Legalize / United Kingdom / Public General Act

National Health Service (Scotland) Act 1978

Type Public General Act

Publication 1978-07-20

Last updated 2025-06-19

State In force

Department Statute Law Database

Source legislation.gov.uk

articles Not indexed

Reform history JSON API

Financial duties of bodies referred to in section 85.

Schemes for meeting losses and liabilities etc. of certain health service bodies.

Personal medical or dental services.

Regulation of financial arrangements of Health Boards, the Agency and the Dental Estimates Board.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Appointment of Commissioner and tenure of office.

Provisions relating to complaints.

Interpretation of Part VI.

Standards and outcomes

State hospitals.

Arbitration.

Transitional provisions and savings, consequential amendments and repeals.

Members

10ZA

(1) The Agency must secure the adequate provision of the patient advice and support service described in section 18 of the Patient Rights (Scotland) Act 2011 (asp 5) in relation to each relevant body.

(2) In exercising its function under subsection (1), the Agency must have regard to the desirability of the service being provided—

(a) in the most efficient and effective manner possible, and

(b) in a manner which co-ordinates with the services of other providers of advice and support.

(3) There may be more than one provider of the patient advice and support service.

(4) The patient advice and support service is not to be provided by—

(a) a Health Board,

(b) a Special Health Board,

(d) the Agency.

(e) an integration joint board.

(5) Each relevant body must make to its provider of the patient advice and support service, in respect of the provider's expenses (as respects its activities relating to the service), payments of such amounts, and at such times, as the Scottish Ministers may direct.

(6) For the purposes of this section, a “relevant body” is—

(a) a Health Board, ...

(ab) an integration joint board, and

(b) any other body that the Scottish Ministers may by order specify.

Primary medical services: persons with whom agreements can be made

Personal dental services: persons with whom agreements may be made.

Services lists

Supply of goods and services to local authorities, etc.

Assistance and support: primary medical services and pharmaceutical care services

Arrangements and regulations for general medical services.

Vacancies for medical practitioners.

Arrangements for providing additional pharmaceutical services.

Powers of NHS Tribunal.

Conditional disqualification etc.

Review etc. of disqualification.

Suspension pending appeal.

Exercise of choice of medical practitioner etc. in certain cases.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Expenses payable by remuneratively employed resident patients.

Calculation of charges for dental appliances and treatment.

Emergency powers.

Relationship of sections 77, 78 and 78A

Power of trustees to make payments to Health Boards.

Expenses payable by remuneratively employed resident patients.

Financial duties of bodies referred to in section 85.

Calculation of charges for dental appliances and treatment.

Accounts of Health Boards and the Agency.

Regulation of financial arrangements of Health Boards, the Agency and the Dental Estimates Board.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Appointment of Commissioner and tenure of office.

Provisions relating to complaints.

Personal medical or dental services: regulations.

Reimbursement of the cost of services provided in another EEA State

State hospitals.

Arbitration.

Transitional provisions and savings, consequential amendments and repeals.

Medical reviewers

7A

(1) HIS must appoint persons employed under paragraph 7(5) to exercise the functions of medical reviewers; and when doing so those employees are to be known as medical reviewers.

(2) HIS must appoint a person employed under paragraph 7(5) to exercise the functions of the senior medical reviewer; and when doing so that employee is to be known as the senior medical reviewer.

(3) A person appointed as a medical reviewer or the senior medical reviewer must—

(a) be a medical practitioner;

(b) have been so throughout the 5 years prior to appointment; and

(4) A member of HIS may not exercise the functions of—

(a) a medical reviewer; or

(b) the senior medical reviewer.

(5) An employee of HIS (other than a medical reviewer) may not exercise any function of a medical reviewer other than those under section 17.

(6) An employee of HIS (other than the senior medical reviewer) may not exercise the functions of the senior medical reviewer (except by virtue of arrangements made under paragraph 11(2C)).

(7) An appointment as a medical reviewer or the senior medical reviewer does not affect the appointed person's status as employed under paragraph 7(5).

Members

Arrangements for providing additional pharmaceutical services.

Conditional disqualification etc.

Provision of certain services under NHS contracts.

Suspension pending appeal.

Exercise of choice of medical practitioner etc. in certain cases.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Payments by Health Boards under general medical services contracts

Emergency powers.

Relationship of sections 77, 78 and 78A

Power of trustees to make payments to Health Boards.

Further provision as to expenditure on drugs.

Financial duties of bodies referred to in section 85.

Schemes for meeting losses and liabilities etc. of certain health service bodies.

Accounts of Health Boards and the Agency.

Regulation of financial arrangements of Health Boards, the Agency and the Dental Estimates Board.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Appointment of Commissioner and tenure of office.

Provisions relating to complaints.

Interpretation of Part VI.

Protection of Health Boards and Common Services Agency.

State hospitals.

Arrangements for providing additional pharmaceutical services.

Transitional provisions and savings, consequential amendments and repeals.

Members

Prior authorisation for the purposes of section 75BA

75BA

(1) This section applies where qualifying EEA expenditure is incurred by a person on or after 25 October 2013 (but see subsections (9) and (14) and section 75BC).

(2) A Health Board must, on an application made by the person, reimburse to that person the amount of the qualifying EEA expenditure incurred by that person, but this is subject to subsections (8) and (9), to any limit applicable under subsection (11) and to any deduction applicable under section 75D.

(3) For the purpose of this section, “qualifying EEA expenditure” is expenditure incurred on the provision by an authorised provider, in an EEA State ..., to a person ordinarily resident in Scotland (“the patient”) of services as respects which condition A or condition B is met.

(4) Condition A is that the services—

(a) are necessary to treat or diagnose a medical condition of the patient, and

(b) are the same as or equivalent to services that a Health Board in whose area a patient resides would make or have made available to a patient under this Act in the circumstances of the patient’s case.

(5) But in the case of services which, although meeting the requirements in paragraphs (a) and (b) of subsection (4), fall within subsection (6), condition A is only met if, before the services were provided, the Health Board had given authorisation under section 75BB for the provision of the services to the patient.

(6) Services fall within this subsection if—

(a) they are subject to planning requirements relating to the objective of ensuring sufficient and permanent access to a balanced range of high quality treatment or to the wish to control costs and avoid, as far as possible, any waste of financial, technical and human resources, and—

(i) involve a stay in hospital accommodation for at least one night, or

(ii) require the use of highly specialised and cost-intensive medical infrastructure or medical equipment,

(b) they involve treatments presenting a particular risk for the patient or the population, or

(c) they are provided by a healthcare provider in circumstances that, on a case-by-case basis, could give rise to serious and specific concerns relating to the quality or safety of the care, with the exception of healthcare services which are subject to European Union legislation ensuring a minimum level of safety and quality throughout the European Union.

(7) Condition B is that before the services were provided the Health Board had given authorisation under section 75BB(4)(b) for the provision of the services to the patient.

(8) The duty in subsection (2) does not apply where the applicant for reimbursement incurred the qualifying EEA expenditure in connection with an arrangement which was entered into by or on behalf of the applicant in the course of business and under which the applicant has gained or might be expected to gain any financial benefit.

(9) This section does not apply in circumstances where Article 20 or 27(3) of Regulation (EC) No. 883/2004 apply.

(10) Subsection (11) applies where the services are the same as or equivalent to services that the Health Board in whose area a patient resides would have made available to that patient under this Act in the circumstances of the patient’s case.

(11) The Health Board may limit the amount of any reimbursement under this section to the cost that the Board would have incurred if the same or an equivalent service had been made available by the Board to a patient resident in the Board’s area.

(12) A Health Board may, on an application made by a person who receives reimbursement of qualifying expenditure under paragraph (2), reimburse to that person travelling expenses (including the travelling expenses of companions) incurred or to be incurred for the purpose of their obtaining any services reimbursed under this section.

(13) The Scottish Ministers may determine—

(a) the form in which an application under this section must be made, and

(b) the information to be provided in support of the application.

(14) This section does not apply where expenditure is incurred in Iceland, Liechtenstein or Norway before Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the application of patients’ rights in cross-border healthcare applies to that state in accordance with the EEA Agreement.

(15) In this section and section 75BB—

“authorised provider” in relation to services provided in an EEA State means a person who is lawfully providing services,

“services” includes any goods, including drugs, medicines and appliances which are used or supplied in connection with the provision of a service, but does not include accommodation other than hospital accommodation.

Prior authorisation for the purposes of section 75BA

75BB

(1) A person may apply to a Health Board under this section for prior authorisation for the purposes of section 75BA in relation to the provision of services (“the requested services”) to a person ordinarily resident in Scotland (“the patient”).

(2) The requested services must be—

(a) services which fall within section 75BA(6) and meet the requirements in paragraphs (a) and (b) of section 75BA(4), or

(b) services that are neither the same as nor equivalent to services that a Health Board in whose area the patient resides would make available to the patient under this Act in the circumstances of the patient’s case.

(3) The Scottish Ministers may determine—

(a) the form in which an application under this section must be made, and

(b) the information to be provided in support of the application.

(4) A Health Board—

(a) must authorise the provision of the requested services if they are services mentioned in subsection (2)(a) (but see subsection (5)), and

(b) may authorise the provision of the requested services in any case where—

(i) the requested services are necessary to treat or diagnose a medical condition of the patient, and

(ii) the duty in paragraph (a) does not apply.

(5) The duty in subsection (4)(a) does not apply if at least one of the following conditions is met—

(a) by receiving the requested services the patient would, according to a clinical evaluation, be exposed with reasonable certainty to a patient-safety risk that cannot be regarded as acceptable, taking into account the potential benefit for the patient of the requested service,

(b) the general public will be exposed with reasonable certainty to a substantial safety hazard as a result of the requested service,

(c) the requested service is to be provided by a healthcare provider that raises serious and specific concerns relating to the respect of standards and guidelines on quality of care and patient safety, including provisions on supervision, whether these standards and guidelines are laid down by laws or regulations or through accreditation systems established by the state in which the requested services will be provided,

(d) the Health Board can provide to the patient services that are the same as or equivalent to the requested services within a period of time that is medically justifiable, taking into account the patient’s state of health at the time the decision under this section is made and the probable course of the medical condition to which the requested services relate.

(6) The matters to which a Health Board is to have regard in determining for the purpose of subsection (5)(d) whether the length of any delay is medically justifiable include—

(a) the patient’s medical history,

(b) the extent of any pain, disability, discomfort or other suffering that is attributable to the medical condition to which the requested services are to relate,

(c) whether any such pain, disability, discomfort or suffering makes it impossible or extremely difficult for the patient to carry out ordinary daily tasks, and

(d) the extent to which the provision of the requested services would be likely to alleviate, or enable the alleviation of, the pain, disability, discomfort or suffering.

(7) In section 75D (deduction of NHS charges)—

(a) in subsection (1) after “75B(1)” insert “or 75BA”;

(b) in subsection (2) after “75C” insert “or 75BA and 75BB”.

(8) Any authorisation or refusal of authorisation in part or full under this section must be in writing.

(9) In this section ... “writing” includes an electronic communication as defined in section 15 of the Electronic Communications Act 2000which has been recorded and is capable of being reproduced.

Deduction of NHS charges

Personal medical or dental services.

Primary medical services: persons with whom agreements can be made

Relationship of sections 77, 78 and 78A

Power of trustees to make payments to Health Boards.

Further provision as to expenditure on drugs.

Inquiries.

Schemes for meeting losses and liabilities etc. of certain health service bodies.

Accounts of Health Boards and the Agency.

Regulation of financial arrangements of Health Boards, the Agency and the Dental Estimates Board.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Relationship of sections 77, 78 and 78A

Power of trustees to make payments to Health Boards.

Services lists

Protection of Health Boards and Common Services Agency.

State hospitals.

Arbitration.

Transitional provisions and savings, consequential amendments and repeals.

Members

Deduction of NHS charges

Inquiries.

Emergency powers.

Relationship of sections 77, 78 and 78A

Power of trustees to make payments to Health Boards.

Further provision as to expenditure on drugs.

Financial duties of bodies referred to in section 85.

Schemes for meeting losses and liabilities etc. of certain health service bodies.

Accounts of Health Boards and the Agency.

Regulation of financial arrangements of Health Boards, the Agency and the Dental Estimates Board.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Appointment of Commissioner and tenure of office.

Provisions relating to complaints.

Interpretation of Part VI.

Protection of Health Boards and Common Services Agency.

State hospitals.

Arbitration.

Restriction of powers under sections 44, 50 and 53.

Members

12K

A Health Board may, with the agreement of another Health Board and the Scottish Ministers, carry out on behalf of that other Health Board any function of that other Health Board.

Reimbursement of Health Board’s costs.

Primary medical services: persons with whom agreements can be made

Personal dental services: persons with whom agreements may be made.

Immunisation.

Persons performing pharmaceutical care services

Duty of Secretary of State.

Medical lists.

Powers of NHS Tribunal.

Conditional disqualification etc.

Review etc. of disqualification.

Suspension pending appeal.

Exercise of choice of medical practitioner etc. in certain cases.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Expenses payable by remuneratively employed resident patients.

Reimbursement of the cost of services provided in another EEA State

Reimbursement of the cost of services provided in another EEA State where expenditure is incurred on or after 25 October 2013.

Deduction of NHS charges

Emergency powers.

Use of accommodation.

Further provision as to expenditure on drugs.

Financial duties of bodies referred to in section 85.

Health Boards' power to enter into general medical services contracts

Accounts of Health Boards and the Agency.

Regulation of financial arrangements of Health Boards, the Agency and the Dental Estimates Board.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Appointment of Commissioner and tenure of office.

Provisions relating to complaints.

Interpretation of Part VI.

Protection of Health Boards and Common Services Agency.

Eligibility to be contractor under general medical services contract

Services lists

Transitional provisions and savings, consequential amendments and repeals.

Members

Inspections of independent health care services

Inspections: best regulatory practice

Inspections: reports

Grant or refusal of registration

Application of Act to condition notices following emergency condition notices

Further provision as respects notice of proposals

Local authorities and other bodies: awareness of HIS reports etc.

Transfer of property rights and liabilities to NHS trusts.

Financial obligations of NHS trusts.

Duty in relation to governance of staff

Power of Health Board to carry out other Health Board's functions

[ Joint Liaison Committees.

Supply of goods and services to local authorities, etc.

Power to make payments towards expenditure on community services.

Provision of certain services under NHS contracts.

NHS contracts.

Personal dental services: persons with whom agreements may be made.

Disqualification provisions in England or Wales or Northern Ireland.

Restriction of powers under sections 44, 50 and 53.

Conditional disqualification etc.

Assistance and support

Deduction of NHS charges

Assistance and support: primary medical services and pharmaceutical care services

Arrangements and regulations for general medical services.

Vacancies for medical practitioners.

Terms and conditions etc.

Powers of NHS Tribunal.

Conditional disqualification etc.

Means of meeting expenditure of Health Boards out of public funds.

Expenses of certain bodies.

Financial duties of bodies referred to in section 85.

Schemes for meeting losses and liabilities etc. of certain health service bodies.

Powers in case of service failure

Appointment of Commissioner and tenure of office.

Protection of Health Boards and Common Services Agency.

Inquiries.

Emergency powers.

Relationship of sections 77, 78 and 78A

Power of trustees to make payments to Health Boards.

Means of meeting expenditure of Health Boards out of public funds.

Further provision as to expenditure on drugs.

Financial duties of bodies referred to in section 85.

Schemes for meeting losses and liabilities etc. of certain health service bodies.

Regulation of financial arrangements of Health Boards, the Agency and the Dental Estimates Board.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Appointment of Commissioner and tenure of office.

Provisions relating to complaints.

Interpretation of Part VI.

Protection of Health Boards and Common Services Agency.

State hospitals.

Arbitration.

Transitional provisions and savings, consequential amendments and repeals.

Members

46A

The Scottish Ministers must, to such extent as they consider necessary to meet all reasonable requirements, provide or secure the provision of—

(a) communication equipment, and

(b) support in using that equipment,

to any person who has lost their voice or has difficulty speaking.

Default powers.

75BC

(1) The duty to reimburse in section 75BA(2) applies in respect of a service provided to a person on or after IP completion day only if one of the following conditions is met.

(2) Condition 1 is that the service began to be provided to the person before IP completion day.

(3) Condition 2 is that—

(a) the application for authorisation under section 75BB in relation to the provision of the service to the person was made before IP completion day, and

(b) the service began to be provided to the person on or after IP completion day and before—

(i) the end of the period specified in the authorisation as the period for which authorisation is granted, or

(ii) if no such period is specified in the authorisation, the end of the period of 1 year beginning with IP completion day.

(4) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Prior authorisation

Inquiries.

Emergency powers.

Charges in respect of non-residents.

Protection of Health Boards and Common Services Agency.

State hospitals.

Further provision as to expenditure on drugs.

Financial duties of bodies referred to in section 85.

Schemes for meeting losses and liabilities etc. of certain health service bodies.

Accounts of Health Boards and the Agency.

Regulation of financial arrangements of Health Boards, the Agency and the Dental Estimates Board.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Provisions relating to complaints.

Interpretation of Part VI.

State hospitals.

Arbitration.

Transitional provisions and savings, consequential amendments and repeals.

Members

Personal medical or dental services.

Primary medical services: persons with whom agreements can be made

Personal dental services: persons with whom agreements may be made.

Services lists

Use of accommodation.

Health Boards' power to enter into general medical services contracts

Other mandatory contract terms

Powers of NHS Tribunal.

Accommodation and services for private patients.

Assistance and support: primary medical services and pharmaceutical care services

Sections 32A and 32B: procedure etc.

Sale of medical practices.

Terms and conditions etc.

Purchase of land and moveable property.

Power to raise money, etc., by appeals, collections, etc.

Disqualification provisions in England or Wales or Northern Ireland.

Sections 32A and 32B: procedure etc.

Powers in case of service failure

Accommodation and services for private patients.

Reimbursement of the cost of services provided in another EEA State

Purchase of land and moveable property.

Means of meeting expenditure of Health Boards out of public funds.

Expenses of certain bodies.

Financial duties of bodies referred to in section 85.

Schemes for meeting losses and liabilities etc. of certain health service bodies.

Accounts of Health Boards and the Agency.

Regulation of financial arrangements of Health Boards, the Agency and the Dental Estimates Board.

Payment of allowances and remuneration to members of certain bodies connected with the health services.

Salary and pension of Commissioner.

Application of certain provisions of the Parliamentary Commissioner Act 1967.

Charges in respect of non-residents.

Protection of Health Boards and Common Services Agency.

State hospitals.

Exemption from stamp duty.

Citation, extent and commencement.

Terms of office etc

Personal dental services: persons with whom agreements may be made.

Primary medical services: persons with whom agreements can be made

Personal dental services: persons with whom agreements may be made.

Services lists

Use of accommodation.

Eligibility to be contractor under general medical services contract

Other mandatory contract terms

Assistance and support

Eligibility to be contractor under pharmaceutical care services contract

Assistance and support: primary medical services and pharmaceutical care services

Arrangements and regulations for general medical services.

Vacancies for medical practitioners.

Terms and conditions etc.

Powers of NHS Tribunal.

Disqualification provisions in England or Wales or Northern Ireland.

Restriction of powers under sections 44, 50 and 53.

Accommodation and services for private patients.

Reimbursement of the cost of services provided in another EEA State

Prior authorisation for the purposes of section 75BA

Deduction of NHS charges

Default powers.

Purchase of land and moveable property.

Power to raise money, etc., by appeals, collections, etc.

Expenses of certain bodies.

Financial duties of bodies referred to in section 85.

Schemes for meeting losses and liabilities etc. of certain health service bodies.

Salary and pension of Commissioner.

Regulation of financial arrangements of Health Boards, the Agency and the Dental Estimates Board.

Payment of allowances and remuneration to members of certain bodies connected with the health services.

Salary and pension of Commissioner.

Application of certain provisions of the Parliamentary Commissioner Act 1967.

Charges in respect of non-residents.

Protection of Health Boards and Common Services Agency.

Exemption from stamp duty.

Citation, extent and commencement.

Terms of office etc

Standards and outcomes

Inspections of independent health care services

Inspections: best regulatory practice

Inspections: reports

Grant or refusal of registration

Application of Act to condition notices following emergency condition notices

Further provision as respects notice of proposals

Local authorities and other bodies: awareness of HIS reports etc.

Duty of HIS to consult the Mental Welfare Commission for Scotland

Scottish Hospital Endowments Research Trust.

Financial obligations of NHS trusts.

Staffing

Duty to ensure appropriate staffing: agency workers

12IA

(1) It is the duty of every Health Board and the Agency to ensure that at all times suitably qualified and competent individuals, from such a range of professional disciplines as necessary, are working in such numbers as are appropriate for—

(a) the health, wellbeing and safety of patients,

(b) the provision of safe and high-quality health care, and

(2) In determining what, in a particular kind of health care provision, constitutes appropriate numbers for the purposes of subsection (1), regard is to be had to—

(a) the nature of the particular kind of health care provision,

(b) the local context in which it is being provided,

(d) the needs of patients being provided it, and

(e) appropriate clinical advice.

12IB

(1) Where, in order to comply with the duty under section 12IA, a Health Board, a relevant Special Health Board or the Agency secures the services of an agency worker (within the meaning of the Agency Workers Regulations 2010), it must comply with subsection (2).

(2) Subject to subsection (3), the amount to be paid to secure the services of that worker during a period should not exceed 150% of the amount that would be paid to a full-time equivalent employee of the Health Board, relevant Special Health Board or the Agency to fill the equivalent post for the same period.

(3) Where, despite subsection (2), in a quarterly reporting period a Health Board, relevant Special Health Board or the Agency does pay an amount higher than the amount prescribed in subsection (2), it must report to the Scottish Ministers, as soon as practicable after the end of that period—

(a) the number of occasions in that period on which it has paid an amount higher than the amount prescribed in subsection (2),

(b) the amount paid on each such occasion (expressed as a percentage of the amount that would be paid to a full-time equivalent employee of the Health Board, relevant Special Health Board or the Agency to fill the equivalent post for the same period) and,

(4) In subsection (3), “quarterly reporting period” means—

(a) the period from the day that the Bill for the Health and Care (Staffing) (Scotland) Act 2019 receives Royal Assent to whichever of 31 March, 30 June, 30 September and 31 December first occurs thereafter,

(b) each subsequent three-month period.

(5) The Scottish Ministers must publish in such manner and at such intervals as they consider appropriate—

(a) information from Health Boards, relevant Special Health Boards and the Agency on the amount spent on all agency workers, and

(b) reports received by them under subsection (3).

12IC

(1) It is the duty of every Health Board and the Agency to put and keep in place arrangements for the real-time assessment of its compliance with the duty imposed by section 12IA.

(2) The arrangements under subsection (1) must, in particular, include—

(a) a procedure for the identification, by any member of staff, of any risks caused by staffing levels to—

(i) the health, wellbeing and safety of patients,

(ii) the provision of safe and high-quality health care, or

(iii) in so far as it affects either of those matters, the wellbeing of staff,

(b) a procedure for the notification of any such risk to an individual with lead professional responsibility (whether clinical or non-clinical) in the area where the risk was identified,

(c) a procedure for the mitigation of any such risks, so far as possible, by such an individual, and a requirement for that individual to seek and have regard to appropriate clinical advice, as necessary, in carrying out such mitigation,

(d) raising awareness among staff about the procedures described in paragraphs (a), (b) and (c),

(e) encouraging and enabling staff to use the procedures described in paragraphs (a) and (b),

(f) training individuals with lead professional responsibility (whether clinical or non-clinical) for particular types of health care in how to implement the arrangements put in place under paragraphs (a) to (e), and

(g) ensuring that such individuals receive adequate time and resources to implement those arrangements.

12ID

(1) It is the duty of every Health Board and the Agency to put and keep in place arrangements for the escalation of any risk—

(a) identified during the real-time assessment of its staffing levels in accordance with arrangements put in place under section 12IC, and

(b) which it has not been possible to mitigate in accordance with the arrangements put in place under that section.

(2) The arrangements under subsection (1) must, in particular, include—

(a) a procedure for the initial reporting of a risk as described in subsection (1), by an individual with lead professional responsibility (whether clinical or non-clinical) in the area where the risk was identified, to a more senior decision-maker,

(b) a requirement for any such decision-maker to seek and have regard to appropriate clinical advice, as necessary, in reaching a decision on the risk, including on how to mitigate it,

(c) a procedure for the onward reporting of the risk, as necessary, to a more senior decision-maker in turn, and a requirement for that decision-maker in turn to seek and have regard to appropriate clinical advice, as necessary, in reaching a decision on the risk, including on how to mitigate it,

(d) a requirement for the arrangements put in place under paragraph (c) to escalate further, as necessary, in order to reach a final decision on the risk, including in appropriate cases by the reporting of the risk to the members of the Health Board or the Agency (as the case may be),

(e) a procedure for the notification of every decision made following the initial report, and the reasons for it, to—

(i) any individual who was involved in identifying the risk in accordance with the arrangements put in place under section 12IC(2)(a),

(ii) any individual who was involved in attempting to mitigate the risk in accordance with the arrangements put in place under section 12IC(2)(c),

(iii) any individual who was involved in reporting the risk in accordance with the arrangements put in place under paragraph (a), (c) or (d) of this subsection, and

(iv) any individual who gave clinical advice in accordance with the arrangements put in place under section 12IC(2)(c), or under paragraph (b), (c) or (d) of this subsection,

(f) a procedure for those individuals to record any disagreement with any decision made following the initial report,

(g) a procedure for those individuals to be able to request a review of the final decision on a risk (other than a final decision made by the members of the Health Board or the Agency) made in accordance with the arrangements put in place under section 12IC(2)(c) or, as the case may be, paragraphs (b), (c) or (d) of this subsection,

(h) raising awareness among staff about the procedures described in paragraphs (a) to (g),

(i) training individuals with lead professional responsibility (whether clinical or non-clinical) for particular types of health care, and other senior decision-makers, in how to implement the arrangements put in place under paragraphs (a) to (h), and

(j) ensuring that such individuals receive adequate time and resources to implement those arrangements.

12IE

(1) It is the duty of every Health Board and the Agency to put and keep in place arrangements to—

(a) collate information relating to every risk escalated to such level as the Health Board or the Agency (as the case may be) consider appropriate in accordance with the arrangements put in place under section 12ID(2), and

(b) identify and address those risks which are considered to be either or both—

(i) severe,

(ii) liable to materialise frequently.

(2) The arrangements under subsection (1) must, in particular, include a procedure for—

(a) the recording of a risk as described in subsection (1)(b),

(b) the reporting of any such risk, as necessary, to a more senior decision-maker, including in appropriate cases to the members of the Health Board or the Agency (as the case may be),

(c) the mitigation of the risk, so far as possible, and a requirement for appropriate clinical advice to be sought and had regard to in carrying out such mitigation, and

(d) the identification of actions to prevent the future materialisation of the risk, so far as possible.

12IF

(1) It is the duty of every Health Board and the Agency to put and keep in place arrangements for—

(a) seeking and having regard to appropriate clinical advice in making decisions and putting in place arrangements in relation to staffing under sections 12IA to 12IE and 12IH to 12IL,

(b) recording and explaining decisions which conflict with that advice.

(2) The arrangements under subsection (1) must, in particular, include—

(a) where a Health Board or the Agency (as the case may be) reaches a decision on a matter which conflicts with the clinical advice it has received—

(i) a procedure for the identification of any risks caused by that decision,

(ii) a procedure for the mitigation of any such risks, so far as possible,

(iii) a procedure for the notification of any such decision, and the reasons for it, to any individual who gave clinical advice on the matter,

(iv) a procedure for any such individual to record any disagreement with the decision made on the matter,

(b) a procedure for individuals with lead clinical professional responsibility for a particular type of health care to report to the members of the Health Board or the Agency (as the case may be), on at least a quarterly basis, about the extent to which that individual considers that it is complying with the duties imposed by—

(i) this section, and

(ii) sections 12IA to 12IE and 12IH to 12IL,

(i) enable and encourage other employees to give views on the operation of this section, and

(ii) record such views in reports made in accordance with the arrangements put in place under paragraph (b),

(d) raising awareness among individuals with lead clinical professional responsibility for particular types of health care in how to implement the arrangements put in place under paragraphs (a) to (c), and

(e) ensuring that such individuals receive adequate time and resources to implement those arrangements.

(3) Every Health Board and the Agency must have regard to the reports received in accordance with the arrangements put in place under subsection (2)(b).

12IG

(1) The Scottish Ministers must take all reasonable steps to ensure that there is a sufficient number of—

(a) registered nurses,

(b) registered midwives,

(d) such other types of employees as the Scottish Ministers may by regulations prescribe,

available to every Health Board, relevant Special Health Board and the Agency to enable the Health Board and the Agency to comply with the duty in section 12IA.

(2) In fulfilling their obligations under subsection (1), the Scottish Ministers must have regard to—

(a) the number of people training for professions mentioned in or by virtue of subsection (1) in Scotland,

(b) any information as to variation in staffing needs caused by differences in the geographical areas for which Health Boards are responsible, for example in areas containing rural or island communities, and

(c) any information provided to them by a Health Board, relevant Special Health Board or the Agency about how it has carried out its duties under this Act.

(3) As soon as reasonably practicable after the end of each financial year, the Scottish Ministers must lay before the Parliament a report setting out—

(a) how they have complied with subsection (1), and

(b) the extent to which Ministers' compliance with subsection (1) enabled Health Boards, relevant Special Health Boards and the Agency to comply with the duty imposed by section 12IA.

12IH

In complying with the duty imposed by section 12IA, every Health Board and the Agency must ensure that all individuals with lead clinical professional responsibility for a team of staff receive sufficient time and resources to discharge that responsibility and their other professional duties, including, in particular, time—

(a) to supervise the meeting of the clinical needs of the patients in their care,

(b) to manage, and support the development of, the staff for whom they are responsible, and

12II

In complying with the duty imposed by section 12IA, every Health Board and the Agency must ensure that its employees receive—

(a) such training as it considers appropriate and relevant for the purposes set out in section 12IA(1)(a) and (b), and

(b) such time and resources as it considers adequate to undertake such training.

12IJ

(1) In relation to health care of a type mentioned in section 12IK, a Health Board or the Agency (as the case may be) must, no less often than at the frequency specified in regulations by the Scottish Ministers, use the common staffing method set out in subsection (2).

(2) The common staffing method means that a Health Board or the Agency (as the case may be)—

(a) uses the staffing level tool and the professional judgement tool as prescribed in regulations under subsection (3) and takes into account the results from those tools,

(b) takes into account, in so far as relevant, any measures for monitoring and improving the quality of health care which are published as standards and outcomes under section 10H(1) by the Scottish Ministers (including any measures developed as part of a national care assurance framework),

(i) its current staffing levels and any vacancies,

(ii) the different skills and levels of experience of its employees,

(iii) the role and professional duties, in particular, of any individual with lead clinical professional responsibility for the particular type of health care,

(iv) the effect that decisions about staffing and the use of resources taken for the particular type of health care may have on the provision of other types of health care including, in particular, those to which this section does not apply,

(v) the local context in which it provides health care,

(vi) patient needs,

(vii) appropriate clinical advice,

(viii) any assessment by HIS, and any relevant assessment by any other person, of the quality of health care which it provides,

(ix) experience gained from using the real-time assessment arrangements under section 12IC(1) and the risk escalation processes under sections 12ID and 12IE,

(x) comments by patients, and by individuals who have a personal interest in their health care (for example family members and carers within the meaning of section 1 of the Carers (Scotland) Act 2016), which relate to the duty imposed by section 12IA, and

(xi) comments by its employees which relate to the duty imposed by section 12IA,

(d) identifies and takes all reasonable steps to mitigate any risks, and

(e) having followed the steps described in paragraphs (a) to (d), decides what changes (if any) are needed as a result to its staffing establishment, and to the way in which it provides health care.

(3) The Scottish Ministers may by regulations prescribe—

(a) a “staffing level tool” designed to provide quantitative information relating to workload, based on patient needs, in order to assist in determining the appropriate staffing levels for a particular kind of health care provision, and

(b) a “professional judgement tool” designed to provide quantitative information relating to professional judgement in order to assist in determining the appropriate staffing levels for a particular kind of health care provision.

(4) For the purposes of this section, a reference to a Health Board's (or, as the case may be) the Agency's staffing establishment is a reference to the number of employees of a particular kind (or kinds) that the Board (or, as the case may be) the Agency have determined as being appropriate to deliver a type of health care mentioned in section 12IK.

(5) The Scottish Ministers may by regulations amend subsection (2) so as to change the description of the common staffing method.

12IK

(1) The types of health care are those described in the first column of the table below, in so far as they are provided at any one of the kinds of locations and by any one of the kinds of employees listed in the corresponding entries in the second and third columns.

Type of health care	Location	Employees
Adult inpatient provision	Hospital wards with 17 occupied beds or more on average	Registered nurses
Clinical nurse specialist provision	Hospitals	Registered nurses who work as clinical nurse specialists
Clinical nurse specialist provision	Community settings	Registered nurses who work as clinical nurse specialists
Community nursing provision	Community settings	Registered nurses
Community children's nursing provision	Community settings	Registered nurses
Emergency care provision	Emergency departments in hospitals	Registered nurses
Emergency care provision	Emergency departments in hospitals	Medical practitioners
Maternity provision	Hospitals	Registered midwives
Maternity provision	Community settings	Registered midwives
Mental health and learning disability provision	Mental health units in hospitals	Registered nurses
Mental health and learning disability provision	Learning disability units in hospitals	Registered nurses
Neonatal provision	Neonatal units in hospitals	Registered midwives
Neonatal provision	Neonatal units in hospitals	Registered nurses
Paediatric inpatient provision	Paediatric wards in hospitals	Registered nurses
Small ward provision	Hospital wards with 16 occupied beds or fewer on average	Registered nurses

(2) In the third column of the table in subsection (1), references to—

(a) registered nurses,

(b) registered midwives, and

include other individuals providing care for patients and acting under the supervision of, or discharging duties delegated to the individual by, the registered nurse, registered midwife or medical practitioner (as the case may be).

(3) But those references do not include individuals who are engaged in a course of studies in order to be admitted to—

(a) the register of members maintained by the Nursing and Midwifery Council under section 60 of the Health Act 1999, or

(b) the register of medical practitioners maintained by the General Medical Council under section 2 of the Medical Act 1983 (with the exception of persons who are already provisionally registered under section 15 of that Act).

(4) The Scottish Ministers may by regulations amend subsections (1) to (3) so as to add, remove, or change the description of a type of health care, including where and by whom it is provided (for example, so as to add to the third column of the table in subsection (1) employees of a kind included in the register of members maintained by the Health and Care Professions Council under section 60 of the Health Act 1999).

12IL

In complying with the duty imposed by section 12IJ, every Health Board and the Agency must—

(a) encourage and support its employees to give views on its staffing arrangements for the types of health care described in section 12IK,

(b) take into account and use any such views it receives to identify best practice, and areas for improvement, in relation to such staffing arrangements,

(c) train employees (including, in particular, employees of a type mentioned in the third column of the table in section 12IK(1)) using the common staffing method on how to use it,

(d) ensure that those employees receive adequate time to use the common staffing method, and

(e) provide information to employees engaged in the types of health care described in section 12IK about its use of the common staffing method, including about—

(i) the results from using the staffing level tool and the professional judgement tool under paragraph (a) of section 12IJ(2),

(ii) the steps taken under paragraphs (b), (c) and (d) of that subsection, and

(iii) the results of its decision under paragraph (e) of that subsection.

12IM

(1) Before the end of the period of 1 month beginning with the last day of each financial year, every Health Board and the Agency must publish, and submit to the Scottish Ministers, a report setting out how during that financial year it has carried out its duties under—

(a) section 12IA (including reference to the related duties under section 2 of the Health and Care (Staffing) (Scotland) Act 2019 to have regard to guiding principles etc. in health care staffing and planning),

(b) section 12IC,

(d) section 12IE,

(e) section 12IF,

(f) section 12IH,

(g) section 12II,

(h) section 12IJ, and

(i) section 12IL.

(2) Following the receipt of such reports from every Health Board and the Agency and before the beginning of the next financial year, the Scottish Ministers must—

(a) collate the reports submitted to them under subsection (1) into a combined report for the year to which the reports relate,

(b) lay that combined report before the Scottish Parliament, and

(c) lay an accompanying statement setting out how they have taken into account and plan to take into account, in their policies for the staffing of the health service, the information included in the combined report.

(3) Information provided under subsection (1) must set out—

(a) whether each Health Board or the Agency has faced any challenges or risk in carrying out its duties under—

(i) section 12IA (including reference to the related duties under section 2 of the Health and Care (Staffing) (Scotland) Act 2019 to have regard to guiding principles etc. in health care staffing and planning),

(ii) section 12IJ, and

(iii) section 12IL, and

(b) the steps the Health Board or the Agency will take to address such challenges.

(4) As soon as reasonably practicable after the end of each financial year, the Scottish Ministers must publish a report (in such manner as they consider appropriate) setting out how each Health Board and the Agency has carried out its duties under—

(a) section 12IA (including reference to the related duties under section 2 of the Health and Care (Staffing) (Scotland) Act 2019 to have regard to guiding principles etc. in health care staffing and planning),

(b) section 12IJ, and

(5) A report under subsection (4) must set out—

(a) whether the Scottish Ministers have identified any challenges or risk faced by the Health Board or the Agency in carrying out its duties under—

(i) section 12IA (including reference to the related duties under section 2 of the Health and Care (Staffing) (Scotland) Act 2019 to have regard to guiding principles etc. in health care staffing and planning),

(ii) section 12IJ, and

(iii) section 12IL, and

(b) the steps that the Scottish Ministers will take as a result.

(6) The Scottish Ministers must lay before the Parliament—

(a) a summary and evaluation of the information submitted to them under subsection (1), and

(b) a report under subsection (4).

12IN

(1) Every Health Board and the Agency must have regard to any guidance issued by the Scottish Ministers about the carrying out of its duties under sections 12IA to 12IM.

(2) Such guidance may, in particular, include provision about—

(a) the related duties under section 2 of the Health and Care (Staffing) (Scotland) Act 2019 to have regard to guiding principles etc. in health care staffing and planning, and

(b) the use of the common staffing method, including—

(i) each of the steps described in paragraphs (a) to (d) of section 12IJ(2), and

(ii) decision-making, under paragraph (e) of that subsection, about staffing establishments and about the way in which health care is provided, and

(c) procedures for the identification, mitigation and escalation of risks caused by staffing levels in arrangements put in place under sections 12IC to 12IE.

(3) Before issuing such guidance, the Scottish Ministers must consult—

(a) every Health Board,

(b) every relevant Special Health Board,

(c) every integration authority (within the meaning of section 59 of the Public Bodies (Joint Working) (Scotland) Act 2014),

(d) HIS,

(e) the Agency,

(f) such trade unions and professional bodies as they consider to be representative of employees of the persons mentioned in paragraphs (a) to (e),

(g) such professional regulatory bodies for employees of the persons mentioned in paragraphs (a) to (e) as they consider appropriate, and

(h) such other persons as they consider appropriate.

(4) The Scottish Ministers must publish any guidance issued under this section.

12IO

In sections 12H to 12IN—

“appropriate clinical advice” means advice obtained from the appropriate level and area of clinical professional structures depending on the particular circumstances of each case (for example from an individual holding a senior executive role in the provision of nursing services),

“employee” means an individual in paid employment by, as the case may be, a Health Board, the Agency or (where an integration scheme under Part 1 of the Public Bodies (Joint Working) (Scotland) Act 2014 applies) a local authority, whether under a contract of service or apprenticeship or under a contract for services,

“health care” means a service for or in connection with the prevention, diagnosis or treatment of illness,

“relevant Special Health Board” means a Special Health Board which is required, by virtue of an order made under section 2, to comply with any of the duties imposed by sections 12IA to 12IN.

HIS functions in relation to staffing

12IP

HIS must monitor the discharge, by every Health Board, relevant Special Health Board and the Agency, of their duties under—

(a) section 12IA (including the related duties under section 2 of the Health and Care (Staffing) (Scotland) Act 2019 to have regard to guiding principles etc. in health care staffing and planning),

(b) section 12IC,

(d) section 12IE,

(e) section 12IF,

(f) section 12IH,

(g) section 12II,

(h) section 12IJ,

(i) section 12IL,

(j) section 12IM, and

(k) section 12IN.

12IQ

(1) In respect of each type of health care mentioned in section 12IK, HIS must monitor—

(a) the effectiveness of the common staffing method described in section 12IJ(2), and

(b) the way in which Health Boards, relevant Special Health Boards and the Agency are using the common staffing method.

(2) In exercising the duty imposed by subsection (1), HIS must from time to time as it considers appropriate carry out reviews of the matters listed in subsection (1)(a) and (b).

(3) In carrying out such a review, HIS must—

(a) consult—

(i) the Scottish Ministers,

(ii) Social Care and Social Work Improvement Scotland,

(iii) every Health Board,

(iv) every relevant Special Health Board,

(v) every integration authority,

(vi) the Agency,

(vii) such trade unions and professional bodies as HIS considers to be representative of employees of the persons mentioned in sub-paragraphs (iii) to (vi),

(viii) such professional regulatory bodies for employees of the persons mentioned in sub-paragraphs (iii) to (vi) as HIS considers appropriate,

(ix) such other providers of health care as HIS considers to have relevant experience of using staffing level tools and professional judgement tools, and

(x) such other persons as HIS considers appropriate, and

(b) have regard to the guiding principles for health and care staffing set out in section 1 of the Health and Care (Staffing) (Scotland) Act 2019.

(4) The Scottish Ministers may direct HIS to carry out a review under subsection (2).

(5) Following a review under subsection (2), HIS may recommend changes to the common staffing method to the Scottish Ministers.

(6) Where HIS makes such recommendations it must submit to the Scottish Ministers, and then publish, a report setting out—

(a) a summary of the review it has carried out under subsection (2),

(b) its recommendations for changes to the common staffing method, and

(7) In recommending changes to the common staffing method, HIS may take into account the development of a new or revised staffing level tool or professional judgement tool under section 12IR(2).

12IR

(1) HIS must—

(a) monitor the effectiveness of any staffing level tool or professional judgement tool which has been prescribed by the Scottish Ministers under section 12IJ(3) (including any new or revised tools which have been developed under this section), and

(b) where it considers that any such tool is no longer effective, recommend the revocation or replacement of the tool to the Scottish Ministers.

(2) HIS may develop and recommend to the Scottish Ministers new or revised staffing level tools and professional judgement tools for use in relation to any kind of health care provision.

(3) In developing such tools, HIS must collaborate with—

(a) the Scottish Ministers,

(b) Social Care and Social Work Improvement Scotland,

(d) every relevant Special Health Board,

(e) every integration authority,

(f) the Agency,

(g) such trade unions and professional bodies as HIS considers to be representative of employees of the persons mentioned in paragraphs (c) to (f),

(h) such professional regulatory bodies for employees of the persons mentioned in paragraphs (c) to (f) as HIS considers appropriate,

(i) such other providers of health care as HIS considers to have relevant experience of using staffing level tools and professional judgement tools, and

(j) such other persons as HIS considers appropriate.

(4) In undertaking such collaboration—

(a) HIS must have regard to—

(i) such guidance, published by professional bodies of the kind described in subsection (3)(g) or by other bodies with experience in relevant fields, as HIS considers appropriate, and

(ii) relevant clinical evidence and research,

(b) HIS and the persons mentioned in subsection (3)(a) to (j) must have regard to the guiding principles for health and care staffing set out in section 1 of the Health and Care (Staffing) (Scotland) Act 2019.

(5) The Scottish Ministers may direct HIS to develop a new or revised staffing level tool or professional judgement tool for use in relation to a particular kind of health care provision specified in the direction.

(6) The Scottish Ministers may by regulations require that assumptions on certain matters (for example, as to staff absence and bed occupancy levels) must be made by HIS in the process of making a recommendation to them under subsection (2).

12IS

(1) When HIS is developing a new or revised staffing level tool or professional judgement tool under section 12IR, it must consider whether the tool should apply to more than one professional discipline.

(2) HIS may at any time recommend to the Scottish Ministers that a staffing level tool or professional judgement tool which has been prescribed by the Scottish Ministers under section 12IJ(3) should apply to more than one professional discipline.

12IT

Every Health Board, relevant Special Health Board and the Agency must give such assistance to HIS as it requires in the performance of its functions under sections 12IP to 12IS.

12IU

(1) HIS may, in pursuance of its functions under sections 12IP to 12IS, serve a notice on a Health Board, relevant Special Health Board or the Agency requiring the Board or the Agency (as the case may be)—

(a) to provide HIS with information about any matter specified in the notice, and

(b) to provide that information by a date specified in the notice.

(2) A notice under subsection (1) must explain why, and in pursuance of which function, the information is required.

(3) A Health Board, relevant Special Health Board or the Agency (as the case may be) must comply with any such notice served on it.

12IV

(1) The following persons must have regard to any guidance issued by the Scottish Ministers about the operation of sections 12IP to 12IU—

(a) HIS,

(b) every Health Board,

(d) the Agency.

(2) Before issuing such guidance, the Scottish Ministers must consult the persons listed in paragraphs (b) to (j) of section 12IR(3) (reading the references to HIS as if they were references to the Scottish Ministers).

(3) The Scottish Ministers must publish any guidance issued under this section.

12IW

In sections 12IP to 12IV—

“employee” has the meaning given by section 12IO,

“integration authority” has the meaning given by section 59 of the Public Bodies (Joint Working) (Scotland) Act 2014,

“relevant Special Health Board” has the meaning given by section 12IO,

“staffing level tool” and “professional judgement tool” are to be construed in accordance with section 12IJ(3).

[ Joint Liaison Committees.

Power to make payments towards expenditure on community services.

Financial assistance by the Secretary of State to voluntary organisations.

NHS contracts.

Personal medical or dental services.

Primary medical services: persons with whom agreements can be made

Health Boards' power to enter into general medical services contracts

Eligibility to be contractor under general medical services contract

Other mandatory contract terms

Assistance and support

Eligibility to be contractor under pharmaceutical care services contract

Assistance and support: primary medical services and pharmaceutical care services

Arrangements and regulations for general medical services.

Vacancies for medical practitioners.

Terms and conditions etc.

Conditional disqualification etc.

Sections 32A and 32B: procedure etc.

Sale of medical practices.

Prior authorisation for the purposes of section 75BA

Default powers.

Powers in case of service failure

Means of meeting expenditure of Health Boards out of public funds.

Accounts of Health Boards and the Agency.

Regulation of financial arrangements of Health Boards, the Agency and the Dental Estimates Board.

Payment of allowances and remuneration to members of certain bodies connected with the health services.

Application of certain provisions of the Parliamentary Commissioner Act 1967.

State hospitals.

Exemption from stamp duty.

Citation, extent and commencement.

Terms of office etc

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