Office of Public Sector Information
PART I continued
(1) For sections 43A and 43B of the 1977 Act (regulations as to Part II remuneration) there is substituted—
(1) The remuneration to be paid to persons who provide general medical services, general dental services, general ophthalmic services or pharmaceutical services under this Part of this Act shall be determined by determining authorities (and they may also determine the remuneration to be paid to persons providing those services in respect of the instruction of any person in matters relating to those services).
(2) For the purposes of this section and section 43B below determining authorities are—
(a) the Secretary of State, and
(b) so far as authorised by him to exercise the functions of determining authorities, any Health Authority or other person appointed by him in an instrument (referred to in this section and section 43B below as an instrument of appointment).
(3) An instrument of appointment—
(a) may contain requirements with which a determining authority appointed by that instrument must comply in making determinations, and
(b) may be contained in regulations.
(4) Subject to this section and section 43B below, regulations may make provision about determining remuneration under subsection (1) above and may in particular impose requirements with which determining authorities must comply in making, or in connection with, determinations (including requirements as to consultation and publication).
(5) Regulations may provide—
(a) that determinations may be made by reference to any of the following—
(i) rates or conditions of remuneration of any persons or any descriptions of persons which are fixed or determined, or to be fixed or determined, otherwise than by way of a determination under subsection (1) above,
(ii) scales, indices or other data of any description specified in the regulations,
(b) that any determination which in accordance with regulations made by virtue of paragraph (a)(ii) above falls to be made by reference to a scale or an index or to any other data may be made not only by reference to that scale or index or those data in the form current at the time of the determination but also by reference to the scale, index or data in any subsequent form attributable to amendment or revision taking effect after that time or to any other cause.
(6) Regulations may—
(a) provide that determining authorities may make determinations which have effect in relation to remuneration in respect of a period beginning on or after a date specified in the determination, which may be the date of the determination or an earlier or later date, but may be an earlier date only if, taking the determination as a whole, it is not detrimental to the persons to whose remuneration it relates,
(b) provide that any determination which does not specify such a date shall have effect in relation to remuneration in respect of a period beginning—
(i) if it is required to be published, on the date of publication,
(ii) if it is not so required, on the date on which it is made.
(7) A reference in this section or section 43B below to a determination is to a determination of remuneration under subsection (1) of this section.
(1) Before a determination is made by the Secretary of State which relates to all persons who provide services of, or of a category falling within, one of the descriptions of services mentioned in section 43A(1) above, he—
(a) shall consult a body appearing to him to be representative of persons to whose remuneration the determination would relate, and
(b) may consult such other persons as he considers appropriate.
(2) Determinations may make different provision for different cases including different provision for any particular case, class of case or area.
(3) Determinations may—
(a) be made in more than one stage,
(b) be made by more than one determining authority,
(c) be varied or revoked by subsequent determinations.
(4) A determination may be varied—
(a) to correct an error, or
(b) where it appears to the determining authority that it was made in ignorance of or under a mistake as to a relevant fact.
(5) Determinations may, in particular, provide that the whole or any part of the remuneration—
(a) is payable only if the determining authority is satisfied as to certain conditions, or
(b) is to be applied for certain purposes or is otherwise subject to certain conditions.
(6) Subject to sections 29(4) and 35(2) above, remuneration under section 43A above may consist of payments by way of—
(a) salary,
(b) fees,
(c) allowances,
(d) reimbursement (in full or in part) of expenses incurred or expected to be incurred in connection with the provision of the services or instruction,
and may be determined from time to time.
(7) At the time a determination is made or varied, certain matters which require determining may be reserved to be decided at a later time.
(8) The matters which may be reserved include in particular—
(a) the amount of remuneration to be paid in particular cases,
(b) whether any remuneration is to be paid in particular cases.
(9) Any determination shall be made after taking into account all the matters which are considered to be relevant by the determining authority and such matters may include in particular—
(a) the amount or estimated amount of expenses (taking into account any discounts) incurred in the past or likely to be incurred in the future (whether or not by persons to whose remuneration the determination will relate) in connection with the provision of services of the description in section 43A(1) above to which the determination will relate or of any category falling within that description,
(b) the amount or estimated amount of any remuneration paid or likely to be paid to persons providing such services,
(c) the amount or estimated amount of any other payments or repayments or other benefits received or likely to be received by any such persons,
(d) the extent to which it is desirable to encourage the provision, either generally or in particular places, of the description or category of services to which the determination will relate,
(e) the desirability of promoting services which are—
(i) economic and efficient, and
(ii) of an appropriate standard.
(10) If the determination is of remuneration for a category of services falling within one of the descriptions of services mentioned in section 43A(1) above, the reference in subsection (9)(a) above to a category of services is a reference to the same category of services or to any other category of services falling within the same description.”
(2) Sections 43A and 43B of the 1977 Act, as substituted by this section, have effect in relation to—
(a) the making of determinations on or after the commencement of this section, and
(b) the variation or revocation on or after the commencement of this section of determinations whenever made,
and in this subsection “determinations” means determinations under Part II of the 1977 Act of the remuneration to be paid to persons who provide services mentioned in section 43A(1).
(3) Section 7(4) of the [1984 c. 48.] Health and Social Security Act 1984 and section 15(3) of the [1988 c. 49.] Health and Medicines Act 1988 (determinations of remuneration for services under Part II of 1977 Act deemed to be valid) have effect in relation to England and Wales as if—
(a) after “inserted by this section” in section 7(4)(b) of the 1984 Act, and
(b) after “section 7 of the Health and Social Security Act 1984” in section 15(3) of the 1988 Act,
there were inserted “and before the coming into force of section 10 of the [1999 c. 8.] Health Act 1999”.
(1) Section 44 of the 1977 Act (recognition of local representative committees) is amended as provided in subsections (2) to (4).
(2) Before subsection (1) there is inserted—
“(A1) A Health Authority may recognise a committee formed for their area which they are satisfied is representative of—
(a) the medical practitioners providing general medical services or general ophthalmic services in that area;
(b) those medical practitioners and the deputy medical practitioners for that area; or
(c) the medical practitioners mentioned in—
(i) paragraph (a) above; or
(ii) paragraph (b) above,
and the section 28C medical practitioners for that area,
and any committee so recognised shall be called the Local Medical Committee for the area.
(B1) A Health Authority may recognise a committee formed for their area which they are satisfied is representative of—
(a) the dental practitioners providing general dental services in that area;
(b) those dental practitioners and the deputy dental practitioners for that area; or
(c) the dental practitioners mentioned in—
(i) paragraph (a) above; or
(ii) paragraph (b) above,
and the section 28C dental practitioners for that area,
and any committee so recognised shall be called the Local Dental Committee for the area.”
(3) In subsection (1), paragraphs (a) and (b) and “the Local Medical Committee, the Local Dental Committee,” are omitted.
(4) After subsection (2) there is inserted—
“(3) For the purposes of this section and section 45 below, a person who meets the condition in subsection (4) below—
(a) is a deputy medical practitioner for the area of a Health Authority if he is a medical practitioner who assists a medical practitioner providing general medical services in that area in the provision of those services but is not himself on a list;
(b) is a section 28C medical practitioner for the area of a Health Authority if he is a medical practitioner who provides or performs personal medical services in accordance with arrangements made under section 28C above by the Health Authority (whether with himself or another);
(c) is a deputy dental practitioner for the area of a Health Authority if he is a dental practitioner who assists a dental practitioner providing general dental services in that area in the provision of those services but is not himself on a list;
(d) is a section 28C dental practitioner for the area of a Health Authority if he is a dental practitioner who provides or performs personal dental services in accordance with arrangements made under section 28C above by the Health Authority (whether with himself or another).
(4) The condition referred to in subsection (3) above is that the person concerned has notified the Health Authority that he wishes to be represented under this section by the appropriate committee for their area (and has not notified them that he wishes to cease to be so represented).
(5) For the purposes of subsection (3) above—
(a) a person is to be treated as assisting a medical practitioner or dental practitioner in the provision of services if he is employed by that practitioner for that purpose or if he acts as his deputy in providing those services; and
(b) “list” has the same meaning as in section 46 below.”
(5) Section 45 of that Act (functions of local representative committees) is amended as provided in subsections (6) to (8).
(6) For subsection (1) there is substituted—
“(1) Regulations may require Health Authorities—
(a) in the exercise of their functions under this Part of this Act to consult committees recognised by them under section 44 above,
(b) in the exercise of any of their functions which relate to arrangements under section 28C above to consult committees recognised by them under section 44(A1)(c) or (B1)(c) above,
on such occasions and to such extent as may be prescribed.
(1A) The power conferred by subsection (1) above is without prejudice to any other power to require a Health Authority to consult any committee recognised under section 44 above.
(1B) Committees recognised under section 44 above shall exercise such other functions as may be prescribed.
(1C) A committee recognised for an area under subsection (A1)(b) or (c) or (B1)(b) or (c) of section 44 above shall, in respect of each year, determine the amount of its administrative expenses for that year attributable —
(a) in the case of a committee recognised under subsection (A1)(b) or (c)(ii) of that section, to the deputy medical practitioners for the area;
(b) in the case of a committee recognised under subsection (A1)(c) of that section, to the section 28C medical practitioners for the area;
(c) in the case of a committee recognised under subsection (B1)(b) or (c)(ii) of that section, to the deputy dental practitioners for the area;
(d) in the case of a committee recognised under subsection (B1)(c) of that section, to the section 28C dental practitioners for the area.”
(7) In subsection (2), “(including travelling and subsistence allowances payable to its members)” is omitted.
(8) After subsection (3) there is inserted—
“(4) Where a committee has made a determination under subsection (1C) above, it shall apportion the amount so determined among the deputy medical practitioners, section 28C medical practitioners, deputy dental practitioners or section 28C dental practitioners, as the case may be, for the area and each such practitioner shall pay in accordance with the committee’s directions the amount so apportioned to him.
(5) References in this section to administrative expenses of a committee include references to travelling and subsistence allowances payable to its members; but the reference in subsection (2) above to a committee’s administrative expenses does not include so much of the committee’s administrative expenses as are determined under subsection (1C) above to be attributable to any practitioners mentioned in that subsection.”
(1) For section 17 of the 1977 Act (Secretary of State’s directions) there is substituted—
(1) The Secretary of State may direct a Health Authority or Special Health Authority to exercise any of his functions relating to the health service which are specified in the directions.
(2) The Secretary of State may direct a Special Health Authority to exercise any functions of a Health Authority or a Primary Care Trust which are specified in the directions.
(3) The functions which may be specified in directions under this section include functions under enactments relating to mental health and nursing homes.
(1) The Secretary of State may give directions to any of the bodies mentioned in subsection (2) below about their exercise of any functions.
(2) The bodies are—
(a) Health Authorities;
(b) Special Health Authorities;
(c) Primary Care Trusts;
(d) NHS trusts.
(3) The power conferred by subsection (1) above shall not be exercised so as to give any directions which may be given under—
(a) section 27, 28A, 41A, 97, 97A or 99 of, or paragraph 10 of Schedule 5 or paragraph 9 of Schedule 5A to, this Act;
(b) section 7(3)(ii) of the [1988 c. 49.] Health and Medicines Act 1988 (directions about the exercise of powers for financing the health service); or
(c) section 28 of the [1999 c. 8.] Health Act 1999 (plans for improving health etc.).
(1) A Health Authority may direct a Primary Care Trust whose area falls within their area to exercise any specified delegable functions.
(2) A function is a delegable function for the purposes of this section if it is a function exercisable by the Health Authority which is not an excepted function.
(3) In subsection (2) above “excepted function” means a function under—
(a) section 4 above;
(b) section 15 above (except in so far as it relates to general medical services);
(c) section 44 or 45(1C) to (4) below; or
(d) any of the other provisions of Part II of this Act—
(i) unless it is a function under section 51, 52 or 53; or
(ii) in relation to the remaining provisions of Part II, except in so far as the function relates to general medical services,
or a function referred to in section 28EE(1)(a) to (d) below.
(4) The Secretary of State may direct Health Authorities that specified delegable functions—
(a) are to be exercisable, or exercisable to (or only to) any specified extent, by Primary Care Trusts; or
(b) are not to be exercisable by Primary Care Trusts,
and that the power under subsection (1) above is to be exercised accordingly.
(5) In this section “specified” means specified in directions.
(1) A Health Authority may give directions to a Primary Care Trust about its exercise of any functions which the authority have directed the trust to exercise under section 17A above.
(2) Directions under this section have effect subject to any directions given under section 17 above.”
(2) Subsection (3) of section 17 of the [1997 c. 46.] 1977 Act applies in relation to the powers to give directions conferred by sections 4, 6 and 8 of the National Health Service (Primary Care) Act 1997 (proposals for, and making, variation and termination of, pilot schemes) as it applies in relation to the powers conferred by any of the provisions mentioned in paragraphs (a) to (c) of that subsection.
(3) For section 18 of the 1977 Act (directions and regulations under sections 11 to 17) down to the end of subsection (1) there is substituted—
(1) Any directions given by the Secretary of State under section 16D, 17 or 17A above shall be given by regulations or by an instrument in writing.
(1A) But any directions given by him—
(a) under section 16D above about functions under section 4 above;
(b) under section 17A(4) above about functions relating to general medical services; or
(c) under section 16D, 17 or 17A above about functions conferred on the Secretary of State by section 20(1) or (2) below,
shall be given by regulations.
(1B) Directions given by a Health Authority under section 17A or 17B above shall be given by an instrument in writing.”
(4) In subsection (3) of that section, for “11 to 17” there is substituted “16 to 17B above”.
(5) Section 13 of the 1977 Act (Secretary of State’s directions) is to cease to have effect.
(1) In section 5 of the 1990 Act (NHS trusts)—
(a) in subsection (1), for paragraphs (a) and (b) there is substituted “to provide goods and services for the purposes of the health service”, and
(b) for subsection (6) there is substituted—
“(6) The functions which may be specified in an order under subsection (1) above include a duty to provide goods or services so specified at or from a hospital or other establishment or facility so specified.”
(2) In section 26(3) of that Act (interpretation of Part I), after the definition of “health board” there is inserted—
““provide” includes manage”.
(3) Any order under section 5(1) of that Act—
(a) is to be treated as always having had effect with the omission of any obligation for the NHS trust to which the order relates to own land specified in the order, and
(b) so far as any functions specified in it could have been specified under that provision as amended by this Act, is to be treated as having been made under that provision as so amended.
(4) Any restriction preventing the acquisition of any land by any NHS trust (including an NHS trust dissolved before the commencement of this section) merely because the land did not comprise a hospital or other establishment or facility previously managed or provided by a Health Authority, a Special Health Authority, a Regional Health Authority or a District Health Authority is to be treated as never having had effect.
(5) An order under section 63 may—
(a) provide for any provision made by it for the purposes of, in consequence of or for giving full effect to this section to be treated as having had effect from a time before the commencement of this section,
(b) make such provision about an NHS trust dissolved before that commencement.
(6) In section 11(1) of the 1990 Act (trust funds and trustees for NHS trusts), for “which is owned and managed” there is substituted “at or from which services are provided”.
(7) In paragraph 3(2) of Schedule 2 to that Act (establishment orders), for “assume responsibility for the ownership and management of” there is substituted “provide services at”.
(8) In paragraph 16(2) of that Schedule (general powers of NHS trusts), for “which is owned and managed” there is substituted “at or from which services are provided”.
(9) In paragraph 3 of Schedule 3 to that Act (borrowing limits), in sub-paragraphs (1) and (2), for the words from “established” to “manage” there is substituted “which are required to provide services at or from”.
(10) The 1990 Act is to be treated as always having had effect subject to the amendments made by this section.
(11) Paragraphs (aa) and (ab) of section 91(3) of the 1977 Act (private trusts for hospitals) are to be treated as always having had effect (until their replacement by paragraph 27(a) of Schedule 4 to this Act) with the omission of “owned and”.
For section 5(9) of the 1990 Act (restrictions on exercise of certain powers) there is substituted—
“(9) A power conferred by paragraph 14 or 15 of Part II of Schedule 2 to this Act may only be exercised—
(a) to the extent that its exercise does not to any significant extent interfere with the performance by the NHS trust of its functions or of its obligations under NHS contracts, and
(b) in circumstances specified in directions under section 17 of the principal Act, with the consent of the Secretary of State.”
(1) Section 9 of the 1990 Act (originating capital debt of, and other financial provisions relating to, NHS trusts) is amended as provided in subsections (2) to (5).
(2) In subsections (1), (2) and (3), for “originating capital debt” there is substituted “originating capital”.
(3) For subsection (4) there is substituted—
“(4) An NHS trust’s originating capital shall be public dividend capital.”
(4) Subsections (5) and (6) are omitted.
(5) In subsection (7), for the words from “the terms” to the end there is substituted—
“(a) the dividend which is to be payable at any time on any public dividend capital issued, or treated as issued, under this Act,
(b) the amount of any such public dividend capital which is to be repaid at any time,
(c) any other terms on which any public dividend capital is so issued, or treated as issued”.
(6) In Schedule 3 to that Act—
(a) in paragraph 3 (limits on indebtedness), sub-paragraph (3) is omitted, and
(b) in paragraph 5 (additional public dividend capital), sub-paragraph (2) is omitted.
(1) This section applies to any NHS trust in existence immediately before commencement.
(2) On commencement so much of the originating capital debt of the NHS trust as remains outstanding immediately before commencement is to be treated as the originating capital of the NHS trust and accordingly is public dividend capital.
(3) Any reference in any enactment, instrument or other document to the originating capital debt of the NHS trust is to be construed (except where the context otherwise requires) as a reference to its originating capital.
(4) The Secretary of State may with the consent of the Treasury determine the amount and time for payment of interest on the NHS trust’s initial loan in respect of the period ending with commencement.
(5) In this section—
“commencement” means the coming into force of this section,
“initial loan” has the meaning given by section 9(5) of the 1990 Act.
(1) Schedule 3 to the 1990 Act is amended as follows.
(2) In paragraph 1 (borrowing powers of NHS trusts), in sub-paragraph (1), after “Subject to” there is inserted “any direction given by the Secretary of State under section 17 of the principal Act, to”.
(3) Sub-paragraphs (3) to (5) of that paragraph are omitted.
(4) For sub-paragraph (6) of that paragraph there is substituted—
“(6) It shall be for the Secretary of State, with the consent of the Treasury, to determine the terms of any loan made by him to an NHS trust (including terms as to the payment of interest, if any).”
(1) It is the duty of each Health Authority, Primary Care Trust and NHS trust to put and keep in place arrangements for the purpose of monitoring and improving the quality of health care which it provides to individuals.
(2) The reference in subsection (1) to health care which a body there mentioned provides to individuals includes health care which the body provides jointly with another person to individuals.
(3) The Secretary of State may by regulations extend the duty in this section to Special Health Authorities of any particular description.
(4) In this section—
“health care” means services for or in connection with the prevention, diagnosis or treatment of illness,
“illness” has the meaning given by section 128(1) of the 1977 Act.
(1) There is to be a body corporate known as the Commission for Health Improvement.
(2) The Commission is to have the functions conferred on it by or under sections 20 to 22.
(3) Schedule 2 makes further provision in relation to the Commission.
Health Act 1999