Health and Social Care Act 2012

(14P) (1) Each clinical commissioning group must, in the exercise of its functions— (a) act with a view to securing that health services are provided in a way which promotes the NHS Constitution, and (b) promote awareness of the NHS Constitution among patients, staff and members of the public. (2) In this section, “patients” and “staff” have the same meaning as in Chapter 1 of Part 1 of the Health Act 2009 (see section 3(7) of that Act). (14Q) Each clinical commissioning group must exercise its functions effectively, efficiently and economically. (14R) (1) Each clinical commissioning group must exercise its functions with a view to securing continuous improvement in the quality of services provided to individuals for or in connection with the prevention, diagnosis or treatment of illness. (2) In discharging its duty under subsection (1), a clinical commissioning group 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 its duty under subsection (1), a clinical commissioning group must have regard to any guidance published under section 14Z8. (14S) Each clinical commissioning group must assist and support the Board in discharging its duty under section 13E so far as relating to securing continuous improvement in the quality of primary medical services. (14T) Each clinical commissioning group must, in the exercise of its functions, have regard to the need to— (a) reduce inequalities between patients with respect to their ability to access health services, and (b) reduce inequalities between patients with respect to the outcomes achieved for them by the provision of health services. (14U) (1) Each clinical commissioning group must, in the exercise of its functions, promote the involvement of patients, and their carers and representatives (if any), in decisions which relate to— (a) the prevention or diagnosis of illness in the patients, or (b) their care or treatment. (2) The Board must publish guidance for clinical commissioning groups on the discharge of their duties under this section. (3) A clinical commissioning group must have regard to any guidance published by the Board under subsection (2). (14V) Each clinical commissioning group must, in the exercise of its functions, act with a view to enabling patients to make choices with respect to aspects of health services provided to them. (14W) (1) Each clinical commissioning group must obtain advice appropriate for enabling it effectively to discharge its functions from persons who (taken together) have a broad range of professional expertise in— (a) the prevention, diagnosis or treatment of illness, and (b) the protection or improvement of public health. (2) The Board may publish guidance for clinical commissioning groups on the discharge of their duties under subsection (1). (3) A clinical commissioning group must have regard to any guidance published by the Board under subsection (2). (14X) Each clinical commissioning group must, in the exercise of its functions, promote innovation in the provision of health services (including innovation in the arrangements made for their provision). (14Y) Each clinical commissioning group must, in the exercise of its functions, promote— (a) research on matters relevant to the health service, and (b) the use in the health service of evidence obtained from research. (14Z) Each clinical commissioning group must, in exercising its functions, have regard to the need to promote education and training for the persons mentioned in section 1F(1) so as to assist the Secretary of State in the discharge of the duty under that section. (14Z1) (1) Each clinical commissioning group must exercise its functions with a view to securing that health services are provided in an integrated way where it considers that this would— (a) improve the quality of those services (including the outcomes that are achieved from their provision), (b) reduce inequalities between persons with respect to their ability to access those services, or (c) reduce inequalities between persons with respect to the outcomes achieved for them by the provision of those services. (2) Each clinical commissioning group must exercise its functions with a view to securing that the provision of health services is integrated with the provision of health-related services or social care services where it considers that this would— (a) improve the quality of the health services (including the outcomes that are achieved from the provision of those services), (b) reduce inequalities between persons with respect to their ability to access those services, or (c) reduce inequalities between persons with respect to the outcomes achieved for them by the provision of those services. (3) In this section— - “health-related services” means services that may have an effect on the health of individuals but are not health services or social care services; - “social care services” means services that are provided in pursuance of the social services functions of local authorities (within the meaning of the Local Authority Social Services Act 1970). (14Z2) (1) This section applies in relation to any health services which are, or are to be, provided pursuant to arrangements made by a clinical commissioning group in the exercise of its functions (“commissioning arrangements”). (2) The clinical commissioning group must make arrangements to secure that individuals to whom the services are being or may be provided are involved (whether by being consulted or provided with information or in other ways)— (a) in the planning of the commissioning arrangements by the group, (b) in the development and consideration of proposals by the group for changes in the commissioning arrangements where the implementation of the proposals would have an impact on the manner in which the services are delivered to the individuals or the range of health services available to them, and (c) in decisions of the group affecting the operation of the commissioning arrangements where the implementation of the decisions would (if made) have such an impact. (3) The clinical commissioning group must include in its constitution— (a) a description of the arrangements made by it under subsection (2), and (b) a statement of the principles which it will follow in implementing those arrangements. (4) The Board may publish guidance for clinical commissioning groups on the discharge of their functions under this section. (5) A clinical commissioning group must have regard to any guidance published by the Board under subsection (4). (6) The reference in subsection (2)(b) to the delivery of services is a reference to their delivery at the point when they are received by users. (14Z3) (1) Any two or more clinical commissioning groups may make arrangements under this section. (2) The arrangements may provide for— (a) one of the clinical commissioning groups to exercise any of the commissioning functions of another on its behalf, or (b) all the clinical commissioning groups to exercise any of their commissioning functions jointly. (3) For the purposes of the arrangements a clinical commissioning group may— (a) make payments to another clinical commissioning group, or (b) make the services of its employees or any other resources available to another clinical commissioning group. (4) For the purposes of the arrangements, all the clinical commissioning groups may establish and maintain a pooled fund. (5) A pooled fund is a fund— (a) which is made up of contributions by all the groups, and (b) out of which payments may be made towards expenditure incurred in the discharge of any of the commissioning functions in respect of which the arrangements are made. (6) Arrangements made under this section do not affect the liability of a clinical commissioning group for the exercise of any of its functions. (7) In this section, “commissioning functions” means the functions of clinical commissioning groups in arranging for the provision of services as part of the health service (including the function of making a request to the Board for the purposes of section 14Z9). (14Z4) (1) Regulations may provide for any prescribed functions of a clinical commissioning group to be exercised jointly with a Local Health Board. (2) Regulations may provide for any functions that are (by virtue of subsection (1)) exercisable jointly by a clinical commissioning group and a Local Health Board to be exercised by a joint committee of the group and the Local Health Board. (3) Arrangements made by virtue of this section do not affect the liability of a clinical commissioning group for the exercise of any of its functions. (14Z5) (1) A clinical commissioning group has power to do anything specified in section 7(2)(a), (b) and (e) to (h) of the Health and Medicines Act 1988 (provision of goods etc.) for the purpose of making additional income available for improving the health service. (2) A clinical commissioning group may exercise a power conferred by subsection (1) only to the extent that its exercise does not to any significant extent interfere with the performance by the group of its functions. (14Z6) (1) A clinical commissioning group may make payments by way of grant or loan to a voluntary organisation which provides or arranges for the provision of services which are similar to the services in respect of which the group has functions. (2) The payments may be made subject to such terms and conditions as the group considers appropriate. (14Z7) (1) The Board may publish a document specifying— (a) circumstances in which a clinical commissioning group is liable to make a payment to a person in respect of services provided by that person in pursuance of arrangements made by another clinical commissioning group in the discharge of its commissioning functions, and (b) how the amount of any such payment is to be determined. (2) A clinical commissioning group is required to make payments in accordance with any document published under subsection (1). (3) Where a clinical commissioning group is required to make a payment by virtue of subsection (2), no other clinical commissioning group is liable to make it. (4) Accordingly, any obligation of another clinical commissioning group to make the payment ceases to have effect. (5) Any sums payable by virtue of subsection (2) may be recovered summarily as a civil debt (but this does not affect any other method of recovery). (6) The Board may publish guidance for clinical commissioning groups for the purpose of assisting them in understanding and applying any document published under subsection (1). (7) In this section and section 14Z8, “commissioning functions” means the functions of clinical commissioning groups in arranging for the provision of services as part of the health service. (14Z8) (1) The Board must publish guidance for clinical commissioning groups on the discharge of their commissioning functions. (2) Each clinical commissioning group must have regard to guidance under this section. (3) The Board must consult the Healthwatch England committee of the Care Quality Commission— (a) before it first publishes guidance under this section, and (b) before it publishes any revised guidance containing changes that are, in the opinion of the Board, significant. (14Z9) (1) The Board may, at the request of a clinical commissioning group, exercise on behalf of the group— (a) any of its functions under section 3 or 3A which are specified in the request, and (b) any other functions of the group which are related to the exercise of those functions. (2) Regulations may provide that the power in subsection (1) does not apply in relation to functions of a prescribed description. (3) Arrangements under this section may be on such terms and conditions (including terms as to payment) as may be agreed between the Board and the clinical commissioning group. (4) Arrangements made under this section do not affect the liability of a clinical commissioning group for the exercise of any of its functions. (14Z10) (1) The Board may provide assistance or support to a clinical commissioning group. (2) The assistance that may be provided includes— (a) financial assistance, and (b) making the services of the Board's employees or any other resources of the Board available to the clinical commissioning group. (3) Assistance or support provided under this section may be provided on such terms and conditions, including terms as to payment, as the Board considers appropriate. (4) The Board may, in particular, impose restrictions on the use of any financial or other assistance or support provided under this section. (5) A clinical commissioning group must comply with any restrictions imposed under subsection (4). (14Z11) (1) Before the start of each relevant period, a clinical commissioning group must prepare a plan setting out how it proposes to exercise its functions in that period. (2) In subsection (1), “relevant period”, in relation to a clinical commissioning group, means— (a) the period which — (i) begins on such day during the first financial year of the group as the Board may direct, and (ii) ends at the end of that financial year, and (b) each subsequent financial year. (3) The plan must, in particular, explain how the group proposes to discharge its duties under— (a) sections 14R, 14T and 14Z2, and (b) sections 223H to 223J. (4) The clinical commissioning group must publish the plan. (5) The clinical commissioning group must give a copy of the plan to the Board before the date specified by the Board in a direction. (6) The clinical commissioning group must give a copy of the plan to each relevant Health and Wellbeing Board. (7) The Board may publish guidance for clinical commissioning groups on the discharge of their functions by virtue of this section and sections 14Z12 and 14Z13. (8) A clinical commissioning group must have regard to any guidance published by the Board under subsection (7). (9) In this Chapter, “relevant Health and Wellbeing Board”, in relation to a clinical commissioning group, means a Health and Wellbeing Board established by a local authority whose area coincides with, or includes the whole or any part of, the area of the group. (14Z12) (1) A clinical commissioning group may revise a plan published by it under section 14Z11. (2) If the clinical commissioning group revises the plan in a way which it considers to be significant— (a) the group must publish the revised plan, and (b) subsections (5) and (6) of section 14Z11 apply in relation to the revised plan as they apply in relation to the original plan. (3) If the clinical commissioning group revises the plan in any other way, the group must— (a) publish a document setting out the changes it has made to the plan, and (b) give a copy of the document to the Board and each relevant Health and Wellbeing Board. (14Z13) (1) This section applies where a clinical commissioning group is— (a) preparing a plan under section 14Z11, or (b) revising a plan under section 14Z12 in a way which it considers to be significant. (2) The clinical commissioning group must consult individuals for whom it has responsibility for the purposes of section 3. (3) The clinical commissioning group must involve each relevant Health and Wellbeing Board in preparing or revising the plan. (4) The clinical commissioning group must, in particular— (a) give each relevant Health and Wellbeing Board a draft of the plan or (as the case may be) the plan as revised, and (b) consult each such Board on whether the draft takes proper account of each joint health and wellbeing strategy published by it which relates to the period (or any part of the period) to which the plan relates. (5) Where a Health and Wellbeing Board is consulted under subsection (4)(b), the Health and Wellbeing Board must give the clinical commissioning group its opinion on the matter mentioned in that subsection. (6) Where a Health and Wellbeing Board is consulted under subsection (4)(b)— (a) it may also give the Board its opinion on the matter mentioned in that subsection, and (b) if it does so, it must give the clinical commissioning group a copy of its opinion. (7) If a clinical commissioning group revises or further revises a draft after it has been given to each relevant Health and Wellbeing Board under subsection (4), subsections (4) to (6) apply in relation to the revised draft as they apply in relation to the original draft. (8) A clinical commissioning group must include in a plan published under section 14Z11(4) or 14Z12(2)— (a) a summary of the views expressed by individuals consulted under subsection (2), (b) an explanation of how the group took account of those views, and (c) a statement of the final opinion of each relevant Health and Wellbeing Board consulted in relation to the plan under subsection (4). (9) In this section, “joint health and wellbeing strategy” means a strategy under section 116A of the Local Government and Public Involvement in Health Act 2007 which is prepared and published by a Health and Wellbeing Board by virtue of section 196 of the Health and Social Care Act 2012. (14Z14) (1) A relevant Health and Wellbeing Board— (a) may give the Board its opinion on whether a plan published by a clinical commissioning group under section 14Z11(4) or 14Z12(2) takes proper account of each joint health and wellbeing strategy published by the Health and Wellbeing Board which relates to the period (or any part of the period) to which the plan relates, and (b) if it does so, must give the clinical commissioning group a copy of its opinion. (2) In this section, “joint health and wellbeing strategy” has the same meaning as in section 14Z13. (14Z15) (1) In each financial year other than its first financial year, a clinical commissioning group must prepare a report (an “annual report”) on how it has discharged its functions in the previous financial year. (2) An annual report must, in particular— (a) explain how the clinical commissioning group has discharged its duties under sections 14R, 14T and 14Z2, and (b) review the extent to which the group has contributed to the delivery of any joint health and wellbeing strategy to which it was required to have regard under section 116B(1)(b) of the Local Government and Public Involvement in Health Act 2007. (3) In preparing the review required by subsection (2)(b), the clinical commissioning group must consult each relevant Health and Wellbeing Board. (4) The Board may give directions to clinical commissioning groups as to the form and content of an annual report. (5) A clinical commissioning group must give a copy of its annual report to the Board before the date specified by the Board in a direction. (6) A clinical commissioning group must— (a) publish its annual report, and (b) hold a meeting for the purpose of presenting the report to members of the public. (14Z16) (1) The Board must conduct a performance assessment of each clinical commissioning group in respect of each financial year. (2) A performance assessment is an assessment of how well the clinical commissioning group has discharged its functions during that year. (3) The assessment must, in particular, include an assessment of how well the group has discharged its duties under— (a) sections 14R, 14T, 14W and 14Z2, (b) sections 223H to 223J, and (c) section 116B(1) of the Local Government and Public Involvement in Health Act 2007 (duty to have regard to assessments and strategies). (4) In conducting a performance assessment, the Board must consult each relevant Health and Wellbeing Board as to its views on the clinical commissioning group's contribution to the delivery of any joint health and wellbeing strategy to which the group was required to have regard under section 116B(1)(b) of that Act of 2007. (5) The Board must, in particular, have regard to— (a) any document published by the Secretary of State for the purposes of this section, and (b) any guidance published under section 14Z8. (6) The Board must publish a report in respect of each financial year containing a summary of the results of each performance assessment conducted by the Board in respect of that year. (14Z17) (1) Sections 14Z18 and 14Z19 apply where the Board has reason to believe— (a) that the area of a clinical commissioning group is no longer appropriate, or (b) that a clinical commissioning group might have failed, might be failing or might fail to discharge any of its functions. (2) For the purposes of this section— (a) a failure to discharge a function includes a failure to discharge it properly, and (b) a failure to discharge a function properly includes a failure to discharge it consistently with what the Board considers to be the interests of the health service. (14Z18) (1) Where this section applies, the Board may require a person mentioned in subsection (2) to provide to the Board any information, documents, records or other items that the Board considers it necessary or expedient to have for the purposes of any of its functions in relation to the clinical commissioning group. (2) The persons mentioned in this subsection are— (a) the clinical commissioning group if it has possession or control of the item in question; (b) any member or employee of the group who has possession or control of the item in question. (3) A person must comply with a requirement imposed under subsection (1). (4) The power conferred by subsection (1) includes power to require that any information, documents or records kept by means of a computer be provided in legible form. (5) The power conferred by subsection (1) does not include power to require the provision of personal records. (6) In subsection (5), “personal records” has the meaning given by section 12 of the Police and Criminal Evidence Act 1984. (14Z19) (1) Where this section applies, the Board may require the clinical commissioning group to provide it with an explanation of any matter which relates to the exercise by the group of any of its functions, including an explanation of how the group is proposing to exercise any of its functions. (2) The Board may require the explanation to be given— (a) orally at such time and place as the Board may specify, or (b) in writing. (3) The clinical commissioning group must comply with a requirement imposed under subsection (1). (14Z20) Any information, documents, records or other items that are obtained by the Board in pursuance of section 14Z18 or 14Z19 may be used by the Board in connection with any of its functions in relation to clinical commissioning groups. (14Z21) (1) This section applies if the Board is satisfied that— (a) a clinical commissioning group is failing or has failed to discharge any of its functions, or (b) there is a significant risk that a clinical commissioning group will fail to do so. (2) The Board may direct the clinical commissioning group to discharge such of those functions, and in such manner and within such period or periods, as may be specified in the direction. (3) The Board may direct— (a) the clinical commissioning group, or (b) the accountable officer of the group, to cease to perform any functions for such period or periods as may be specified in the direction. (4) The Board may— (a) terminate the appointment of the clinical commissioning group's accountable officer, and (b) appoint another person to be its accountable officer. (5) Paragraph 12(4) of Schedule 1A does not apply to an appointment under subsection (4)(b). (6) The Board may vary the constitution of the clinical commissioning group, including doing so by— (a) varying its area, (b) adding any person who is a provider of primary medical services to the list of members, or (c) removing any person from that list. (7) The Board may dissolve the clinical commissioning group. (8) Where a direction is given under subsection (3) the Board may— (a) exercise any of the functions that are the subject of the direction on behalf of the clinical commissioning group or (as the case may be) the accountable officer; (b) direct another clinical commissioning group or (as the case may be) the accountable officer of another clinical commissioning group to perform any of those functions on behalf of the group or (as the case may be) the accountable officer, in such manner and within such period or periods as may be specified in the directions. (9) A clinical commissioning group to which a direction is given under subsection (3) must— (a) where the Board exercises a function of the group under subsection (8)(a), co-operate with the Board, and (b) where a direction is given under subsection (8)(b) to another clinical commissioning group or to the accountable officer of another clinical commissioning group, co-operate with the other group or (as the case may be) the accountable officer. (10) Before exercising the power conferred by subsection (8)(b) the Board must consult the clinical commissioning group to which it is proposing to give the direction. (11) Where the Board exercises a power conferred by subsection (6) or (7), the Board may make a property transfer scheme or a staff transfer scheme. (12) In subsection (11), “property transfer scheme” and “staff transfer scheme” have the same meaning as in section 14I. (13) Part 3 of Schedule 1A applies in relation to a property transfer scheme or a staff transfer scheme under subsection (11) as it applies in relation to a property transfer scheme or (as the case may be) a staff transfer scheme under section 14I(1). (14) For the purposes of this section— (a) a failure to discharge a function includes a failure to discharge it properly, and (b) a failure to discharge a function properly includes a failure to discharge it consistently with what the Board considers to be the interests of the health service. (14Z22) (1) Before exercising the power to dissolve a clinical commissioning group under section 14Z21(7) the Board must consult the following persons— (a) the clinical commissioning group, (b) relevant local authorities, and (c) any other persons the Board considers it appropriate to consult. (2) For that purpose, the Board must provide those persons with a statement— (a) explaining that it is proposing to exercise the power, and (b) giving its reasons for doing so. (3) After consulting those persons (and before exercising the power), the Board must publish a report containing its response to the consultation. (4) If the Board decides to exercise the power, the report must, in particular, explain its reasons for doing so. (5) Regulations may make provision as to the procedure to be followed by the Board before the exercise of the powers conferred by sections 14Z18, 14Z19 and 14Z21. (6) The Board must publish guidance as to how it proposes to exercise the powers conferred by those sections. (7) For the purposes of subsection (1) a local authority is a relevant local authority if its area coincides with, or includes the whole or any part of, the area of the clinical commissioning group. (14Z23) (1) A clinical commissioning group may disclose information obtained by it in the exercise of its functions if— (a) the information has previously been lawfully disclosed to the public, (b) the disclosure is made under or pursuant to regulations under section 113 or 114 of the Health and Social Care (Community Health and Standards) Act 2003 (complaints about health care or social services), (c) the disclosure is made in accordance with any enactment or court order, (d) the disclosure is necessary or expedient for the purposes of protecting the welfare of any individual, (e) the disclosure is made to any person in circumstances where it is necessary or expedient for the person to have the information for the purpose of exercising functions of that person under any enactment, (f) the disclosure is made for the purpose of facilitating the exercise of any of the clinical commissioning group's functions, (g) the disclosure is made in connection with the investigation of a criminal offence (whether or not in the United Kingdom), or (h) the disclosure is made for the purpose of criminal proceedings (whether or not in the United Kingdom). (2) Paragraphs (a) to (c) and (h) of subsection (1) have effect notwithstanding any rule of common law which would otherwise prohibit or restrict the disclosure. (14Z24) (1) In this Chapter— - “financial year”, in relation to a clinical commissioning group, includes the period which begins on the day the group is established and ends on the following 31 March; - “the health service” means the health service in England; - “health services” means services provided as part of the health service and, in section 14Z2, also includes services that are to be provided as part of the health service; - “relevant Health and Wellbeing Board”, in relation to a clinical commissioning group, has the meaning given by section 14Z11(9). (2) Any reference (however expressed) in the following provisions of this Act to the functions of a clinical commissioning group includes a reference to the functions of the Secretary of State that are exercisable by the group by virtue of arrangements under section 7A— - section 6E(7) and (10)(b), - section 14C(2)(e), - section 14P, - section 14Q, - section 14T, - section 14U(1), - section 14V, - section 14W(1), - section 14X, - section 14Y, - section 14Z, - section 14Z1(1) and (2), - section 14Z2(1), - section 14Z4(1), - section 14Z5(2), - section 14Z6(1), - section 14Z7(7), - section 14Z11(1), - section 14Z15(1), - section 14Z16(2), - sections 14Z17(1), 14Z19(1) and 14Z21(1) and (3), - section 14Z23(1), - section 72(1), - section 75(1)(a) and (2), - section 77(1)(b), - section 82, - section 89(1A)(d), - section 94(3A)(d), - section 223C(2)(b), - section 223H(1), - in Schedule 1A, paragraphs 3(1) and (3), 6, 12(9)(b) and 16(3). (3) Any reference (however expressed) in the following provisions of other Acts to the functions of a clinical commissioning group includes a reference to the functions of the Secretary of State that are exercisable by the group by virtue of arrangements under section 7A— - sections 116 to 116B of the Local Government and Public Involvement in Health Act 2007 (joint strategic needs assessments etc.), - section 199(4) of the Health and Social Care Act 2012 (supply of information to Health and Wellbeing Boards), - section 291(2)(d) of that Act (breaches of duties to co-operate), - in Schedule 6 to that Act, paragraph 8(4). (4) The Secretary of State may by order amend the list of provisions specified in subsection (2) or (3).

Financial arrangements for clinical commissioning groups

27

After section 223F of the National Health Service Act 2006 insert—

(223G) (1) The Board must pay in respect of each financial year to each clinical commissioning group sums not exceeding the amount allotted for that year by the Board to the group towards meeting the expenditure of the group which is attributable to the performance by it of its functions in that year. (2) In determining the amount to be allotted to a clinical commissioning group for any year, the Board may take into account— (a) the expenditure of the clinical commissioning group during any previous financial year, and (b) the amount that it proposes to hold, during the year to which the allotment relates, in any contingency fund established under section 223F. (3) An amount is allotted to a clinical commissioning group for a year under this section when the group is notified in writing by the Board that the amount is allotted to it for that year. (4) The Board may make a new allotment under this section increasing or reducing an allotment previously so made. (5) Where the Board allots an amount to a clinical commissioning group or makes a new allotment under subsection (4), it must notify the Secretary of State. (6) The Board may give directions to a clinical commissioning group with respect to— (a) the application of sums paid to it by virtue of a new allotment increasing an allotment previously so made, and (b) the payment of sums by it to the Board in respect of charges or other sums referable to the valuation or disposal of assets. (7) Sums falling to be paid to clinical commissioning groups under this section are payable subject to such conditions as to records, certificates or otherwise as the Board may determine. (8) In this section and sections 223H to 223K “financial year” includes the period which begins on the day the clinical commissioning group is established and ends on the following 31 March. (223H) (1) Each clinical commissioning group must, in respect of each financial year, perform its functions so as to ensure that its expenditure which is attributable to the performance by it of its functions in that year does not exceed the aggregate of— (a) the amount allotted to it for that year under section 223G, (b) any sums received by it in that year under any provision of this Act (other than sums received by it under section 223G), and (c) any sums received by it in that year otherwise than under this Act for the purpose of enabling it to defray such expenditure. (2) The Board may by directions determine— (a) whether specified sums must, or must not, be treated for the purposes of this section as received by a specified clinical commissioning group, (b) whether specified expenditure must, or must not, be treated for those purposes as expenditure within subsection (1) of a specified clinical commissioning group, or (c) the extent to which, and the circumstances in which, sums received by a clinical commissioning group under section 223G but not yet spent must be treated for the purposes of this section as part of the expenditure of the group, and to which financial year's expenditure they must be attributed. (3) The Secretary of State may by directions require a clinical commissioning group to use specified banking facilities for any specified purposes. (4) In this section, “specified” means specified in the directions. (223I) (1) For the purposes of this section and section 223J— (a) a clinical commissioning group's capital resource use, in relation to a financial year, means the group's use of capital resources in that year, and (b) a clinical commissioning group's revenue resource use, in relation to a financial year, means the group's use of revenue resources in that year. (2) A clinical commissioning group must ensure that its capital resource use in a financial year does not exceed the amount specified by direction of the Board. (3) A clinical commissioning group must ensure that its revenue resource use in a financial year does not exceed the amount specified by direction of the Board. (4) Any directions given in relation to a financial year under subsection (6) of section 223D apply (in relation to that year) for the purposes of this section as they apply for the purposes of that section. (5) The Board may by directions make provision for determining to which clinical commissioning group a use of capital resources or revenue resources is to be attributed for the purposes of this section or section 223J. (6) Where the Board gives a direction under subsection (2) or (3), it must notify the Secretary of State. (223J) (1) The Board may direct a clinical commissioning group to ensure that its capital resource use in a financial year which is attributable to matters specified in the direction does not exceed an amount so specified. (2) The Board may direct a clinical commissioning group to ensure that its revenue resource use in a financial year which is attributable to matters specified in the direction does not exceed an amount so specified. (3) The Board may direct a clinical commissioning group to ensure that its revenue resource use in a financial year which is attributable to prescribed matters relating to administration does not exceed an amount specified in the direction. (4) The Board may give directions, in relation to a financial year, specifying uses of capital resources or revenue resources which must, or must not, be taken into account for the purposes of subsection (1) or (as the case may be) subsection (2) or (3). (5) The Board may not exercise the power conferred by subsection (1) or (2) in relation to particular matters unless the Secretary of State has given a direction in relation to those matters under subsection (1) of section 223E or (as the case may be) subsection (2) of that section. (6) The Board may not exercise the power conferred by subsection (3) in relation to prescribed matters relating to administration unless the Secretary of State has given a direction in relation to those matters under subsection (3)(a) of section 223E. (223K) (1) The Board may, after the end of a financial year, make a payment to a clinical commissioning group. (2) For the purpose of determining whether to make a payment under subsection (1) and (if so) the amount of the payment, the Board must take into account at least one of the following factors— (a) the quality of relevant services provided during the financial year; (b) any improvement in the quality of relevant services provided during that year (in comparison to the quality of relevant services provided during previous financial years); (c) the outcomes identified during the financial year as having been achieved from the provision at any time of relevant services; (d) any improvement in the outcomes identified during that financial year as having been so achieved (in comparison to the outcomes identified during previous financial years as having been so achieved). (3) For that purpose, the Board may also take into account either or both of the following factors— (a) relevant inequalities identified during that year; (b) any reduction in relevant inequalities identified during that year (in comparison to relevant inequalities identified during previous financial years). (4) Regulations may make provision as to the principles or other matters that the Board must or may take into account in assessing any factor mentioned in subsection (2) or (3). (5) Regulations may provide that, in prescribed circumstances, the Board may, if it considers it appropriate to do so— (a) not make a payment that would otherwise be made to a clinical commissioning group under subsection (1), or (b) reduce the amount of such a payment. (6) Regulations may make provision as to how payments under subsection (1) may be spent (which may include provision as to circumstances in which the whole or part of any such payments may be distributed to members of the clinical commissioning group). (7) A clinical commissioning group must publish an explanation of how the group has spent any payment made to it under subsection (1). (8) In this section— - “relevant services” means services provided in pursuance of arrangements made by the clinical commissioning group— 1. under section 3 or 3A or Schedule 1, or 2. by virtue of section 7A; - “relevant inequalities” means inequalities between the persons for whose benefit relevant services are at any time provided with respect to— 1. their ability to access the services, or 2. the outcomes achieved for them by their provision.

Requirement for primary medical services provider to belong to clinical commissioning group

28

• (1) In section 89 of the National Health Service Act 2006 (general medical services contracts: required terms), after subsection (1) insert—

(1A) Regulations under subsection (1) may, in particular, make provision— (a) for requiring a contractor who provides services of a prescribed description (a “relevant contractor”) to be a member of a clinical commissioning group; (b) as to arrangements for securing that a relevant contractor appoints one individual to act on its behalf in the dealings between it and the clinical commissioning group to which it belongs; (c) for imposing requirements with respect to those dealings on the individual appointed for the purposes of paragraph (b); (d) for requiring a relevant contractor, in doing anything pursuant to the contract, to act with a view to enabling the clinical commissioning group to which it belongs to discharge its functions (including its obligation to act in accordance with its constitution). (1B) Provision by virtue of subsection (1A)(a) may, in particular, describe services by reference to the manner or circumstances in which they are performed. (1C) In the case of a contract entered into by two or more individuals practising in partnership— (a) regulations making provision under subsection (1A)(a) may make provision for requiring each partner to secure that the partnership is a member of the clinical commissioning group; (b) regulations making provision under subsection (1A)(b) may make provision as to arrangements for securing that the partners make the appointment; (c) regulations making provision under subsection (1A)(d) may make provision for requiring each partner to act as mentioned there. (1D) Regulations making provision under subsection (1A) for the case of a contract entered into by two or more individuals practising in partnership may make provision as to the effect of a change in the membership of the partnership. (1E) The regulations may require an individual appointed for the purposes of subsection (1A)(b)— (a) to be a member of a profession regulated by a body mentioned in section 25(3) of the National Health Service Reform and Health Care Professions Act 2002, and (b) to meet such other conditions as may be prescribed.

• (2) In section 94 of that Act (regulations about arrangements under section 92 of that Act for provision of primary medical services), after subsection (3) insert—

(3A) Regulations under subsection (3)(d) may— (a) require a person who provides services of a prescribed description in accordance with section 92 arrangements (a “relevant provider”) to be a member of a clinical commissioning group; (b) make provision as to arrangements for securing that a relevant provider appoints one individual to act on its behalf in dealings between it and the clinical commissioning group to which it belongs; (c) impose requirements with respect to those dealings on the individual appointed for the purposes of paragraph (b); (d) require a relevant provider, in doing anything pursuant to section 92 arrangements, to act with a view to enabling the clinical commissioning group to which it belongs to discharge its functions (including its obligation to act in accordance with its constitution). (3B) Provision by virtue of subsection (3A)(a) may, in particular, describe services by reference to the manner or circumstances in which they are performed. (3C) In the case of an agreement made with two or more persons— (a) regulations making provision under subsection (3A)(a) may require each person to secure that the persons collectively are a member of the clinical commissioning group; (b) regulations making provision under subsection (3A)(b) may make provision as to arrangements for securing that the persons collectively make the appointment; (c) regulations making provision under subsection (3A)(d) may require each person to act as mentioned there. (3D) Regulations making provision under subsection (3A) for the case of an agreement made with two or more persons may make provision as to the effect of a change in the composition of the group of persons involved. (3E) The regulations may require an individual appointed for the purposes of subsection (3A)(b)— (a) to be a member of a profession regulated by a body mentioned in section 25(3) of the National Health Service Reform and Health Care Professions Act 2002, and (b) to meet such other conditions as may be prescribed.

Further provision about local authorities' role in the health service

Other health service functions of local authorities under the 2006 Act

29

• (1) The National Health Service Act 2006 (c. 41) is amended as follows.

• (2) In section 111 (dental public health)—

• (a) in subsection (1) for “A Primary Care Trust” substitute “A local authority”,

• (b) in subsection (2)—

• (i) for “Primary Care Trust” (in each place where it occurs) substitute “local authority”, and

• (ii) in paragraph (b) for “other Primary Care Trusts” substitute “other local authorities”, and

• (c) after subsection (2) insert—

(3) In this section, “local authority” has the same meaning as in section 2B.

• (3) In section 249 (joint working with the prison service) after subsection (4) insert—

(4A) For the purposes of this section, each local authority (within the meaning of section 2B) is to be treated as an NHS body.

Appointment of directors of public health

30

In Part 3 of the National Health Service Act 2006 (local authorities and the NHS) before section 74 insert—

(73A) (1) Each local authority must, acting jointly with the Secretary of State, appoint an individual to have responsibility for — (a) the exercise by the authority of its functions under section 2B, 111 or 249 or Schedule 1, (b) the exercise by the authority of its functions by virtue of section 6C(1) or (3), (c) anything done by the authority in pursuance of arrangements under section 7A, (d) the exercise by the authority of any of its functions that relate to planning for, or responding to, emergencies involving a risk to public health, (e) the functions of the authority under section 325 of the Criminal Justice Act 2003, and (f) such other functions relating to public health as may be prescribed. (2) The individual so appointed is to be an officer of the local authority and is to be known as its director of public health. (3) Subsection (4) applies if the Secretary of State— (a) considers that the director has failed or might have failed to discharge (or to discharge properly) the responsibilities of the director under— (i) subsection (1)(b), or (ii) subsection (1)(c) where the arrangements relate to the Secretary of State's functions under section 2A, and (b) has consulted the local authority. (4) The Secretary of State may direct the local authority to— (a) review how the director has discharged the responsibilities mentioned in subsection (3)(a); (b) investigate whether the director has failed to discharge (or to discharge properly) those responsibilities; (c) consider taking any steps specified in the direction; (d) report to the Secretary of State on the action it has taken in pursuance of a direction given under any of the preceding paragraphs. (5) A local authority may terminate the appointment of its director of public health. (6) Before terminating the appointment of its director of public health, a local authority must consult the Secretary of State. (7) A local authority must have regard to any guidance given by the Secretary of State in relation to its director of public health, including guidance as to appointment and termination of appointment, terms and conditions and management. (8) In this section, “local authority” has the same meaning as in section 2B.

Exercise of public health functions of local authorities

31

In Part 3 of the National Health Service Act 2006 after section 73A insert—

(73B) (1) A local authority must, in the exercise of any functions mentioned in subsection (2), have regard to any document published by the Secretary of State for the purposes of this section. (2) The functions mentioned in this subsection are— (a) the exercise by the authority of its functions under section 2B, 111 or 249 or Schedule 1, (b) the exercise by the authority of its functions by virtue of section 6C(1) or (3), (c) anything done by the authority in pursuance of arrangements under section 7A, (d) the functions of the authority under section 325 of the Criminal Justice Act 2003, and (e) such other functions relating to public health as may be prescribed. (3) The Secretary of State may give guidance to local authorities as to the exercise of any functions mentioned in subsection (2). (4) A document published under subsection (1), and guidance given under subsection (3), may include guidance as to the appointment of officers of the local authority to discharge any functions mentioned in subsection (2), and as to their terms and conditions, management and dismissal. (5) The director of public health for a local authority must prepare an annual report on the health of the people in the area of the local authority. (6) The local authority must publish the report. (7) In this section, “local authority” has the same meaning as in section 2B.

Complaints about exercise of public health functions by local authorities

32

In Part 3 of the National Health Service Act 2006 (local authorities and the NHS) after section 73B insert—

(73C) (1) Regulations may make provision about the handling and consideration of complaints made under the regulations about — (a) the exercise by a local authority of any of its public health functions; (b) the exercise by a local authority of its functions by virtue of section 6C(1) or (3); (c) anything done by a local authority in pursuance of arrangements made under section 7A; (d) the exercise by a local authority of any of its other functions— (i) which relate to public health, and (ii) for which its director of public health has responsibility; (e) the provision of services by another person in pursuance of arrangements made by a local authority in the exercise of any function mentioned in paragraphs (a) to (d). (2) The regulations may provide for a complaint to be considered by one or more of the following— (a) the local authority in respect of whose functions the complaint is made; (b) an independent panel established under the regulations; (c) any other person or body. (3) The regulations may provide for a complaint or any matter raised by a complaint— (a) to be referred to a Local Commissioner under Part 3 of the Local Government Act 1974 for the Commissioner to consider whether to investigate the complaint or matter under that Part; (b) to be referred to any other person or body for that person or body to consider whether to take any action otherwise than under the regulations. (4) Where the regulations make provision under subsection (3)(a) they may also provide for the complaint to be treated as satisfying sections 26A and 26B of the Act of 1974. (5) Section 115 of the Health and Social Care (Community Health and Standards) Act 2003 (health care and social services complaints regulations: supplementary) applies in relation to regulations under this section as it applies in relation to regulations under subsection (1) of section 113 of that Act. (6) In this section, “local authority” has the same meaning as in section 2B.

Abolition of Strategic Health Authorities and Primary Care Trusts

Abolition of Strategic Health Authorities

33

• (1) The Strategic Health Authorities continued in existence or established under section 13 of the National Health Service Act 2006 are abolished.

• (2) Chapter 1 of Part 2 of that Act (Strategic Health Authorities) is repealed.

Abolition of Primary Care Trusts

34

• (1) The Primary Care Trusts continued in existence or established under section 18 of the National Health Service Act 2006 are abolished.

• (2) Chapter 2 of Part 2 of that Act (Primary Care Trusts) is repealed.

Functions relating to fluoridation of water

Fluoridation of water supplies

35

• (1) Chapter 4 of Part 3 of the Water Industry Act 1991 (fluoridation), as amended by the Water Act 2003, is amended as follows.

• (2) In section 87 (fluoridation of water supplies at request of relevant authorities), in subsection (3)(a) for sub-paragraph (i) substitute—

(i) in relation to areas in England, are to the Secretary of State;

.

• (3) After subsection (3) of that section insert—

(3A) The Secretary of State may make a request under subsection (1) only if the Secretary of State is required to do so by section 88G(2) (following the making of a fluoridation proposal in accordance with section 88B).

• (4) In subsection (4) of that section, for paragraph (a) substitute—

(a) in relation to England, such area as the Secretary of State considers appropriate for the purpose of complying with section 88G(2);

.

• (5) After subsection (7) of that section insert—

(7A) The Secretary of State must, in relation to the terms to be included in any arrangements under this section, consult any local authority whose area includes, coincides with or is wholly or partly within the specified area. (7B) In this section and the following provisions of this Chapter “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 Common Council of the City of London.

• (6) After subsection (7B) of that section (as inserted by subsection (5) above) insert—

(7C) If the Secretary of State and the Welsh Ministers request a particular water undertaker to enter into arrangements in respect of adjoining areas— (a) they must co-operate with each other so as to secure that the arrangements (taken together) are operable and efficient; and (b) if suitable terms are not agreed for all the arrangements, a combined reference may be made by them under section 87B below to enable the terms of each set of arrangements to be determined so that they are consistent. (7D) If the Secretary of State requests a water undertaker to vary arrangements for an area which adjoins an area in respect of which the Welsh Ministers have made arrangements with the same water undertaker, the Secretary of State must co-operate with the Welsh Ministers so as to secure that following the variation the arrangements (taken together) will be operable and efficient. (7E) If the Welsh Ministers request a water undertaker to vary arrangements for an area which adjoins an area in respect of which the Secretary of State has made arrangements with the same water undertaker, the Welsh Ministers must co-operate with the Secretary of State so as to secure that following the variation the arrangements (taken together) will be operable and efficient. (7F) If suitable terms are not agreed for a variation to which subsection (7D) or (7E) applies, a combined reference may be made by the Secretary of State and the Welsh Ministers under section 87B below so that (following the variation) both sets of arrangements are consistent.

• (7) Omit subsections (8) to (10) of that section.

• (8) In subsection (11) of that section for “a relevant authority” substitute “the Welsh Ministers”.

• (9) In section 87A (target concentration of fluoridation), after subsection (3) insert—

(3A) If the Secretary of State proposes to— (a) make arrangements which provide for the concentration in the specified area (or any part of it) to be lower than the general target concentration, or (b) vary existing arrangements so that they so provide, the Secretary of State shall consult any local authority whose area includes, coincides with or is wholly or partly within the specified area.

• (10) In section 87B (fluoridation arrangements: determination of terms), in subsection (2) —

• (a) for paragraph (a) substitute—

(a) the Secretary of State may— (i) determine the terms of the arrangements as the Secretary of State sees fit; or (ii) refer the matter for determination by such other person as the Secretary of State considers appropriate; and”, and

• (b) omit paragraph (b).

• (11) In that section, in subsection (4) for the words from the beginning to “section 87(8)(b) or (10)” substitute “Where a combined reference is made under section 87(7C)(b) or 87(7F)”.

• (12) In section 87C (fluoridation arrangements: compliance), omit subsection (8).

• (13) In section 89—

• (a) in the heading, after “Consultation” insert “:Wales”,

• (b) in subsections (1) and (4) for “a relevant authority” substitute “the Welsh Ministers”,

• (c) in subsection (1) for “the appropriate authority” (in each place where it occurs) substitute “the Welsh Ministers”,

• (d) in subsection (3), in paragraph (a) for “relevant authorities” substitute “the Welsh Ministers”,

• (e) in subsection (4) for “the appropriate authority so directs” substitute “the Welsh Ministers so direct”, and

• (f) omit subsection (5).

• (14) In section 90A (review of fluoridation) after subsection (5) insert—

(5A) The relevant authority must, in exercising its functions under subsection (1)— (a) consult any local authority affected by the arrangements at such times as the relevant authority considers appropriate, and (b) in particular, consult any such local authority before it publishes a report under paragraph (b) of that subsection.

Procedural requirements in connection with fluoridation of water supplies

36

After section 88A of the Water Industry Act 1991 insert—

(88B) (1) The Secretary of State may not request a water undertaker to enter into arrangements under section 87(1) unless a fluoridation proposal is made to the Secretary of State. (2) A fluoridation proposal is a proposal that the Secretary of State enter into arrangements with one or more water undertakers to increase the fluoride content of the water supplied by the undertaker or undertakers to premises within such area or areas in England as may be specified in the proposal. (3) A fluoridation proposal may be made by one or more local authorities in England. (4) A local authority may not make a fluoridation proposal unless its area includes, coincides with or is wholly or partly within the area, or at least one of the areas, specified in the proposal. (5) In the following provisions of this Chapter, “proposer”, in relation to a fluoridation proposal, means the local authority or authorities which made the proposal. (6) Any reference in the following provisions of this Chapter to a local authority affected by a fluoridation proposal is a reference to a local authority whose area includes, coincides with or is wholly or partly within the area, or at least one of the areas, specified in the proposal. (88C) (1) This section applies if a fluoridation proposal is made. (2) The proposer must consult the Secretary of State as to whether the arrangements which would result from implementing the proposal would be operable and efficient. (3) The proposer must consult each water undertaker who supplies water to premises within the area or areas specified in the proposal as to whether the arrangements which would result from implementing the proposal, insofar as they might affect the undertaker, would be operable and efficient. (4) Each person consulted under subsection (2) or (3) must give the proposer its opinion on the matter mentioned in that subsection. (5) The proposer must notify the Secretary of State of the opinion of each water undertaker consulted under subsection (3). (6) If the Secretary of State informs the proposer that the Secretary of State is of the opinion that the arrangements would not be operable and efficient, no further steps may be taken in relation to the proposal. (88D) (1) This section applies where— (a) a fluoridation proposal is made, (b) the Secretary of State is of the opinion that the arrangements which would result from implementing the proposal would be operable and efficient, (c) one or more local authorities other than the proposer are affected by the proposal, and (d) the proposer wishes to take further steps in relation to the proposal. (2) The proposer must notify any other local authority which is affected by the proposal. (3) The proposer must make arrangements for enabling the authorities affected by the proposal to decide whether further steps should be taken in relation to the proposal. (4) The Secretary of State must by regulations— (a) make provision as to the arrangements which must be made for the purposes of subsection (3), and (b) prescribe conditions, with respect to the outcome of the arrangements, which must be satisfied before any further steps may be taken in relation to the proposal. (88E) (1) This section applies where— (a) a fluoridation proposal is made, (b) the Secretary of State is of the opinion that the arrangements which would result from implementing the proposal would be operable and efficient, (c) in a case where section 88D applies, the conditions prescribed under subsection (4)(b) of that section are satisfied, and (d) the proposer wishes to take further steps in relation to the proposal. (2) The proposer must comply with such requirements as may be prescribed in regulations made by the Secretary of State as to the steps to be taken for the purposes of consulting and ascertaining opinion in relation to the proposal. (3) The proposer may (after any requirements imposed by regulations under subsection (2) have been complied with) modify the proposal. (4) But the proposal may not be modified so as to extend the boundary of any area to which it relates, or to add another area, except in circumstances prescribed in regulations by the Secretary of State. (5) The proposer must (after any requirements imposed by regulations under subsection (2) have been complied with) decide whether to request the Secretary of State to make such requests under section 87(1) as are necessary to implement the proposal. (6) The Secretary of State may by regulations make provision— (a) as to factors which the proposer must or may take into account in making the decision mentioned in subsection (5); (b) as to the procedure to be followed by the proposer in exercising functions under or by virtue of subsection (2) or (5). (88F) (1) This section applies in relation to the exercise of functions under or by virtue of section 88E(2) to (5) (“the fluoridation functions”) except where the proposer is a single local authority and either— (a) no other local authorities are affected by the proposal, or (b) no other local authority which is affected by the proposal informs the proposer that it wishes to participate in the exercise of the fluoridation functions. (2) The local authorities affected by the proposal must— (a) arrange for an existing joint committee of the authorities to exercise the fluoridation functions, (b) establish a joint committee of the authorities for that purpose, or (c) arrange for the Health and Wellbeing Boards established by them under section 194 of the Health and Social Care Act 2012 to exercise the fluoridation functions. (3) Where arrangements are made under subsection (2)(c) the Health and Wellbeing Boards in question must exercise the power conferred by section 198(b) of the Health and Social Care Act 2012 to establish a joint sub-committee of the Boards to exercise the fluoridation functions. (4) The Secretary of State may by regulations make provision— (a) for subsection (2)(a) to apply only in relation to a joint committee which meets prescribed conditions as to its membership; (b) as to the membership of a joint committee established under subsection (2)(b) (including provision as to qualification and disqualification for membership and the holding and vacating of office as a member); (c) as to the membership of a joint sub-committee of Health and Wellbeing Boards established in accordance with subsection (3); (d) as to the procedure to be followed by any joint committee, or any joint sub-committee of Health and Wellbeing Boards, in exercising the fluoridation functions. (88G) (1) This section applies if the Secretary of State is requested to make such requests under section 87(1) as are necessary to implement a fluoridation proposal. (2) The Secretary of State must comply with the request if the Secretary of State is satisfied that the requirements imposed by sections 88B to 88F have been met in relation to the proposal. (3) Subsection (2) does not require the Secretary of State to consider the adequacy of any steps taken for the purposes of complying with any requirement to consult or to ascertain opinion which is imposed under or by virtue of section 88C(2) or (3), 88D(4) or 88E(2). (88H) (1) This section applies where a water undertaker enters into arrangements with the Secretary of State under section 87(1). (2) The Secretary of State may require all local authorities affected by the arrangements to make payments to the Secretary of State to meet any costs incurred by the Secretary of State under the terms of the arrangements. (3) The amount to be paid by each of the affected local authorities is to be determined— (a) where a joint committee, or a joint sub-committee of Health and Wellbeing Boards, has exercised the fluoridation functions of the authorities in relation to the proposal which resulted in the arrangements being made and the committee or sub-committee continues to exist at the time when the Secretary of State exercises the power conferred by subsection (2), by that committee or sub-committee; (b) in any other case, by agreement between the local authorities. (4) If the amount to be paid by the affected local authorities is not determined as mentioned in subsection (3), the Secretary of State may— (a) determine the amount to be paid, or (b) refer the matter for determination by such other person as the Secretary of State considers appropriate. (5) The amount determined in accordance with subsection (3) may, at the request of one or more of the affected local authorities, be varied with the agreement of all of them. (6) If the affected local authorities fail to reach agreement for the purposes of subsection (5), the Secretary of State may— (a) determine whether to vary the amount (and, if so, how), or (b) refer the matter for determination by such other person as the Secretary of State considers appropriate. (7) Any reference in this section to a local authority affected by arrangements under section 87(1) is a reference to a local authority whose area includes, coincides with or is wholly or partly within the area specified in the arrangements. (88I) (1) The Secretary of State may not request a water undertaker to vary arrangements entered into by the water undertaker under section 87(1) unless a proposal (“a variation proposal”) is made to the Secretary of State for a variation in the arrangements. (2) The Secretary of State may not give notice to a water undertaker under section 87C(7) to terminate arrangements entered into by the water undertaker under section 87(1) unless a proposal (“a termination proposal”) is made to the Secretary of State for the termination of the arrangements. (3) Subsection (1) does not apply in relation to a variation to provide for the concentration of fluoride in the area specified in the arrangements (or any part of it) to be lower than the general target concentration. (4) The Secretary of State may by regulations provide that subsection (1) or (2) does not apply in prescribed circumstances. (5) A variation or termination proposal may be made by one or more of the local authorities affected by the arrangements. (6) The Secretary of State may by regulations provide that, where a termination proposal is made in relation to arrangements under section 87(1), no further termination proposal may be made in relation to the arrangements until the end of such period as may be specified in the regulations. (7) In the following provisions of this Chapter, “proposer”, in relation to a variation or termination proposal, means the local authority or authorities which made the proposal. (8) Any reference in this section and in the following provisions of this Chapter to a local authority affected by a variation or termination proposal is a reference to a local authority whose area includes, coincides with or is wholly or partly within the area specified in the arrangements. (9) In relation to a proposal for the variation of the area specified in arrangements under section 87(1), any reference in this section and in the following provisions of this Chapter to a local authority affected by the proposal also includes a reference to a local authority whose area would include, coincide with or be wholly or partly within the area specified in the arrangements if the variation were made. (88J) (1) This section applies if a variation or termination proposal is made. (2) In the case of a variation proposal, the proposer must consult the Secretary of State and the water undertaker who entered into the arrangements as to whether the arrangements as varied in accordance with the proposal would be operable and efficient. (3) In the case of a termination proposal, the proposer must consult the Secretary of State and the water undertaker who entered into the arrangements as to whether it would be reasonably practicable to terminate the arrangements. (4) Each person consulted under subsection (2) or (3) must give the proposer its opinion on the matter mentioned in that subsection. (5) The proposer must notify the Secretary of State of the opinion of each water undertaker consulted under subsection (2) or (3). (6) If the Secretary of State informs the proposer that the Secretary of State is of the opinion that the arrangements as varied would not be operable and efficient or (as the case may be) that it would not be reasonably practicable to terminate the arrangements, no further steps may be taken in relation to the proposal. (88K) (1) This section applies where— (a) a variation or termination proposal is made, (b) the Secretary of State is of the opinion that the arrangements as varied would be operable and efficient or (as the case may be) that it would be reasonably practicable to terminate the arrangements, (c) one or more local authorities other than the proposer are affected by the proposal, and (d) the proposer wishes to take further steps in relation to the proposal. (2) The proposer must notify any other local authority which is affected by the proposal. (3) The proposer must make arrangements for enabling the authorities affected by the proposal to decide whether further steps should be taken in relation to the proposal. (4) The duty in subsection (3) does not apply in relation to the proposal if the Secretary of State so directs by an instrument in writing. (5) The Secretary of State may by regulations provide that the duty in subsection (3) does not apply in prescribed circumstances. (6) The Secretary of State must by regulations— (a) make provision as to the arrangements which must be made for the purposes of subsection (3), and (b) prescribe conditions, with respect to the outcome of the arrangements, which must be satisfied before any further steps may be taken in relation to the proposal. (88L) (1) This section applies where— (a) a variation or termination proposal is made, (b) the Secretary of State is of the opinion that the arrangements which would result from implementing the proposal would be operable and efficient or (as the case may be) that it would be reasonably practicable to terminate the arrangements, (c) in a case where the duty in section 88K(3) applies, the conditions prescribed under subsection (6)(b) of that section are satisfied, and (d) the proposer wishes to take further steps in relation to the proposal. (2) The proposer must comply with such requirements as may be prescribed in regulations made by the Secretary of State as to the steps to be taken for the purposes of consulting and ascertaining opinion in relation to the proposal. (3) The duty in subsection (2) does not apply in relation to the proposal if the Secretary of State so directs by an instrument in writing. (4) The Secretary of State may by regulations provide that the duty in subsection (2) does not apply in prescribed circumstances. (5) The proposer of a variation proposal may (after any requirements imposed by regulations under subsection (2) have been complied with) modify the proposal. (6) But, except in circumstances prescribed in regulations by the Secretary of State, the proposal may not be modified so as to propose the extension of the boundary of the area specified in the arrangements or, if the proposal is that the arrangements be varied so as to extend the boundary, may not be modified so as to propose a further extension of it. (7) The proposer must (after any requirements imposed by regulations under subsection (2) have been complied with) decide whether to request the Secretary of State to request the water undertaker to vary the arrangements or (as the case may be) to give notice under section 87C(7) to the water undertaker to terminate the arrangements. (8) The Secretary of State may by regulations may make provision— (a) as to factors which the proposer must or may take into account in making the decision mentioned in subsection (7); (b) as to the procedure to be followed by the proposer in exercising functions under or by virtue of subsection (2) or (7). (88M) (1) This section applies in relation to the exercise of functions under or by virtue of section 88L(2) to (7) (“the relevant functions”) except where the proposer is a single local authority and either— (a) no other local authorities are affected by the proposal, or (b) no other local authority which is affected by the proposal informs the proposer that it wishes to participate in the exercise of the functions. (2) The local authorities affected by the proposal must— (a) arrange for an existing joint committee of the authorities to exercise the relevant functions, (b) establish a joint committee of the authorities for that purpose, or (c) arrange for the Health and Wellbeing Boards established by them under section 194 of the Health and Social Care Act 2012 to exercise the relevant functions. (3) The duty in subsection (2) does not apply in relation to the proposal if the Secretary of State so directs by an instrument in writing. (4) The Secretary of State may by regulations provide that the duty in subsection (2) does not apply in prescribed circumstances. (5) Where arrangements are made under subsection (2)(c) the Health and Wellbeing Boards in question must exercise the power conferred by section 198(b) of the Health and Social Care Act 2012 to establish a joint sub-committee of the Boards to exercise the relevant functions. (6) The Secretary of State may by regulations make provision— (a) for subsection (2)(a) to apply only in relation to a joint committee which meets prescribed conditions as to its membership; (b) as to the membership of a joint committee established under subsection (2)(b) (including provision as to qualification and disqualification for membership and the holding and vacating of office as a member); (c) as to the membership of a joint sub-committee of Health and Wellbeing Boards established in accordance with subsection (5); (d) as to the procedure to be followed by any joint committee, or any joint sub-committee of Health and Wellbeing Boards, in exercising the relevant functions. (88N) (1) This section applies if (following the making of a variation or termination proposal) the Secretary of State is requested— (a) to request a variation of arrangements entered into under section 87(1), or (b) (as the case may be) to give notice under section 87C(7) to a water undertaker to terminate such arrangements. (2) The Secretary of State must comply with the request if satisfied that the requirements imposed by sections 88I to 88M have been met in relation to the proposal. (3) Subsection (2) does not require the Secretary of State to consider the adequacy of any steps taken for the purposes of complying with any requirement to consult or to ascertain opinion which is imposed under or by virtue of section 88J(2) or (3), 88K(6) or 88L(2). (88O) (1) The Secretary of State may by regulations prescribe circumstances in which arrangements must be made in accordance with the regulations— (a) for consulting and ascertaining opinion on whether arrangements under section 87(1) (“section 87(1) arrangements”) should be maintained, and (b) for enabling authorities affected by section 87(1) arrangements to decide whether to propose to the Secretary of State that they be maintained. (2) The regulations must make provision requiring the Secretary of State to give notice under section 87C(7) to a water undertaker to terminate section 87(1) arrangements entered into by the undertaker if— (a) the outcome of arrangements made by virtue of subsection (1)(b) is that the affected authorities decide not to propose that the section 87(1) arrangements be maintained, and (b) the Secretary of State is satisfied that any requirements imposed by regulations under subsection (1), as to the arrangements to be made for the purposes mentioned in that subsection, have been met. (3) Subsection (2)(b) does not require the Secretary of State to consider the adequacy of any steps taken for the purposes of complying with any requirement to consult or to ascertain opinion which is imposed by regulations made under subsection (1). (4) The provision that may be made by regulations under subsection (1) (as to the arrangements to be made for the purposes mentioned in that subsection) includes provision corresponding, or similar, to any requirements imposed by or under sections 88K to 88M.

Fluoridation of water supplies: transitional provision

37

• (1) In relation to any time on or after the commencement of section 35, any relevant arrangements which have effect immediately before its commencement are to be treated for the purposes of Chapter 4 of Part 3 of the Water Industry Act 1991 as if they were arrangements entered into by the water undertaker with the Secretary of State under section 87(1) of that Act.

• (2) In subsection (1) “relevant arrangements” means—

• (a) any arrangements entered into by a water undertaker with a Strategic Health Authority under section 87(1) of the Water Industry Act 1991, and

• (b) any arrangements which are treated as arrangements falling within paragraph (a) by virtue of section 91 of that Act (as it had effect immediately before the commencement of this section).

• (3) In its application to arrangements which are treated by virtue of subsection (1) as arrangements entered into by a water undertaker with the Secretary of State under section 87(1) of the Water Industry Act 1991, section 88H of that Act applies as if for subsection (3) there were substituted—

(3) The amount to be paid by each of the affected local authorities is to be determined by agreement between the local authorities.

.

• (4) Section 91 of the Water Industry Act 1991 (pre-1985 fluoridation schemes) ceases to have effect in relation to arrangements which are (by virtue of subsection (1)) treated as if they were arrangements entered into by a water undertaker with the Secretary of State under section 87(1) of that Act.

Functions relating to mental health matters

Approval functions

38

• (1) After section 12 of the Mental Health Act 1983 insert—

(12ZA) (1) The Secretary of State may enter into an agreement with another person for an approval function of the Secretary of State to be exercisable by the Secretary of State concurrently— (a) with that other person, and (b) if a requirement under section 12ZB has effect, with the other person by whom the function is exercisable under that requirement. (2) In this section and sections 12ZB and 12ZC, “approval function” means— (a) the function under section 12(2), or (b) the function of approving persons as approved clinicians. (3) An agreement under this section may, in particular, provide for an approval function to be exercisable by the other party— (a) in all circumstances or only in specified circumstances; (b) in all areas or only in specified areas. (4) An agreement under this section may provide for an approval function to be exercisable by the other party— (a) for a period specified in the agreement, or (b) for a period determined in accordance with the agreement. (5) The other party to an agreement under this section must comply with such instructions as the Secretary of State may give with respect to the exercise of the approval function. (6) An instruction under subsection (5) may require the other party to cease to exercise the function to such extent as the instruction specifies. (7) The agreement may provide for the Secretary of State to pay compensation to the other party in the event of an instruction such as is mentioned in subsection (6) being given. (8) An instruction under subsection (5) may be given in such form as the Secretary of State may determine. (9) The Secretary of State must publish instructions under subsection (5) in such form as the Secretary of State may determine; but that does not apply to an instruction such as is mentioned in subsection (6). (10) An agreement under this section may provide for the Secretary of State to make payments to the other party; and the Secretary of State may make payments to other persons in connection with the exercise of an approval function by virtue of this section. (12ZB) (1) The Secretary of State may impose a requirement on the National Health Service Commissioning Board (“the Board”) or a Special Health Authority for an approval function of the Secretary of State to be exercisable by the Secretary of State concurrently— (a) with the Board or (as the case may be) Special Health Authority, and (b) if an agreement under section 12ZA has effect, with the other person by whom the function is exercisable under that agreement. (2) The Secretary of State may, in particular, require the body concerned to exercise an approval function— (a) in all circumstances or only in specified circumstances; (b) in all areas or only in specified areas. (3) The Secretary of State may require the body concerned to exercise an approval function— (a) for a period specified in the requirement, or (b) for a period determined in accordance with the requirement. (4) Where a requirement under subsection (1) is imposed, the Board or (as the case may be) Special Health Authority must comply with such instructions as the Secretary of State may give with respect to the exercise of the approval function. (5) An instruction under subsection (4) may be given in such form as the Secretary of State may determine. (6) The Secretary of State must publish instructions under subsection (4) in such form as the Secretary of State may determine. (7) Where the Board or a Special Health Authority has an approval function by virtue of this section, the function is to be treated for the purposes of the National Health Service Act 2006 as a function that it has under that Act. (8) The Secretary of State may make payments in connection with the exercise of an approval function by virtue of this section. (12ZC) (1) A relevant person may provide another person with such information as the relevant person considers necessary or appropriate for or in connection with— (a) the exercise of an approval function; or (b) the exercise by the Secretary of State of the power— (i) to enter into an agreement under section 12ZA; (ii) to impose a requirement under section 12ZB; or (iii) to give an instruction under section 12ZA(5) or 12ZB(4). (2) The relevant persons are— (a) the Secretary of State; (b) a person who is a party to an agreement under section 12ZA; or (c) if the Secretary of State imposes a requirement under section 12ZB on the National Health Service Commissioning Board or a Special Health Authority, the Board or (as the case may be) Special Health Authority. (3) This section, in so far as it authorises the provision of information by one relevant person to another relevant person, has effect notwithstanding any rule of common law which would otherwise prohibit or restrict the provision. (4) In this section, “information” includes documents and records.

• (2) In section 54(1) of that Act (requirement for certain medical evidence etc. to be from practitioner approved under section 12 of the Act), after “the Secretary of State” insert “, or by another person by virtue of section 12ZA or 12ZB above,”.

• (3) In section 139(4) of that Act (protection for acts done in pursuance of the Act: exceptions), at the end insert “or against a person who has functions under this Act by virtue of section 12ZA in so far as the proceedings relate to the exercise of those functions”.

• (4) In section 145(1) of that Act (interpretation), in the definition of “approved clinician”, after “the Secretary of State” insert “or another person by virtue of section 12ZA or 12ZB above”.

• (5) In each of the following provisions, after “the Secretary of State” insert “, or by another person by virtue of section 12ZA or 12ZB of that Act,”—

• (a) in section 8(2) of the Criminal Procedure (Insanity) Act 1964 (interpretation), in the definition of “duly approved”,

• (b) in section 51(1) of the Criminal Appeal Act 1968 (interpretation), in the definition of “duly approved”,

• (c) in section 6(1) of the Criminal Procedure (Insanity and Unfitness to Plead) Act 1991 (interpretation), in the definition of “duly approved”,

• (d) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

• (e) in section 172(1) of the Armed Forces Act 2006 (fitness to stand trial etc: definition of “duly approved”), and

• (f) in section 258(5) of that Act (mentally disordered offenders), in the definition of “medical report”.

Discharge of patients

39

• (1) In section 23 of the Mental Health Act 1983 (discharge of patients), omit subsections (3) and (3A).

• (2) In section 24 of that Act (visiting and examination of patients), omit subsections (3) and (4).

• (3) In Schedule 1 to that Act (application of certain provisions of that Act to patients subject to hospital and guardianship orders)—

• (a) in Part 1, in paragraph 1, omit “24(3) and (4),”, and

• (b) in Part 2, in paragraph 1, omit “24(3) and (4),”.

• (4) In consequence of the repeals made by this section—

• (a) in the National Health Service and Community Care Act 1990, in Schedule 9—

• (i) omit paragraph 24(3)(a) and the “and” following it, and

• (ii) omit paragraph 24(4),

• (b) in the Health Authorities Act 1995, in Schedule 1, omit paragraph 107(2)(a) and (3),

• (c) in the Care Standards Act 2000, in Schedule 4, omit paragraph 9(3),

• (d) in the Health and Social Care (Community Health and Standards) Act 2003, in Schedule 4, omit paragraphs 53(a) and 54,

• (e) in the Domestic Violence, Crime and Victims Act 2004—

• (i) omit sections 37A(5), 38A(3), 43A(5) and 44A(3),

• (ii) in section 37A(7)(a), omit “, (5)”, and

• (iii) in section 43A(7), omit “, (5)”, and

• (f) in the Mental Health Act 2007, in Schedule 3, omit paragraphs 10(5) and (6) and 11(3) and (4).

After-care

40

• (1) Section 117 of the Mental Health Act 1983 (after-care) is amended as follows.

• (2) In subsection (2)—

• (a) after “duty of the” insert “clinical commissioning group or”,

• (b) omit “Primary Care Trust or” in each place it appears, and

• (c) after “such time as the” insert “clinical commissioning group or”.

• (3) After subsection (2C) insert—

(2D) Subsection (2), in its application to the clinical commissioning group, has effect as if for “to provide” there were substituted “to arrange for the provision of”. (2E) The Secretary of State may by regulations provide that the duty imposed on the clinical commissioning group by subsection (2) is, in the circumstances or to the extent prescribed by the regulations, to be imposed instead on another clinical commissioning group or the National Health Service Commissioning Board. (2F) Where regulations under subsection (2E) provide that the duty imposed by subsection (2) is to be imposed on the National Health Service Commissioning Board, subsection (2D) has effect as if the reference to the clinical commissioning group were a reference to the National Health Service Commissioning Board. (2G) Section 272(7) and (8) of the National Health Service Act 2006 applies to the power to make regulations under subsection (2E) as it applies to a power to make regulations under that Act.

• (4) In subsection (3)—

• (a) after “section “the” insert “clinical commissioning group or”,

• (b) omit “Primary Care trust or” in each place it appears, and

• (c) after “means the”, in the first place it appears, insert “clinical commissioning group or”.

• (5) In section 275 of the National Health Service Act 2006 (interpretation) after subsection (4) insert—

(5) In each of the following, the reference to section 3 includes a reference to section 117 of the Mental Health Act 1983 (after-care)— (a) in section 223K(8), paragraph (a) of the definition of “relevant services”, (b) in section 244(3), paragraph (a)(i) of the definition of “relevant health service provider”, (c) in section 252A(10), the definition of “service arrangements”, (d) section 253(1A)(d)(ii).

• (6) In section 48 of the Health and Social Care Act 2008 (special reviews and investigations), in subsection (2)(ba), after “the National Health Service Act 2006” insert “or section 117 of the Mental Health Act 1983 (after-care)”.

• (7) In section 97 of that Act (general interpretation of Part 1), in subsection (2A), after “section 7A of that Act)” insert “or section 117 of the Mental Health Act 1983 (after-care)”.

• (8) In consequence of the repeals made by subsections (2)(b) and (4)(b), omit paragraph 47 of Schedule 2 to the National Health Service Reform and Health Care Professions Act 2002.

Provision of pocket money for in-patients

41

• (1) Section 122 of the Mental Health Act 1983 (provision of pocket money for in-patients) is amended as follows.

• (2) In subsection (1)—

• (a) for “Secretary of State may” substitute “Welsh Ministers may (in relation to Wales)”,

• (b) for “he thinks fit” substitute “the Welsh Ministers think fit”,

• (c) for “their” substitute “those persons'”,

• (d) for “him” substitute “the Welsh Ministers”, and

• (e) for “they” substitute “those persons”.

• (3) In subsection (2)—

• (a) omit “the National Health Service Act 2006 and”, and

• (b) for “either of those Acts” substitute “that Act”.

• (4) In section 146 of that Act (application to Scotland), omit “122,”.

Transfers to and from special hospitals

42

• (1) Omit section 123 of the Mental Health Act 1983 (transfers to and from special hospitals).

• (2) In section 68A of that Act (power to reduce periods after which cases must be referred to tribunal), in subsection (4)—

• (a) after paragraph (c), insert “or”,

• (b) omit the “or” following paragraph (d), and

• (c) omit paragraph (e).

• (3) In section 138 of that Act (retaking of patients escaping from custody), in subsection (4)(a), omit “or under section 123 above”.

• (4) In consequence of the repeal made by subsection (1), omit paragraph 67 of Schedule 4 to the Health Act 1999.

• (5) This section does not affect—

• (a) the authority for the detention of a person who is liable to be detained under the Mental Health Act 1983 before the commencement of this section,

• (b) that Act in relation to any application, order or direction for admission or removal to a hospital made under that Act before that commencement, or

• (c) the authority for the retaking of a person who, before that commencement, escapes while being taken to or from a hospital as mentioned in section 138(4)(a) of that Act.

Independent mental health advocates

43

• (1) In section 130A of the Mental Health Act 1983 (independent mental health advocates: England), in subsection (1)—

• (a) for “The Secretary of State” substitute “A local social services authority whose area is in England”, and

• (b) at the end insert “for whom the authority is responsible for the purposes of this section”.

• (2) In subsection (4) of that section, for “the Secretary of State” substitute “a local social services authority”.

• (3) In section 130C of that Act (provision supplementary to section 130A), after subsection (4) insert—

(4A) A local social services authority is responsible for a qualifying patient if— (a) in the case of a qualifying patient falling within subsection (2)(a) above, the hospital or registered establishment in which he is liable to be detained is situated in that authority's area; (b) in the case of a qualifying patient falling within subsection (2)(b) above, that authority is the responsible local social services authority within the meaning of section 34(3) above; (c) in the case of a qualifying patient falling within subsection (2)(c), the responsible hospital is situated in that authority's area; (d) in the case of a qualifying patient falling within subsection (3)— (i) in a case where the patient has capacity or is competent to do so, he nominates that authority as responsible for him for the purposes of section 130A above, or (ii) in any other case, a donee or deputy or the Court of Protection, or a person engaged in caring for the patient or interested in his welfare, nominates that authority on his behalf as responsible for him for the purposes of that section. (4B) In subsection (4A)(d) above— (a) the reference to a patient who has capacity is to be read in accordance with the Mental Capacity Act 2005; (b) the reference to a donee is to a donee of a lasting power of attorney (within the meaning of section 9 of that Act) created by the patient, where the donee is acting within the scope of his authority and in accordance with that Act; (c) the reference to a deputy is to a deputy appointed for the patient by the Court of Protection under section 16 of that Act, where the deputy is acting within the scope of his authority and in accordance with that Act.