3.In December 1997 and January 1998, the Government published White Papers on its proposals for the National Health Service in England, Scotland and Wales (Cm 3807 The new NHS; Cm 3811 Designed to Care; Cm 3841 Putting Patients First). Further to the White Paper The new NHS, detailed proposals on quality and partnership in England were set out in the consultation document A First Class Service (HSC 1998/113), published in July 1998, and the discussion document Partnership in Action, published in September 1998. Further to the White Paper Putting Patients First, detailed proposals on quality and partnership in Wales were set out in the consultation documents Quality Care and Clinical Excellence, published in July 1998 and Partnership for Improvement, published in October 1998. Action has already been taken to implement many of the proposals set out in these documents. The Act implements those proposals that require primary legislation.
4.The Act’s main purpose is to make changes to the way in which the National Health Service is run in England, Wales and Scotland. The Act abolishes GP fund-holding in all three countries. It amends the National Health Service Act 1977 to make provision for the establishment of new statutory bodies in England and Wales to be known as Primary Care Trusts, and provides for NHS trusts in Scotland to take on additional functions.
5.The Act amends the legislative framework for NHS trusts. It makes changes to the provisions in the National Health Service and Community Care Act 1990 concerning the establishment of NHS trusts, including retrospective changes to the purposes for which NHS trusts are established, and to the current NHS trust financial regime. It extends the Secretary of State’s current powers of direction in respect of NHS trusts to cover all their functions, in line with other NHS bodies. It also replaces the provisions about special hospitals to enable NHS trusts in England and Wales, with Secretary of State approval, to provide high security psychiatric services.
6.The Act provides for new arrangements aimed at improving the quality of the care provided to patients receiving NHS services. It places a new statutory duty of quality on Health Authorities, NHS trusts and Primary Care Trusts and establishes a new statutory body for England and Wales, to be known as the Commission for Health Improvement, to monitor and help improve the quality of health care provided by the NHS. It also introduces measures to enable the Secretary of State to require general medical practitioners, general dental practitioners, ophthalmic opticians (also known as optometrists) and pharmacists to hold approved indemnity cover.
7.The Act creates a new duty of co-operation within the NHS and extends the duty of co-operation between NHS bodies and local authorities in England and Wales. It provides for local strategies to be developed for improving health and health care, and for new operational flexibilities to allow NHS bodies and local authorities to enter into joint arrangements for the purchase or provision of health and health-related services (e.g. social care). The Act also provides for the allocation of additional funding to Health Authorities on the basis of their past performance.
8.The Act introduces a number of measures designed to tackle fraud against the NHS. It introduces a civil penalty to be imposed where a person fails to pay an NHS charge, or claims a payment to which he is not entitled, towards the cost of an NHS charge or service. It creates a new criminal offence in England and Wales of knowingly making false representations to obtain exemption or remission from NHS charges. It also extends the functions of the NHS Tribunal to enable it to impose sanctions specifically on family health service practitioners who have defrauded the NHS.
9.In addition, the Act provides for the Secretary of State for Health to make regulations and directions securing compliance with aspects of a negotiated pharmaceutical price regulation scheme, to regulate the profits of companies outside the negotiated agreement and to set maximum prices for medicines supplied to the NHS. It amends the powers of the Health Service Commissioner to release information. It also enables Her Majesty to regulate health care professions by Order in Council and to make provision by Order in Council for the exercise of NHS functions across the English/Scottish border.