice—
(a)
to pay at any time so much of any amount referred to in subsection
(1)(a) or (b) for which he is jointly and severally liable with another as
45

National Health Service (Wales) Bill [HL]
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at that time has been paid, or ordered by a court to be paid, by that
other, or
(b)
to a penalty charge, or a further sum by way of penalty, if he shows
that he did not act wrongfully, or with any lack of care, in respect of
the charge or payment in question.
5
142
Offences relating to charges
(1)
A person is guilty of an offence if he does any act mentioned in subsection (2)
with a view to securing for himself or another—
(a)
the evasion of the whole or part of any charge under this Act in
respect of the provision of goods or services to which section 140
10
applies,
(b)
the reduction, remission or repayment of any such charge, where he or
the other is not entitled to the reduction, remission or repayment,
(c)
a payment under this Act (whether to, or for the benefit of, himself or
the other) in respect of the cost of obtaining such goods or services,
15
where he or the other is not entitled to, or to the benefit of, the payment.
(2)
The acts referred to in subsection (1) are—
(a)
knowingly making, or causing or knowingly allowing another to make,
a false statement or representation, or
(b)
in the case of any document or information which he knows to be false
20
in a material particular, producing or providing it or causing or
knowingly allowing another to produce or provide it.
(3)
A person guilty of an offence under this section is liable on summary
conviction to a fine not exceeding level 4 on the standard scale.
(4)
A person, although he is not a barrister or solicitor, may conduct any
25
proceedings under this section before a magistrates’ court if he is authorised to
do so by the Welsh Ministers.
(5)
Proceedings for an offence under this section may be begun within—
(a)
the period of three months beginning with the date on which
evidence, sufficient in the opinion of the Welsh Ministers to justify a
30
prosecution for the offence, comes to their knowledge, or
(b)
the period of 12 months beginning with the commission of the
offence.
(6)
For the purposes of subsection (5), a certificate purporting to be signed by or
on behalf of the Welsh Ministers as to the date on which such evidence as is
35
mentioned in paragraph (a) of that subsection came to their knowledge, is
conclusive evidence of that date.
(7)
Where a person is convicted of an offence under this section in respect of any
charge or payment under this Act, he is not liable in respect of the charge or
payment to pay any penalty charge or further sum by way of penalty which
40
would otherwise be recoverable from him under section 141.
(8)
Where a person pays any penalty charge, or further charge by way of penalty,
recoverable under section 141 in respect of any charge or payment under this
Act, he must not be convicted of an offence under this section in respect of the
charge or payment.
45

National Health Service (Wales) Bill [HL]
Part 10 — Protection of NHS from fraud and other unlawful activities
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(9)
Subsection (4) of section 140 applies for the purposes of this section as it applies
for the purposes of that.
Part 10
Protection of NHS from fraud and other unlawful activities
Preliminary
5
143
Compulsory disclosure of documents
(1)
This Part confers power to require the production of documents in connection
with the exercise of the Welsh Ministers’ counter fraud functions in relation to
the health service.
(2)
The Welsh Ministers’ “counter fraud functions” in relation to the health service
10
means their power (by virtue of section 2(1)(b)) to take action for the purpose
of preventing, detecting or investigating fraud, corruption or other unlawful
activities carried out against or otherwise affecting—
(a)
the health service, or
(b)
the Welsh Ministers, in relation to their responsibilities for the health
15
service.
(3)
In this Part, the Welsh Ministers’ counter fraud functions in relation to the
health service are collectively referred to as functions to which this Part
applies.
(4)
“Investigating” means investigating in relation to civil or criminal proceedings.
20
144
Persons and bodies about which provision is made by this Part
(1)
This section applies for the purposes of this Part.
(2)
Subject to any provision made under subsection (6), “NHS body” has the
meaning given by section 22(6).
(3)
A “health service provider” means any person (other than an NHS body)
25
providing—
(a)
primary medical services, primary dental services or pharmaceutical
services under this Act or the National Health Service Act 2006 (c. 00),
(b)
primary ophthalmic services under that Act, or
(c)
general ophthalmic services.
30
(4)
An “NHS contractor” means any person (other than an NHS body or a person
within subsection (3)) providing services of any description under
arrangements made with an NHS body.
(5)
A “statutory health body” means any body (other than an NHS body, or a
person within subsection (3) or (4)) established by or under an enactment
35
and—
(a)
providing services in connection with the provision of, or
(b)
exercising functions in relation to,

the health service in either England or Wales or both.
(6)
The Welsh Ministers may by order—
40