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National Health Service (Wales) Act 2006

Type Public General Act

Publication 2006-11-08

Last updated 2026-03-28

State In force

Department Statute Law Database

Source legislation.gov.uk

articles Not indexed

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(a) where the cross-border Special Health Authority is exercising functions in relation to Wales only, of references to the Welsh Ministers and the Scottish Ministers acting jointly, and

(b) where the Authority is exercising functions in relation to England and Wales, of references to the Welsh Ministers and the Secretary of State acting concurrently with each other and jointly with the Scottish Ministers.

(5) In subsections (3) and (4), “cross-border Special Health Authority” means a Special Health Authority which is established under the National Health Service Act 2006 and the National Health Service (Wales) Act 2006 by virtue of—

(a) paragraph 1(2) of Schedule 2 to the National Health Service (Consequential Provisions) Act 2006, or

(b) the power under section 28 of the National Health Service Act 2006 and the power under section 22 of the National Health Service (Wales) Act 2006 being exercised together.

6BA

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6BB

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Orders, regulations and directions

2A

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Nursing services

25A

(1) Subsection (2) applies where a Local Health Board is considering the extent of provision of nursing services for its area necessary to meet all reasonable requirements.

(2) The Local Health Board must have regard to the importance of—

(a) providing sufficient nurses to allow the nurses time to care for patients sensitively, and

(b) where securing the provision of nursing services, ensuring that there are sufficient nurses to allow the nurses time to care for patients sensitively.

(3) Where an NHS Trust in Wales provides nursing services it must provide those services to such extent as it considers necessary to meet all reasonable requirements; and subsection (4) applies where an NHS Trust in Wales is considering the extent of provision of nursing services.

(4) The NHS Trust must have regard to the importance of—

(a) providing sufficient nurses to allow the nurses time to care for patients sensitively, and

(b) where securing the provision of nursing services, ensuring that there are sufficient nurses to allow the nurses time to care for patients sensitively.

(5) For the purposes of having regard to the importance of providing sufficient nurses to allow the nurses time to care for patients sensitively, a Local Health Board or NHS Trust in Wales must (among other things) undertake workforce planning (including planning the recruitment, retention, education and training of nurses).

(6) In this section, and in sections 25B to 25E, references to—

(a) a nurse providing care for patients include the provision of care by a person other than a nurse acting under the supervision of, or discharging duties delegated to the person by, a nurse;

(b) a “nurse” mean a registered nurse;

(c) an “NHS Trust in Wales” mean an NHS trust all or most of whose hospitals, establishments and facilities are situated in Wales.

Nurse staffing levels

25B

(1) Where a Local Health Board or NHS Trust in Wales provides nursing services in a situation to which this section applies, it must—

(a) designate a person or a description of person to calculate the number of nurses appropriate to provide care to patients that meets all reasonable requirements in that situation (the “nurse staffing level”),

(b) take all reasonable steps to maintain the nurse staffing level, and

(2) A person designated by virtue of subsection (1)(a) (“a designated person”) must calculate the nurse staffing level in accordance with section 25C.

(3) This section applies to the following situations—

(a) adult acute medical inpatient wards,

(b) adult acute surgical inpatient wards, and

25C

(1) When calculating a nurse staffing level, a designated person must—

(a) exercise professional judgement, and

(b) take into account each of the following—

(i) the average ratio of nurses to patients appropriate to provide care to patients that meets all reasonable requirements, estimated for a specified period using evidence-based workforce planning tools;

(ii) the extent to which patients' well-being is known to be particularly sensitive to the provision of care by a nurse.

(2) A designated person may calculate different nurse staffing levels—

(a) in relation to different periods of time;

(b) depending on the conditions in which care is provided by a nurse.

25D

(1) The Welsh Ministers must issue guidance about the duties under sections 25B and 25C and Local Health Boards and any NHS Trust to which those sections apply must have regard to the guidance.

(2) The guidance may set out, in particular, that when calculating a nurse staffing level a designated person should exercise professional judgement by taking the following into account—

(a) the qualifications, competencies, skills and experience of the nurses providing care to patients;

(b) the conditions in which care by a nurse is provided;

(i) the physical condition and layout of the ward or other situation in which the care is provided;

(ii) the turnover of patients receiving the care;

(d) services or care provided to patients by other health professionals or other staff (for example, health care support workers), and their qualifications, competencies, skills and experience;

(e) the extent to which the nurses providing care are required to undertake supervisory or administrative functions.

(3) The guidance may also make provision about workforce planning that Local Health Boards and NHS Trusts may undertake in order to enable them to comply with their duties under sections 25B and 25C.

(4) Before issuing guidance the Welsh Ministers must consult—

(a) Local Health Boards and any NHS Trust that is under a duty to have regard to the guidance,

(b) such organisations as appear to them to represent the interests of any—

(i) providers of care homes, or

(ii) providers of independent hospitals in Wales,

likely to be affected by the guidance,

(c) such organisations as appear to them to represent the interests of any other persons likely to be affected by the guidance, and

(d) such other persons likely to be affected by the guidance as they consider appropriate.

(5) For the purposes of subsection (4)—

“care home” means premises at which a care home service within the meaning given by paragraph 1 of Schedule 1 to the Regulation and Inspection of Social Care (Wales) Act 2016 (anaw 2) is provided, and

“independent hospital” has the meaning given in section 2 of the Care Standards Act 2000 (c.14).

25E

(1) Each Local Health Board and any NHS Trust to which the duty in section 25B applies must submit a nurse staffing levels report (whether or not as part of a wider report) in accordance with this section.

(2) A nurse staffing levels report must set out, in respect of the period to which the report relates (the “reporting period”)—

(a) the extent to which nurse staffing levels have been maintained;

(b) the impact the Board or Trust considers that not maintaining nurse staffing levels has had on care provided to patients by nurses, for example by reference to complaints about care provided to patients by nurses made in accordance with the Complaints Regulations or by reference to an increase in incidents of harm caused by—

(i) errors in administering medication to patients;

(ii) patients falling;

(iii) patients developing hospital-acquired pressure ulcers;

(3) Each nurse staffing levels report must be submitted to the Welsh Ministers no later than 30 days after the last day of the reporting period.

(4) The Welsh Ministers must, after the expiry of each reporting period—

(a) prepare and publish a document summarising the content of the nurse staffing levels reports submitted in respect of that reporting period, and

(b) lay each report submitted to them in that period before the National Assembly for Wales.

(5) For the purposes of this section the reporting period is—

(a) in the case of the initial reporting period, the period of three years beginning with the commencement of this section, and

(b) in the case of all subsequent reporting periods, the period of three years beginning with the day after the last day of the preceding reporting period.

(6) In subsection (2)(b) “Complaints Regulations” means regulations made under—

(a) section 113 of the Health and Social Care (Community Health and Standards) Act 2003 (c.43);

(b) the NHS Redress (Wales) Measure 2008 (nawm 1).

82A

(1) A Local Health Board must prepare and publish an assessment of needs for pharmaceutical services in its area.

(2) A Local Health Board must—

(a) keep the assessment most recently published by it under subsection (1) under review, and

(b) revise it as appropriate.

(3) Regulations must—

(a) specify a date by which a Local Health Board is to prepare and publish its first assessment under subsection (1);

(b) make provision about circumstances in which a Local Health Board is to review and if appropriate revise its assessment (and may make such provision by reference to, among other things, a period within which or following which a Local Health Board is to review and if appropriate revise its assessment);

(4) The regulations may make other provision about the preparation, publication, review and revision of an assessment under subsection (1), including (among other things) about—

(a) the information to be contained in an assessment (which may include, among other things, information relating to persons with whom a Local Health Board has entered into a general medical services contract);

(b) the extent to which an assessment is to take account of likely future needs and of other matters;

(d) procedural requirements.

Welsh Ministers' duty to secure quality in health services

1A

(1) The Welsh Ministers must exercise their functions in relation to the health service with a view to securing improvement in the quality of health services.

(2) For the purposes of this section—

“health services” means any services provided or secured in accordance with this Act;

“quality” includes, but is not limited to, quality in terms of—the effectiveness of health services,the safety of health services, andthe experience of individuals to whom health services are provided.

(3) The Welsh Ministers must publish an annual report on the steps they have taken to comply with the duty in subsection (1).

(4) The report must include an assessment of the extent of any improvement in outcomes achieved by virtue of those steps.

(5) The Welsh Ministers must lay a copy of the report before the National Assembly for Wales.

12A

(1) Each Local Health Board must exercise its functions with a view to securing improvement in the quality of health services.

(2) For the purposes of this section—

“health services” means any services provided or secured in accordance with this Act;

“quality” includes, but is not limited to, quality in terms of—the effectiveness of health services,the safety of health services, andthe experience of individuals to whom health services are provided.

(3) Each Local Health Board must publish an annual report on the steps it has taken to comply with the duty in subsection (1).

(4) The report must include an assessment of the extent of any improvement in outcomes achieved by virtue of those steps.

(5) The Welsh Ministers must issue guidance to Local Health Boards in relation to the requirements imposed by subsections (1) and (3).

(6) The guidance must, in particular, include guidance about—

(a) the evidence to be used in support of an assessment required by this section, and

(b) the conduct of such an assessment.

(7) Each Local Health Board must have regard to guidance issued under subsection (5).

20A

(1) Each NHS trust must exercise its functions with a view to securing improvement in the quality of health services.

(2) For the purposes of this section—

“health services” means any services provided or secured in accordance with this Act;

“quality” includes, but is not limited to, quality in terms of—the effectiveness of health services,the safety of health services, andthe experience of individuals to whom health services are provided.

(3) Each NHS trust must publish an annual report on the steps it has taken to comply with the duty in subsection (1).

(4) The report must include an assessment of the extent of any improvement in outcomes achieved by virtue of those steps.

(5) The Welsh Ministers must issue guidance to NHS trusts in relation to the requirements imposed by subsections (1) and (3).

(6) The guidance must, in particular, include guidance about—

(a) the evidence to be used in support of an assessment required by this section, and

(b) the conduct of such an assessment.

(7) Each NHS trust must have regard to guidance issued under subsection (5).

24A

(1) Each Special Health Authority must exercise its functions with a view to securing improvement in the quality of health services.

(2) For the purposes of this section—

“health services” means any services provided or secured in accordance with this Act;

“quality” includes, but is not limited to, quality in terms of—the effectiveness of health services,the safety of health services, andthe experience of individuals to whom health services are provided.

(3) Each Special Health Authority must publish an annual report on the steps it has taken to comply with the duty in subsection (1).

(4) The report must include an assessment of the extent of any improvement in outcomes achieved by virtue of those steps.

(5) The Welsh Ministers must issue guidance to Special Health Authorities in relation to the requirements imposed by subsections (1) and (3).

(6) The guidance must, in particular, include guidance about—

(a) the evidence to be used in support of an assessment required by this section, and

(b) the conduct of such an assessment.

(7) Each Special Health Authority must have regard to guidance issued under subsection (5).

(8) This section does not apply in relation to a cross-border Special Health Authority (within the meaning of section 8A(5)).

Inadequate provision of pharmaceutical services

Special trustees for a university or teaching hospital

Conditional inclusion in ophthalmic and pharmaceutical lists

Procurement

10A

(1) The Welsh Ministers may, by regulations, make provision in relation to the processes to be followed and objectives to be pursued by relevant authorities in the procurement of—

(a) services provided as part of the health service in Wales (“health services”), and

(b) goods or other services that are connected to those health services.

(2) Regulations under subsection (1) must include provision specifying steps to be taken when following a competitive tendering process.

(3) Regulations under subsection (1) must, in relation to the procurement of the services or goods to which they apply, make provision for the purposes of—

(a) ensuring transparency;

(b) ensuring fairness;

(d) managing conflicts of interest.

(4) Before making regulations under subsection (1), the Welsh Ministers must carry out such consultation as they consider appropriate and publish a summary of the responses they receive.

(5) Explanatory material accompanying regulations made under subsection (1) must set out how the regulations make provision for the purposes of subsection (3).

(6) The Welsh Ministers must publish such guidance as they consider appropriate about compliance with the regulations.

(7) A relevant authority must have regard to guidance published under this section.

(8) The Welsh Ministers must—

(a) review the operation of the regulations, and

(b) publish the conclusions of the review before the end of the period of 5 years beginning with the day on which the regulations come into force.

(9) In this section “relevant authority” means—

(a) a county council or county borough council in Wales;

(b) a local health board established under section 11;

(d) a special health authority established under section 22.

Direct payments for health care

10B

(1) The Welsh Ministers may, for the purpose of securing the provision to a patient of anything to which subsection (3) applies, make payments to the patient or to a person nominated by the patient.

(2) Subsection (1) is subject to any provision made by regulations under section 10C.

(3) This subsection applies to—

(a) anything that the Welsh Ministers may or must provide under section 2(1) or 3(1);

(b) anything for which the Welsh Ministers must arrange under paragraph 8 of Schedule 1;

(d) anything the Welsh Ministers may provide under paragraph 10 of Schedule 1 (including anything for which a grant may be made under paragraph 10(3) of Schedule 1).

(4) Payments may not be made under subsection (1) unless the patient consents to the making of the payments, subject to any provision made by regulations under section 10C in respect of a patient who lacks capacity or is a child.

(5) Where the Welsh Ministers make payments under subsection (1), they must, having regard to the purposes for which the payments are made, make arrangements for the provision to the patient, payee or their representative of such information, advice or other support, as the Welsh Ministers consider appropriate.

(6) Regulations may provide that a Local Health Board may, for the purpose of securing the provision to a patient of after-care services that a Local Health Board must provide under section 117 of the Mental Health Act 1983 (c. 20), make payments to the patient or to a person nominated by the patient.

(7) Regulations under subsection (6) must—

(a) provide that payments under the regulations cannot be made unless the patient consents to the making of the payments, subject to any provision made by regulations under section 10C in respect of a patient who lacks capacity or is a child;

(b) make provision in respect of information, advice or other support to be provided by a Local Health Board to patients, payees or their representatives in connection with the payments.

(8) In section 10C and section 10D, “direct payments” means payments made under subsection (1) or under regulations made under subsection (6).

(9) In this section and section 10C—

(a) “child” means a person who has not attained the age of 16;

(b) references to a person lacking capacity are references to a person lacking capacity within the meaning of the Mental Capacity Act 2005 (c. 9).

10C

(1) Regulations may make provision about direct payments.

(2) The regulations may, in particular, make provision about—

(a) the circumstances in which, and descriptions of persons and services in respect of which, direct payments may, must or must not be made;

(b) the circumstances in which direct payments may, must or must not be made to a person nominated by the patient;

(c) the making of direct payments (and, in particular, as to persons to whom payments may or must be made) if the patient lacks capacity to consent to the making of the payments or is a child;

(d) matters to which the Welsh Ministers or a Local Health Board may or must have regard when making a decision about direct payments;

(e) conditions that the Welsh Ministers or a Local Health Board may, must or must not attach in relation to direct payments;

(f) the steps that the Welsh Ministers or a Local Health Board may or must take before, or after, making a decision about direct payments;

(g) the conditions that the patient or (if different) the payee may or must be required to comply with before, after, or at the time when a direct payment is made;

(h) the amount of any direct payment or how it is to be calculated;

(i) the circumstances in which the Welsh Ministers or a Local Health Board may or must stop making direct payments;

(j) the circumstances in which the Welsh Ministers or a Local Health Board may or must require all or part of a direct payment to be repaid by the patient or (if different) the payee, or otherwise;

(k) the monitoring of the making of direct payments, of their use by the patient or (if different) the payee, or of services which they are used to secure;

(l) the review of decisions as to whether a direct payment should be made;

(m) the arrangements to be made by the Welsh Ministers or Local Health Board for providing patients, payees or their representatives with information, advice or other support in connection with direct payments;

(n) the extent to which such support is to be treated as a service in respect of which direct payments may be made.

(3) If the regulations make provision about persons who lack capacity to consent to the making of direct payments, the regulations may also make provision about the cases or circumstances where a person who has lacked that capacity but no longer does so (whether because of fluctuating capacity or regaining or gaining capacity).

(4) The regulations may provide for a sum that must be repaid to the Welsh Ministers or Local Health Board (as the case may be) by virtue of a condition or other requirement imposed by or under the regulations to be recoverable as a debt due to the Welsh Ministers or Local Health Board (as the case may be).

(5) The regulations may make provision—

(a) for a service in respect of which a direct payment has been made under section 10B(1) to be regarded as provided or arranged for by the Welsh Ministers under an enactment mentioned in section 10B(3), only to such extent and subject to such conditions as the regulations may specify;

(b) displacing functions or obligations of a Local Health Board with respect to the provision of after-care services under section 117 of the Mental Health Act 1983 (c. 20), only to such extent and subject to such conditions as the regulations may prescribe.

(6) In this section, “service” includes anything in respect of which direct payments may be made.

10D

(1) The Welsh Ministers or a Local Health Board may arrange with any person or body to provide assistance in connection with direct payments.

(2) Arrangements may be made under subsection (1) with voluntary organisations.

(3) Powers under this section may be exercised on such terms as may be agreed, including terms as to the making of payments by or to the Welsh Ministers or the Local Health Board.

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