Health Bill [H.L.]

House of Lords

Session 1998-99
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Arrangement of Clauses (Contents)

Health Bill [H.L.]

A
B I L L
[AS AMENDED ON REPORT]
TO
Amend the law about the national health service; make provision in relation to arrangements and payments between health service bodies and local authorities with respect to health and health-related functions; confer power to regulate any professions concerned (wholly or partly) with the physical or mental health of individuals; and for connected purposes.
BE IT ENACTED by the Queen's most Excellent Majesty, by and with the advice and consent of the Lords Spiritual and Temporal, and Commons, in this present Parliament assembled, and by the authority of the same, as follows:-

PART I

THE NATIONAL HEALTH SERVICE

Fund-holding practices

Repeal of law about fund-holding practices.     1. In the National Health Service and Community Care Act 1990 (referred to in this Act as the 1990 Act), sections 14 to 17 (which make provision in relation to fund-holding practices) are to cease to have effect.

Local administration

Primary Care Trusts.     2. - (1) After section 16 of the National Health Service Act 1977 (referred to in this Act as the 1977 Act) there is inserted-

"Primary Care Trusts.     16A. - (1) The Secretary of State may establish bodies to be known as Primary Care Trusts with a view, in particular, to their-

(a) providing or arranging for the provision of services under this Part of this Act,

(b) exercising functions in relation to the provision of general medical services under Part II of this Act, and

(c) providing services in accordance with section 28C arrangements.

    (2) Each Primary Care Trust shall be established by an order made by him (referred to in this Act as a PCT order) and following a majority vote by the members of the Primary Care Group concerned after consultation with all health care professionals that would be covered by the Primary Care Trust.

    (3) A Primary Care Trust shall be established for the area specified in its PCT order and shall exercise its functions in accordance with any prohibitions or restrictions in the order.

    (4) If any consultation requirements apply, they must be complied with before a PCT order is made.

    (5) In this section, "consultation requirements" means requirements about consultation contained in regulations (and the regulations must impose requirements where a PCT order establishes a Primary Care Trust).

    (6) Schedule 5A to this Act (which makes further provision about Primary Care Trusts) shall have effect.

Exercise of functions by Primary Care Trusts.     16B. - (1) This section applies to functions which are exercisable by a Primary Care Trust under or by virtue of this Act, the National Health Service and Community Care Act 1990 or any prescribed provision of any other Act.

    (2) Regulations may provide for functions to which this section applies-

(a) to be exercisable on behalf of the Primary Care Trust-

(i) by another Primary Care Trust;

(ii) by a committee or sub-committee, or an officer, of the Primary Care Trust or another Primary Care Trust; or

(iii) by a joint committee or joint sub-committee of the Primary Care Trust and any one or more Health Authorities or other Primary Care Trusts; or

(b) to be exercisable by the Primary Care Trust jointly with any one or more Health Authorities, NHS trusts or other Primary Care Trusts.".

    (2) Schedule 1 (which inserts the new Schedule 5A in the 1977 Act) is to have effect.

Primary Care Trusts: finance.     3. - (1) Before section 98 of the 1977 Act there is inserted-

"Public funding of Primary Care Trusts.     97C. - (1) It is the duty of every Health Authority, in respect of each financial year, to pay to each Primary Care Trust whose area falls within their area-

(a) sums equal to the trust's general Part II expenditure, and

(b) sums not exceeding the amount allotted by the authority to the trust for that year towards meeting the trust's main expenditure in that year.

    (2) Any payment under subsection (1)(a) above shall be made out of money paid to the Health Authority under subsection (1) of section 97 above and any payment under subsection (1)(b) above shall be made out of money paid to the authority under subsection (3) of that section.

    (3) An amount is allotted to a Primary Care Trust for a year under this section when the trust is notified by the Health Authority that the amount is allotted to it for that year; and the Health Authority may make an allotment under this section increasing or reducing an allotment previously so made.

    (4) The Secretary of State may give directions to a Primary Care Trust about the payment of sums by the trust to the Health Authority in whose area the area of the trust falls in respect of charges or other sums referable to the valuation or disposal of assets.

    (5) Where any part of a sum paid to a Primary Care Trust by a Health Authority under subsection (1) above derives from a sum which was paid to the authority under subsection (1) or (3) of section 97 above subject to a direction (under subsection (6)(a) of that section) that it be applied for a particular purpose, the authority shall direct the trust that the sum paid to the trust shall be applied for the same purpose.

    (6) Sums falling to be paid to Primary Care Trusts under this section shall be payable subject to compliance with such conditions as to records, certificates or otherwise as the Secretary of State may determine.

Financial duties of Primary Care Trusts.     97D. - (1) It is the duty of every Primary Care Trust, in respect of each financial year, to perform its functions so as to secure that the expenditure of the trust which is attributable to the performance by the trust of its functions in that year (not including expenditure within subsection (1)(a) of section 97C above) does not exceed the aggregate of-

(a) the amount allotted to it for that year under subsection (1)(b) of that section;

(b) any sums received by it in that year under any provision of this Act (other than sums received by it under that section); and

(c) any sums received by it in that year otherwise than under this Act for the purpose of enabling it to defray any such expenditure.

    (2) The Secretary of State may give such directions to a Primary Care Trust as appear to be requisite to secure that the trust complies with the duty imposed on it by subsection (1) above.

    (3) Directions under subsection (2) above may be specific in character.

    (4) To the extent to which-

(a) any expenditure is defrayed by a Primary Care Trust as trustee or on behalf of a Primary Care Trust by special trustees, or

(b) any sums are received by a Primary Care Trust as trustee or under section 96A above,

that expenditure and, subject to subsection (6) below, those sums shall be disregarded for the purposes of this section.

    (5) For the purposes of this section sums which, in the hands of a Primary Care Trust, cease to be trust funds and become applicable by the Primary Care Trust otherwise than as trustee shall be treated, on their becoming so applicable, as having been received by the Primary Care Trust otherwise than as trustee.

    (6) Of the sums received by a Primary Care Trust under section 96A above so much only as accrues to the Primary Care Trust after defraying any expenses incurred in obtaining them shall be disregarded under subsection (4) above.

    (7) Subject to subsection (4) above, the Secretary of State may by directions determine-

(a) whether specified sums are, or are not, to be treated for the purposes of this section as received under this Act by a specified Primary Care Trust;

(b) whether specified expenditure is, or is not, to be treated for those purposes as expenditure within subsection (1) above of a specified Primary Care Trust; or

(c) the extent to which, and the circumstances in which, sums received by a Primary Care Trust under section 97C above but not yet spent are to be treated for the purposes of this section as part of the expenditure of the Primary Care Trust and to which financial year's expenditure they are to be attributed.

    (8) In subsection (7) above, "specified" means of a description specified in the directions."

Expenditure of Health Authorities and Primary Care Trusts.     4. - (1) After Schedule 12 to the 1977 Act there is inserted-

"SCHEDULE 12A

EXPENDITURE OF HEALTH AUTHORITIES AND PRIMARY CARE TRUSTS

Health Authorities: general Part II expenditure

1. - (1) In section 97 above and this Schedule, general Part II expenditure, in relation to a Health Authority, means expenditure of the authority which-

(a) is attributable to the payment of remuneration to persons providing services in pursuance of Part II of this Act, and

(b) is not excluded by sub-paragraph (2) below.

    (2) Expenditure is excluded if it is attributable to-

(a) the reimbursement of expenses of persons providing services in pursuance of Part II which are designated expenses incurred in connection with the provision of the services (or in giving instruction in matters relating to the services),

(b) remuneration referable to the cost of drugs,

(c) remuneration paid to persons providing additional pharmaceutical services (in accordance with directions under section 41A above), in respect of such of those services as are designated, or

(d) remuneration of a designated description which is determined by the Health Authority and paid to persons providing general medical services in pursuance of Part II.

Health Authorities: main expenditure

    2.- (1) In section 97 above, main expenditure, in relation to a Health Authority and the year in question, means-

(a) expenditure of the authority mentioned in sub-paragraph (2) below,

(b) any other expenditure of the authority attributable to the performance of their functions in that year (other than general Part II expenditure and remuneration referable to the cost of drugs), and

(c) expenditure attributable to remuneration referable to the cost of drugs for which the authority are accountable in that year (whether paid by them or another authority).

    (2) The expenditure referred to in sub-paragraph (1)(a) above is expenditure attributable to-

(a) the reimbursement in that year of expenses of persons providing services in pursuance of Part II which are designated expenses incurred in connection with the provision of the services (or in giving instruction in matters relating to the services),

(b) remuneration paid in that year to persons providing additional pharmaceutical services (in accordance with directions under section 41A above), in respect of such of those services as are designated, or

(c) remuneration of a designated description which is determined by the Health Authority and paid in that year to persons providing general medical services in pursuance of Part II.

    3.- (1) For each financial year, the Secretary of State shall apportion, in such manner as he thinks appropriate, among all Health Authorities the total of the remuneration referable to the cost of drugs which is paid by each Health Authority in that year.

    (2) A Health Authority are accountable in any year for remuneration referable to the cost of drugs to the extent (and only to the extent) that such remuneration is apportioned to them under sub-paragraph (1) above.

    (3) Where in any financial year any remuneration referable to the cost of drugs for which a Health Authority are accountable is paid by another Health Authority, the remuneration is to be treated (for the purposes of sections 97 and 97A above) as having been paid by the first authority in the performance of their functions.

    (4) The Secretary of State may, in particular, exercise his discretion under sub-paragraph (1) above-

(a) so that any apportionment reflects, in the case of each Health Authority, the financial consequences of orders for the provision of drugs, being orders which in his opinion are attributable to the authority in question,

(b) by reference to averaged or estimated amounts.

    (5) The Secretary of State may make provision for any remuneration referable to the cost of drugs which is paid by a Health Authority other than the Health Authority which are accountable for the payment to be reimbursed in such manner as he may determine.

PCTs: general Part II expenditure

    4.- (1) In section 97C above and this Schedule, general Part II expenditure, in relation to a Primary Care Trust, means expenditure of the trust which-

(a) is attributable to the payment of remuneration to persons providing services in pursuance of Part II of this Act, and

(b) is not excluded by sub-paragraph (2) below.

    (2) Expenditure is excluded if it is attributable to-

(a) the reimbursement of expenses of persons providing services in pursuance of Part II which are designated expenses incurred in connection with the provision of the services (or in giving instruction in matters relating to the services), or

(b) remuneration of a designated description which is determined by the Health Authority within whose area the area of the trust falls and paid to persons providing general medical services in pursuance of Part II.

PCTs: main expenditure

    5.- (1) In section 97C above, main expenditure, in relation to a Primary Care Trust and the year in question, means-

(a) expenditure of the trust mentioned in sub-paragraph (2) below, and

(b) any other expenditure of the trust attributable to the performance of its functions in that year (other than general Part II expenditure),

and is to be treated as including any expenditure apportioned to the trust for that year under paragraph 6 below.

    (2) The expenditure referred to in sub-paragraph (1)(a) above is expenditure attributable to-

(a) the reimbursement in that year of expenses of persons providing services in pursuance of Part II which are designated expenses incurred in connection with the provision of the services (or in giving instruction in matters relating to the services), or

(b) remuneration of a designated description which is determined by the Health Authority within whose area the area of the trust falls and paid in that year to persons providing general medical services in pursuance of Part II.

    6.- (1) For each financial year, a Health Authority may apportion, to such extent and in such manner as they think appropriate, among the Primary Care Trusts whose areas fall within their area, the remuneration referable to the cost of drugs for which the authority are accountable in that year.

    (2) Where in any financial year-

(a) any remuneration referable to the cost of drugs for which the Health Authority are accountable is paid (whether by them or another Health Authority), and

(b) that remuneration is apportioned to a Primary Care Trust under sub-paragraph (1) above,

that remuneration is to be treated for the purposes of sections 97C and 97D as having been paid by the trust in the performance of its functions.

Interpretation

    7.- (1) In this Schedule-

"designated" means designated in writing by the Secretary of State (and different designations may be made for different purposes),

"drugs" includes medicines and listed appliances (within the meaning of section 41 above),

"pharmaceutical services" does not include additional pharmaceutical services.

    (2) The Secretary of State shall determine what remuneration paid by Health Authorities to persons providing pharmaceutical services is to be treated for the purposes of this Schedule as remuneration referable to the cost of drugs.

    (3) The Secretary of State may treat all remuneration paid by Health Authorities to such persons, so far as it is met by an NHS trust or Primary Care Trust under section 103(3) below, as remuneration referable to the cost of drugs for those purposes."

    (2) Section 97 of the 1977 Act is amended as follows-

(a) subsection (2) is omitted,

(b) in subsection (3), at the end there is inserted "in that year",

(c) for subsections (3A) and (3B) there is substituted-

    "(3BB) Schedule 12A to this Act (which defines "general Part II expenditure" and "main expenditure" for the purposes of, and supplements, this section and section 97C below) shall have effect".

    (3) Section 103(3) of the 1977 Act (special arrangements as to payment of remuneration) is amended as follows-

(a) in paragraph (a), for the words from "the Health Authority" to the end of that paragraph there is substituted "a Health Authority so determined in respect of the whole or any part of that remuneration",

(b) in paragraph (b), for "that" there is substituted "the whole or (as the case may be) that part of the".

    (4) This section has effect for the financial years 1999-2000 and subsequent financial years.

Primary Care Trusts: provision of services etc.     5. - (1) After section 18 of the 1977 Act there is inserted-

"Primary Care Trusts: further functions

Provision of services etc.     18A. - (1) A Primary Care Trust may provide services under an agreement made under section 28C below, and may do so as a member of a qualifying body (within the meaning of section 28D).

    (2) A Primary Care Trust may arrange for the provision by the trust to another health service body of goods or services which are of the same description as those which, at the time of making the arrangement, the trust has power to provide in carrying out its other functions.

    (3) A Primary Care Trust may provide premises for the use of persons-

(a) providing general medical, general dental, general ophthalmic or pharmaceutical services, or

(b) performing personal medical or personal dental services under an agreement made under section 28C below,

on any terms it thinks fit.

    (4) A Primary Care Trust which manages any hospital may make accommodation available there for patients who give undertakings (or for whom undertakings are given) to pay any charges imposed by the trust in respect of the accommodation.

    (5) A Primary Care Trust has power to do anything specified in section 7(2) of the Health and Medicines Act 1988 (provision of goods, services etc.), other than make accommodation available for patients at any hospital it manages, for the purpose of making additional income available for improving the health service.

    (6) A Primary Care Trust may only exercise a power conferred by subsection (4) or (5) above-

(a) to the extent that its exercise does not to any significant extent interfere with the performance by the trust of its functions or of its obligations under NHS contracts, and

(b) in circumstances specified in directions under section 17 above, with the Secretary of State's consent.

    (7) In this section-

"accommodation" includes services,

"hospital" means a health service hospital and includes any establishment or facility managed for the purposes of the health service."

© Parliamentary copyright 1999
Prepared 22 March 1999