Health and Social Care Act 2012

PART 1 — The health service in England

The health service: overview

Sections 174 to 177: supplementary

1

For section 1 of the National Health Service Act 2006 (Secretary of State's duty to promote health service) substitute—

(1) (1) The Secretary of State must continue the promotion in England of a comprehensive health service designed to secure improvement— (a) in the physical and mental health of the people of England, and (b) in the prevention, diagnosis and treatment of physical and mental illness. (2) For that purpose, the Secretary of State must exercise the functions conferred by this Act so as to secure that services are provided in accordance with this Act. (3) The Secretary of State retains ministerial responsibility to Parliament for the provision of the health service in England. (4) The services provided as part of the health service in England must be free of charge except in so far as the making and recovery of charges is expressly provided for by or under any enactment, whenever passed.

Financial provision

2

After section 1 of the National Health Service Act 2006 insert—

(1A) (1) The Secretary of State must exercise the functions of the Secretary of State in relation to the health service with a view to securing continuous improvement in the quality of services provided to individuals for or in connection with— (a) the prevention, diagnosis or treatment of illness, or (b) the protection or improvement of public health. (2) In discharging the duty under subsection (1) the Secretary of State must, in particular, act with a view to securing continuous improvement in the outcomes that are achieved from the provision of the services. (3) The outcomes relevant for the purposes of subsection (2) include, in particular, outcomes which show— (a) the effectiveness of the services, (b) the safety of the services, and (c) the quality of the experience undergone by patients. (4) In discharging the duty under subsection (1), the Secretary of State must have regard to the quality standards prepared by NICE under section 234 of the Health and Social Care Act 2012.

The Secretary of State’s duty as to the NHS Constitution

3

After section 1A of the National Health Service Act 2006 insert—

(1B) (1) In exercising functions in relation to the health service, the Secretary of State must have regard to the NHS Constitution. (2) In this Act, “NHS Constitution” has the same meaning as in Chapter 1 of Part 1 of the Health Act 2009 (see section 1 of that Act).

The Secretary of State’s duty as to reducing inequalities

4

After section 1B of the National Health Service Act 2006 insert—

(1C) In exercising functions in relation to the health service, the Secretary of State must have regard to the need to reduce inequalities between the people of England with respect to the benefits that they can obtain from the health service.

The Secretary of State’s duty as to promoting autonomy

5

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

The Secretary of State’s duty as to research

6

After section 1D of the National Health Service Act 2006 insert—

(1E) In exercising functions in relation to the health service, the Secretary of State must promote— (a) research on matters relevant to the health service, and (b) the use in the health service of evidence obtained from research.

The Secretary of State’s duty as to education and training

7

After section 1E of the National Health Service Act 2006 insert—

(1F) (1) The Secretary of State must exercise the functions of the Secretary of State under any relevant enactment so as to secure that there is an effective system for the planning and delivery of education and training to persons who are employed, or who are considering becoming employed, in an activity which involves or is connected with the provision of services as part of the health service in England. (2) Any arrangements made with a person under this Act for the provision of services as part of that health service must include arrangements for securing that the person co-operates with the Secretary of State in the discharge of the duty under subsection (1) (or, where a Special Health Authority is discharging that duty by virtue of a direction under section 7, with the Special Health Authority). (3) In subsection (1), “relevant enactment” means— (a) section 63 of the Health Services and Public Health Act 1968, (b) this Act, (c) the Health and Social Care Act 2008, (d) the Health Act 2009, and (e) the Health and Social Care Act 2012.

Secretary of State’s duty as to reporting on and reviewing treatment of providers

8

After section 1F of the National Health Service Act 2006 insert—

(1G) (1) The Secretary of State must, within one year of the passing of the Health and Social Care Act 2012, lay a report before Parliament on the treatment of NHS health care providers as respects any matter, including taxation, which might affect their ability to provide health care services for the purposes of the NHS or the reward available to them for doing so. (2) The report must include recommendations as to how any differences in the treatment of NHS health care providers identified in the report could be addressed. (3) The Secretary of State must keep under review the treatment of NHS health care providers as respects any such matter as is mentioned in subsection (1). (4) In this section— (a) “NHS health care providers” means persons providing or intending to provide health care services for the purposes of the NHS, and (b) “health care services for the purposes of the NHS” has the same meaning as in Part 3 of the Health and Social Care Act 2012.

The NHS Commissioning Board

9

• (1) After section 1G of the National Health Service Act 2006 insert—

(1H) (1) There is to be a body corporate known as the National Health Service Commissioning Board (“the Board”). (2) The Board is subject to the duty under section 1(1) concurrently with the Secretary of State except in relation to the part of the health service that is provided in pursuance of the public health functions of the Secretary of State or local authorities. (3) For the purpose of discharging that duty, the Board— (a) has the function of arranging for the provision of services for the purposes of the health service in England in accordance with this Act, and (b) must exercise the functions conferred on it by this Act in relation to clinical commissioning groups so as to secure that services are provided for those purposes in accordance with this Act. (4) Schedule A1 makes further provision about the Board. (5) In this Act— (a) any reference to the public health functions of the Secretary of State is a reference to the functions of the Secretary of State under sections 2A and 2B and paragraphs 7C, 8 and 12 of Schedule 1, and (b) any reference to the public health functions of local authorities is a reference to the functions of local authorities under sections 2B and 111 and paragraphs 1 to 7B and 13 of Schedule 1.

• (2) Before Schedule 1 to that Act, insert the Schedule set out in Schedule 1 to this Act.

Clinical commissioning groups

10

After section 1H of the National Health Service Act 2006 insert—

(1I) (1) There are to be bodies corporate known as clinical commissioning groups established in accordance with Chapter A2 of Part 2. (2) Each clinical commissioning group has the function of arranging for the provision of services for the purposes of the health service in England in accordance with this Act.

Arrangements for provision of health services

The Secretary of State’s duty as to protection of public health

11

After section 2 of the National Health Service Act 2006 insert—

(2A) (1) The Secretary of State must take such steps as the Secretary of State considers appropriate for the purpose of protecting the public in England from disease or other dangers to health. (2) The steps that may be taken under subsection (1) include— (a) the conduct of research or such other steps as the Secretary of State considers appropriate for advancing knowledge and understanding; (b) providing microbiological or other technical services (whether in laboratories or otherwise); (c) providing vaccination, immunisation or screening services; (d) providing other services or facilities for the prevention, diagnosis or treatment of illness; (e) providing training; (f) providing information and advice; (g) making available the services of any person or any facilities. (3) Subsection (4) applies in relation to any function under this section which relates to— (a) the protection of the public from ionising or non-ionising radiation, and (b) a matter in respect of which the Health and Safety Executive has a function. (4) In exercising the function, the Secretary of State must— (a) consult the Health and Safety Executive, and (b) have regard to its policies.

Duties as to improvement of public health

12

After section 2A of the National Health Service Act 2006 insert—

(2B) (1) Each local authority must take such steps as it considers appropriate for improving the health of the people in its area. (2) The Secretary of State may take such steps as the Secretary of State considers appropriate for improving the health of the people of England. (3) The steps that may be taken under subsection (1) or (2) include— (a) providing information and advice; (b) providing services or facilities designed to promote healthy living (whether by helping individuals to address behaviour that is detrimental to health or in any other way); (c) providing services or facilities for the prevention, diagnosis or treatment of illness; (d) providing financial incentives to encourage individuals to adopt healthier lifestyles; (e) providing assistance (including financial assistance) to help individuals to minimise any risks to health arising from their accommodation or environment; (f) providing or participating in the provision of training for persons working or seeking to work in the field of health improvement; (g) making available the services of any person or any facilities. (4) The steps that may be taken under subsection (1) also include providing grants or loans (on such terms as the local authority considers appropriate). (5) In this section, “local authority” means— (a) a county council in England; (b) a district council in England, other than a council for a district in a county for which there is a county council; (c) a London borough council; (d) the Council of the Isles of Scilly; (e) the Common Council of the City of London.

Duties of clinical commissioning groups as to commissioning certain health services

13

• (1) Section 3 of the National Health Service Act 2006 is amended as follows.

• (2) In subsection (1)—

• (a) for the words from the beginning to “reasonable requirements” substitute “A clinical commissioning group must arrange for the provision of the following to such extent as it considers necessary to meet the reasonable requirements of the persons for whom it has responsibility”, and

• (b) in each of paragraphs (d) and (e) for the words “as he considers” substitute “as the group considers”.

• (3) After that subsection insert—

(1A) For the purposes of this section, a clinical commissioning group has responsibility for— (a) persons who are provided with primary medical services by a member of the group, and (b) persons who usually reside in the group's area and are not provided with primary medical services by a member of any clinical commissioning group. (1B) Regulations may provide that for the purposes of this section a clinical commissioning group also has responsibility (whether generally or in relation to a prescribed service or facility) for persons who— (a) were provided with primary medical services by a person who is or was a member of the group, or (b) have a prescribed connection with the group's area. (1C) The power conferred by subsection (1B)(b) must be exercised so as to provide that, in relation to the provision of services or facilities for emergency care, a clinical commissioning group has responsibility for every person present in its area. (1D) Regulations may provide that subsection (1A) does not apply— (a) in relation to persons of a prescribed description (which may include a description framed by reference to the primary medical services with which the persons are provided); (b) in prescribed circumstances. (1E) The duty in subsection (1) does not apply in relation to a service or facility if the Board has a duty to arrange for its provision.

• (4) After subsection (1E) insert—

(1F) In exercising its functions under this section and section 3A, a clinical commissioning group must act consistently with— (a) the discharge by the Secretary of State and the Board of their duty under section 1(1) (duty to promote a comprehensive health service), and (b) the objectives and requirements for the time being specified in the mandate published under section 13A.

• (5) Omit subsections (2) and (3).

• (6) For the heading to section 3 substitute “Duties of clinical commissioning groups as to commissioning certain health services”.

• (7) For the cross-heading preceding section 3 substitute “Arrangements for the provision of certain health services”.

• (8) In section 272 of that Act (orders, regulations, rules and directions), in subsection (6) before paragraph (za) insert—

(zza) regulations under section 3(1D),

.

Power of clinical commissioning groups as to commissioning certain health services

14

After section 3 of the National Health Service Act 2006 insert—

(3A) (1) Each clinical commissioning group may arrange for the provision of such services or facilities as it considers appropriate for the purposes of the health service that relate to securing improvement— (a) in the physical and mental health of the persons for whom it has responsibility, or (b) in the prevention, diagnosis and treatment of illness in those persons. (2) A clinical commissioning group may not arrange for the provision of a service or facility under subsection (1) if the Board has a duty to arrange for its provision by virtue of section 3B or 4. (3) Subsections (1A), (1B) and (1D) of section 3 apply for the purposes of this section as they apply for the purposes of that section.

Power to require Board to commission certain health services

15

After section 3A of the National Health Service Act 2006 insert—

(3B) (1) Regulations may require the Board to arrange, to such extent as it considers necessary to meet all reasonable requirements, for the provision as part of the health service of— (a) dental services of a prescribed description; (b) services or facilities for members of the armed forces or their families; (c) services or facilities for persons who are detained in a prison or in other accommodation of a prescribed description; (d) such other services or facilities as may be prescribed. (2) A service or facility may be prescribed under subsection (1)(d) only if the Secretary of State considers that it would be appropriate for the Board (rather than clinical commissioning groups) to arrange for its provision as part of the health service. (3) In deciding whether it would be so appropriate, the Secretary of State must have regard to— (a) the number of individuals who require the provision of the service or facility; (b) the cost of providing the service or facility; (c) the number of persons able to provide the service or facility; (d) the financial implications for clinical commissioning groups if they were required to arrange for the provision of the service or facility. (4) Before deciding whether to make regulations under this section, the Secretary of State must— (a) obtain advice appropriate for that purpose, and (b) consult the Board. (5) The reference in subsection (1)(b) to members of the armed forces is a reference to persons who are members of— (a) the regular forces within the meaning of the Armed Forces Act 2006, or (b) the reserve forces within the meaning of that Act.

Secure psychiatric services

16

• (1) Section 4 of the National Health Service Act 2006 (high security psychiatric services) is amended as follows.

• (2) In subsection (1) for the words from the beginning to “duty to provide” substitute “The Board must arrange for the provision of”.

• (3) In subsection (3)—

• (a) after “may be provided” insert

— (a)

, and

• (b) after paragraph (a) insert

, and (b) only by a person approved by the Secretary of State for the purposes of this subsection.

• (4) After subsection (3) insert—

(3A) The Secretary of State may— (a) give directions to a person who provides high security psychiatric services about the provision by that person of those services; (b) give directions to the Board about the exercise of its functions in relation to high security psychiatric services.

Other services etc. provided as part of the health service

17

• (1) In section 5 of the National Health Service Act 2006 (other services) for “about the Secretary of State and services under this Act” substitute “about the provision of services for the purposes of the health service in England”.

• (2) Schedule 1 to that Act is amended as follows.

• (3) In paragraph 1 (medical inspection of pupils)—

• (a) for “The Secretary of State” substitute “A local authority”, and

• (b) for “local authorities” substitute “the local authority”.

• (4) In paragraph 2—

• (a) in sub-paragraph (1)—

• (i) for “The Secretary of State” substitute “A local authority”, and

• (ii) omit “, by arrangement with any local authority,”,

• (b) in sub-paragraph (2)—

• (i) for “The Secretary of State” substitute “A local authority”,

• (ii) after “educational establishment” insert “in its area”, and

• (iii) for “a local authority” substitute “the local authority”, and

• (c) omit sub-paragraph (3).

• (5) In paragraph 4—

• (a) for “A local authority may not make an arrangement” substitute “A local authority may not provide for any medical inspection or treatment”, and