Office of Public Sector Information
PART 1 continued
(1) It is the duty of every Local Health Board, in respect of each financial year, to perform its functions so as to secure that the expenditure of the Board which is attributable to the performance by the Board of its functions in that year (not including expenditure within subsection (1)(a) of section 97F above) does not exceed the aggregate of—
(a) the amount allotted to it for that year under subsection (1)(b) of that section;
(b) any sums received by it in that year under any provision of this Act (other than sums received by it under that section); and
(c) any sums received by it in that year otherwise than under this Act for the purpose of enabling it to defray any such expenditure.
(2) The National Assembly for Wales may give such directions to a Local Health Board as appear to be requisite to secure that the Board complies with the duty imposed on it by subsection (1) above.
(3) Directions under subsection (2) may be specific in character.
(4) To the extent to which—
(a) any expenditure is defrayed by a Local Health Board as trustee or on behalf of a Local Health Board by special trustees; or
(b) any sums are received by a Local Health Board as trustee or under section 96A above,
that expenditure and, subject to subsection (6) below, those sums shall be disregarded for the purposes of this section.
(5) For the purposes of this section sums which, in the hands of a Local Health Board, cease to be trust funds and become applicable by the Local Health Board otherwise than as trustee shall be treated, on their becoming so applicable, as having been received by the Local Health Board otherwise than as trustee.
(6) Of the sums received by a Local Health Board under section 96A above so much only as accrues to the Local Health Board after defraying any expenses incurred in obtaining them shall be disregarded under subsection (4) above.
(7) Subject to subsection (4) above, the National Assembly for Wales may by directions determine—
(a) whether specified sums are, or are not, to be treated for the purposes of this section as received under this Act by a specified Local Health Board;
(b) whether specified expenditure is, or is not, to be treated for those purposes as expenditure within subsection (1) above of a specified Local Health Board; or
(c) the extent to which, and the circumstances in which, sums received by a Local Health Board under section 97F above but not yet spent are to be treated for the purposes of this section as part of the expenditure of the Local Health Board and to which financial year’s expenditure they are to be attributed.
(8) In subsection (7) above, “specified” means of a description specified in the directions.
(1) It is the duty of every Local Health Board to ensure that the use of its resources in a financial year does not exceed the amount specified for it in relation to that year by the National Assembly for Wales.
(2) For the purpose of subsection (1) above no account shall be taken of any use of resources for the purposes of a Board’s general Part 2 expenditure (within the meaning of paragraph 6A of Schedule 12A).
(3) But in specifying an amount for a Local Health Board under subsection (1) above (or in varying the amount under subsection (5) below), the National Assembly for Wales may take into account (in whatever way it thinks appropriate)—
(a) any such use of resources; and
(b) the use of any resources which would have been for the purpose of the Board’s general Part 2 expenditure but for an order under section 103(1) below,
during any period the Assembly thinks appropriate (or such elements of such uses of resources as it thinks appropriate).
(4) For the purpose of subsection (1) above the National Assembly for Wales may give directions—
(a) specifying uses of resources which are to be, or not to be, taken into account;
(b) making provision for determining to which Local Health Board certain uses of resources are to be attributed;
(c) specifying descriptions of resources which are to be, or not to be, taken into account.
(5) Where an amount has been specified under this section in respect of a financial year, it may be varied by a later specification.
(6) Subsections (4) to (6) of section 97G above shall apply in relation to the duty under subsection (1) above as they apply in relation to the duty under section 97G(1); and for that purpose references to the defraying of expenditure and the receipt of sums shall be construed as references to the incurring of liabilities and the acquisition of assets.
(7) The provisions in section 97G(2) and (3) above about the giving of directions by the National Assembly for Wales shall apply in relation to the duty under subsection (1) above as they apply in relation to the duty under section 97G(1).
(8) In this section a reference to the use of resources is a reference to their expenditure, consumption or reduction in value.”
(1) The 1977 Act is amended as follows.
(2) In section 97 (means of meeting expenditure of Health Authorities etc out of public funds), in subsection (3BB), for “section 97C” there is substituted “sections 97C and 97F”.
(3) Schedule 12A to the 1977 Act (expenditure of Health Authorities and Primary Care Trusts) is amended as follows.
(4) In paragraph 3—
(a) in each of sub-paragraphs (1), (4) and (5), for “Secretary of State” there is substituted “National Assembly for Wales”,
(b) in sub-paragraph (1), for “he” there is substituted “it”,
(c) in sub-paragraph (4)—
(i) for “his discretion” there is substituted “its discretion”, and
(ii) for “his opinion” there is substituted “the Assembly’s opinion”, and
(d) in sub-paragraph (5), for “he” there is substituted “the Assembly”.
(5) In paragraph 4(2), the word “or” at the end of paragraph (a) is omitted, and after paragraph (a) there is inserted—
“(aa) remuneration referable to the cost of drugs,
(ab) remuneration paid to persons providing additional pharmaceutical services (in accordance with directions under section 41A above), in respect of such of those services as are designated, or”.
(6) In paragraph 5(1)—
(a) the “and” at the end of paragraph (a) is omitted,
(b) in paragraph (b), for “(other than general Part II expenditure),” there is substituted “(other than general Part 2 expenditure and remuneration referable to the cost of drugs), and”, and
(c) for the words following paragraph (b) there is substituted—
“(c) expenditure attributable to remuneration referable to the cost of drugs for which the trust is accountable in that year (whether paid by it or by another trust).”
(7) In paragraph 5(2), the “or” at the end of paragraph (a) is omitted, and after paragraph (a) there is inserted—
“(aa) remuneration paid in that year to persons providing additional pharmaceutical services (in accordance with directions under section 41A above), in respect of such of those services as are designated, or”.
(8) For paragraph 6 there is substituted—
“6 (1) For each financial year, the Secretary of State shall apportion, in such manner as he thinks appropriate, among all Primary Care Trusts the total of the remuneration referable to the cost of drugs which is paid by each Primary Care Trust in that year.
(2) A Primary Care Trust is accountable in any year for remuneration referable to the cost of drugs to the extent (and only to the extent) that such remuneration is apportioned to it under sub-paragraph (1) above.
(3) Where in any financial year any remuneration referable to the cost of drugs for which a Primary Care Trust is accountable is paid by another Primary Care Trust, the remuneration is to be treated (for the purposes of sections 97C and 97D above) as having been paid by the first trust in the performance of its functions.
(4) The Secretary of State may, in particular, exercise his discretion under sub-paragraph (1) above—
(a) so that any apportionment reflects, in the case of each Primary Care Trust, the financial consequences of orders for the provision of drugs, being orders which in his opinion are attributable to the trust in question,
(b) by reference to averaged or estimated amounts.
(5) The Secretary of State may make provision for any remuneration referable to the cost of drugs which is paid by a Primary Care Trust other than the trust which is accountable for the payment to be reimbursed in such manner as he may determine.”
(9) After paragraph 6 there is inserted—
6A (1) In section 97F above and this Schedule, general Part 2 expenditure, in relation to a Local Health Board, means expenditure of the Board which—
(a) is attributable to the payment of remuneration to persons providing services in pursuance of Part 2 of this Act, and
(b) is not excluded by sub-paragraph (2) below.
(2) Expenditure is excluded if it is attributable to—
(a) the reimbursement of expenses of persons providing services in pursuance of Part 2 which are designated expenses incurred in connection with the provision of the services (or in giving instruction in matters relating to the services),
(b) remuneration referable to the cost of drugs,
(c) remuneration paid to persons providing additional pharmaceutical services (in accordance with directions under section 41A above), in respect of such of those services as are designated, or
(d) remuneration of a designated description which is determined by the Board and paid to persons providing general medical services in pursuance of Part 2.
6B (1) In section 97F above, main expenditure, in relation to a Local Health Board and the year in question, means—
(a) expenditure of the Board mentioned in sub-paragraph (2) below,
(b) any other expenditure of the Board attributable to the performance of its functions in that year (other than general Part 2 expenditure and remuneration referable to the cost of drugs), and
(c) expenditure attributable to remuneration referable to the cost of drugs for which the Board is accountable in that year (whether paid by it or by another Board).
(2) The expenditure referred to in sub-paragraph (1)(a) above is expenditure attributable to—
(a) the reimbursement in that year of expenses of persons providing services in pursuance of Part 2 which are designated expenses incurred in connection with the provision of the services (or in giving instruction in matters relating to the services),
(b) remuneration paid in that year to persons providing additional pharmaceutical services (in accordance with directions under section 41A above), in respect of such of those services as are designated, or
(c) remuneration of a designated description which is determined by the Board and paid in that year to persons providing general medical services in pursuance of Part 2.
6C (1) For each financial year, the National Assembly for Wales shall apportion, in such manner as it thinks appropriate, among all Local Health Boards the total of the remuneration referable to the cost of drugs which is paid by each Local Health Board in that year.
(2) A Local Health Board is accountable in any year for remuneration referable to the cost of drugs to the extent (and only to the extent) that such remuneration is apportioned to it under sub-paragraph (1) above.
(3) Where in any financial year any remuneration referable to the cost of drugs for which a Local Health Board is accountable is paid by another Local Health Board, the remuneration is to be treated (for the purposes of sections 97F and 97G above) as having been paid by the first Board in the performance of its functions.
(4) The National Assembly for Wales may, in particular, exercise its discretion under sub-paragraph (1) above—
(a) so that any apportionment reflects, in the case of each Local Health Board, the financial consequences of orders for the provision of drugs, being orders which in the Assembly’s opinion are attributable to the Board in question,
(b) by reference to averaged or estimated amounts.
(5) The National Assembly for Wales may make provision for any remuneration referable to the cost of drugs which is paid by a Local Health Board other than the Board which is accountable for the payment to be reimbursed in such manner as the Assembly may determine.”
(10) In paragraph 7—
(a) in sub-paragraph (1)—
(i) in the definition of “designated”, after “Secretary of State” there is inserted “or, as the case may be, the National Assembly for Wales”, and
(ii) in the definition of “remuneration referable to the cost of drugs”, for “paragraph 1(2)(b)” there is substituted “paragraphs 1(2)(b), 4(2)(aa) and 6A(2)(b)”,
(b) in sub-paragraph (2), for “Health Authorities” there is substituted “Primary Care Trusts”, and at the end there is inserted “and the National Assembly for Wales shall make the corresponding determination in relation to Health Authorities and Local Health Boards.”, and
(c) in sub-paragraph (3)—
(i) for “Health Authorities” there is substituted “Primary Care Trusts”,
(ii) “or Primary Care Trust” is omitted, and
(iii) at the end there is inserted “, and the National Assembly for Wales may so treat all remuneration paid by Health Authorities to such persons, so far as it is so met.”
In section 18 of the 1999 Act (duty of quality), in subsection (4), at the end of the definition of “health care” there is inserted “, and the environment in which such services are provided”.
(1) Section 20 of the 1999 Act (functions of the Commission for Health Improvement) is amended as provided in subsections (2) to (4).
(2) In subsection (1)—
(a) in paragraph (d), for “particular types of health care” there is substituted “health care”,
(b) the “and” at the end of paragraph (d) is omitted, and
(c) after paragraph (d) there is inserted—
“(da) the function of conducting reviews of, and making reports on, the quality of data obtained by others relating to the management, provision or quality of, or access to or availability of, health care for which NHS bodies or service providers have responsibility, the validity of conclusions drawn from such data, and the methods used in their collection and analysis,”.
(3) After subsection (1) there is inserted—
“(1A) The functions of conducting reviews and of carrying out investigations include—
(a) the collection and analysis of data, and
(b) the assessment of performance against criteria.
(1B) Subject to any regulations under paragraph (d) of subsection (2), the Commission must publish at least a summary of each report it makes in the exercise of the functions conferred on it by or under this section and sections 21 and 22.”
(4) In subsection (2), for paragraph (d) there is substituted—
“(d) as to cases or classes of case in which the Commission must publish reports (and not just summaries),”.
(5) In section 33 of the Audit Commission Act 1998 (c. 18) (studies for improving economy etc in services), in subsection (6)(c), after “Secretary of State” there is inserted “, the Commission for Health Improvement”.
(1) In section 20 of the 1999 Act (functions of the Commission for Health Improvement)—
(a) in subsection (1), after the paragraph (da) inserted by section 12 there is inserted—
“(db) the function of carrying out inspections of NHS bodies and service providers, and persons who provide or are to provide health care for which NHS bodies or service providers have responsibility, and making reports on the inspections, and”, and
(b) after the subsections (1A) and (1B) inserted by section 12 there is inserted—
“(1C) The inspections referred to in paragraph (db) of subsection (1) are to be carried out only in connection with the function referred to in paragraph (d) of that subsection.
(1D) If after carrying out—
(a) a review under subsection (1)(b),
(b) an investigation under subsection (1)(c),
(c) any function equivalent to one referred to in paragraph (a) or (b) prescribed under subsection (1)(e), or
(d) an inspection under subsection (1)(db),
the Commission is of the view referred to in subsection (1E) as to a body, service provider or other person reviewed, investigated or inspected (taking account, if appropriate, of any other relevant information the Commission may have), the Commission must make a report of its view to the Secretary of State.
(1E) The view referred to is that—
(a) the health care for which the body or service provider in question has responsibility is of unacceptably poor quality (whether generally or in particular areas), or
(b) there are significant failings in the way the body, service provider or other person is being run (including, where the service provider or other person is an individual, the way his practice is being run).
(1F) In its report, the Commission may recommend to the Secretary of State that he take special measures in relation to the body or service provider in question with a view to improving the health care for which it is responsible or the way the body, service provider or other person (or, as mentioned in subsection (1E)(b), his practice) is being run.
(1G) The report must give the Commission’s reasons for its view, and for any recommendation under subsection (1F).”
(2) In section 23 of that Act (powers of the Commission to obtain information)—
(a) in subsection (1)(a), for “NHS premises” there is substituted “relevant premises”,
(b) in subsection (2)(d), after “section 20(1)(c)” there is inserted “, (d) or (db), or any functions equivalent to those under section 20(1)(c) prescribed under section 20(1)(e)”, and
(c) in subsection (6)—
(i) the definition of “NHS premises” is omitted, and
(ii) after the definition of “prescribed” there is inserted—
““relevant premises” means—
(a) premises owned or controlled by an NHS body,
(b) premises owned or controlled by a Local Health Board,
(c) premises owned or controlled by a service provider and used for purposes connected with the services provided,
(d) any other premises used for any purpose connected with the provision of health care for which an NHS body, a service provider or a Local Health Board has responsibility,
(and terms used in this definition have the meaning given by section 20(7) (disregarding section 20(8)(b))).”
(1) Schedule 2 to the 1999 Act (the Commission for Health Improvement) is amended as follows.
(2) After paragraph 5 there is inserted—
“5A (1) The Secretary of State may direct a Special Health Authority to exercise—
(a) his function of appointing the chairman and the other members referred to in paragraph 4(c), and
(b) any functions conferred on him by regulations under paragraph 5 in relation to the appointment or tenure of office of the chairman and those other members.
(2) The National Assembly for Wales may direct a Special Health Authority to exercise—
(a) its function of appointing the member referred to in paragraph 4(b), and
(b) any functions conferred on it by regulations under paragraph 5 in relation to the appointment or tenure of office of that member.
(3) If the Secretary of State or the Assembly gives such directions, the 1977 Act has effect as if—
(a) the directions were directions under section 16D of that Act, and, accordingly,
(b) the functions were exercisable by the Special Health Authority under section 16D.”
(3) In paragraph 7 (employees)—
(a) in sub-paragraph (2), the words after “Commission” are omitted, and
(b) sub-paragraphs (6) and (7) are omitted.
(4) In paragraph 8 (delegation of functions)—
(a) the existing text is renumbered as sub-paragraph (1) of that paragraph,
(b) in that sub-paragraph (1) (as so renumbered), for “a committee” to the end there is substituted—
“(a) a committee, sub-committee, member or employee of the Commission, or
(b) any other person.”, and
(c) after sub-paragraph (1) there is inserted—
“(2) If the Commission arranges for the discharge of any function falling within section 20(1A) of this Act by one or more committees or sub-committees of the Commission, the persons by whom those functions are to be discharged are to be known collectively as “the Office for Information on Health Care Performance”.
(3) If the Commission arranges for the discharge of any function as mentioned in sub-paragraph (1)(b), the arrangements may include provision with respect to the payment of remuneration and allowances to, or amounts in respect of, such persons.”
(5) In paragraph 12—
(a) in sub-paragraph (1), for “the exercise of its functions” there is substituted “the way in which the Commission has exercised its functions”, and
(b) after sub-paragraph (1) there is inserted—
“(1A) As soon as possible after the end of each financial year, the Commission must also make a report to the Secretary of State and the National Assembly for Wales on what it has found in relation to NHS bodies and service providers in the course of exercising its functions during the year.
(1B) The Secretary of State must lay before Parliament any reports he receives under sub-paragraphs (1) and (1A).
(1C) The National Assembly for Wales must publish any report it receives under sub-paragraph (1A).”
(1) The Secretary of State shall establish a body to be known as a Patients' Forum—
(a) for each NHS trust all or most of whose hospitals, establishments and facilities are situated in England, and
(b) for each Primary Care Trust.
(2) The members of each Patients' Forum are to be appointed by the Commission for Patient and Public Involvement in Health.
(3) A Patients' Forum must—
(a) monitor and review the range and operation of services provided by, or under arrangements made by, the trust for which it is established,
(b) obtain the views of patients and their carers about those matters and report on those views to the trust,
(c) provide advice, and make reports and recommendations, about matters relating to the range and operation of those services to the trust,
(d) make available to patients and their carers advice and information about those services,
(e) in prescribed circumstances, perform any prescribed function of the trust with respect to the provision of a service affording assistance to patients and their families and carers,
(f) carry out such other functions as may be prescribed.
(4) In providing advice or making recommendations under subsection (3)(c), a Patients' Forum must have regard to the views of patients and their carers.
(5) If, in the course of exercising its functions, a Patients' Forum becomes aware of any matter which in its view—
(a) should be considered by a relevant overview and scrutiny committee, the Forum may refer that matter to the committee,
(b) should be brought to the attention of the Commission for Patient and Public Involvement in Health, it may refer that matter to the Commission.
(6) Subsection (5) does not prejudice the power of a Patients' Forum to make such other representations or referrals as it thinks fit, to such persons or bodies as it thinks fit, about matters arising in the course of its exercising its functions.
(7) Patients' Forums must in prescribed circumstances—
(a) co-operate with each other in the exercise of their functions,
(b) exercise functions jointly with one or more other Forums.
(8) References in subsection (3) to services are references to—
(a) services provided as part of the health service in England,
(b) services provided in England in pursuance of section 31 arrangements in relation to the exercise of health-related functions of a local authority, and
(c) services provided elsewhere (and not as part of the health service in England) in pursuance of section 31 arrangements with a local authority in England.
(9) In this section—
“carer”, in relation to a patient, means a person who provides care for the patient, but who is not employed to do so by any body in the exercise of its functions under any enactment,
“the health service” has the same meaning as in the 1977 Act,
“patient” includes (as well as a patient within the meaning of that Act) a person who receives services provided in pursuance of section 31 arrangements in relation to the exercise of health-related functions of a local authority,
“prescribed” means prescribed by regulations made by the Secretary of State,
“relevant overview and scrutiny committee”, in relation to a Patients' Forum, means any overview and scrutiny committee in relation to which the Primary Care Trust or NHS trust for which the Forum is established is a local NHS body by virtue of regulations made under section 7(4) of the Health and Social Care Act 2001 (c. 15) (including that provision as read with section 8(5) and as applied by section 10(2) of that Act),
“section 31 arrangements” means arrangements under regulations under section 31 of the 1999 Act (arrangements between NHS bodies and local authorities).
(1) A Patients' Forum established for a Primary Care Trust (a “PCT Patients' Forum”) has the following additional functions—
(a) providing independent advocacy services to persons in the Trust’s area or persons to whom services have been provided by, or under arrangements with, the Trust,
(b) making available to patients and their carers advice and information about the making of complaints in relation to services provided by or under arrangements with the Trust, and
(c) representing to persons and bodies which exercise functions in relation to the area of the Trust (including, in particular, any relevant overview and scrutiny committee) the views of members of the public in the Trust’s area about matters affecting their health.
(2) In subsection (1), references to services have the meaning given by section 15(8).
(3) It is also the function of a PCT Patients' Forum—
(a) to promote the involvement of members of the public in the area of the Trust in consultations or processes leading (or potentially leading) to decisions by those mentioned in subsection (4), or the formulation of policies by them, which would or might affect (whether directly or not) the health of those members of the public,
(b) to make available advice and information to such members of the public about such involvement,
(c) to advise those mentioned in subsection (4) about how to encourage such involvement (including, in the case of bodies mentioned in subsection (4) to which section 11 of the Health and Social Care Act 2001 (c. 15) applies, advising them how to comply with the requirements of that section in relation to the area of the Primary Care Trust), and
(d) to monitor how successful those mentioned in subsection (4) are at achieving such involvement.
(4) Those referred to in subsection (3) are—
(a) Strategic Health Authorities whose areas include any part of the area of the Primary Care Trust,
(b) the Primary Care Trust itself,
(c) NHS trusts which provide services to patients in the area of the Primary Care Trust,
(d) other public bodies, and
(e) others providing services to the public or a section of the public.
National Health Service Reform and Health Care Professions Act 2002