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Health Act 2009

Part 1.Quality and Delivery of NHS Services in England

General Background: NHS Next Stage Review

8.In a statement to the House of Commons on 4 July 2007(1), the Secretary of State for Health, Rt Hon. Alan Johnson, announced a review of the National Health Service (NHS). The NHS Next Stage Review, which was led by Lord Darzi of Denham, sought to develop a plan for the NHS over the next decade by engaging with patients, staff and the public.

9.On 4 October 2007 the Interim Report, Our NHS, Our Future,(2) was published. The Interim Report set out a 10 year plan for the NHS and considered how the NHS could become fairer and more personalised, effective and safe. It set out immediate and longer term priorities in these areas.

10.The NHS Next Stage Review Final Report, High Quality Care for All,(3) was published on 30 June 2008. The Final Report responds to the ten Strategic Health Authority strategic plans and puts forward a strategy for the NHS with a focus on quality.

11.This Act implements the parts of the NHS Next Stage Review that require primary legislation. The Act includes provisions concerning the NHS Constitution, Quality Accounts and direct payments for NHS healthcare services.

Chapter 1 - NHS Constitution

12.The Interim Report published in October 2007 set out the case for an NHS Constitution. This was said to be

to enshrine the values of the NHS and increase local accountability to patients and public.

13.On 30 June 2008, the Department of Health published A Consultation on the NHS Constitution(4). The NHS Constitution and the Handbook to the Constitution were published on 21 January 2009(5).

14.The sections of the Act on the NHS Constitution set out duties of specified bodies involved in the provision, commissioning or regulation of NHS care and of other persons providing NHS services under contracts or arrangements. The Act provides that those bodies are to have regard to the NHS Constitution, and for the Secretary of State to review the NHS Constitution at least every ten years, after consultation with patients and bodies representing patients, the public, staff and bodies representing staff, carers and local authorities. The Act also provides that the Secretary of State must revise the accompanying Handbook to the NHS Constitution at least every three years. The Secretary of State must also report on the effect of the NHS Constitution on patients, the public, staff and carers every three years.

Chapter 2 - Quality Accounts

15.High Quality Care for All said that from April 2010 all healthcare providers working for or on behalf of the NHS would be placed under a legal requirement to publish an annual Quality Account. Sections 8 and 9 of the Act therefore place a duty on those providers although section 8 also gives the Secretary of State a regulation-making power enabling the Secretary of State to exempt prescribed persons, or the providers of prescribed services, from this requirement.

16.The duty is to publish prescribed information about quality of services for the period 1 April to 31 March each year. Section 8 gives the Secretary of State a further regulation-making power, including power to determine the form, content and timetable for publication of a Quality Account.

Chapter 3 - Direct payments

17.The Government made a commitment in High Quality Care for All to pilot personal health budgets, including piloting direct payments for health care where this would make most sense for particular patients in certain circumstances. Direct payments are monetary payments to patients with which they can procure health care services.

18.The Department published Personal Health Budgets: First Steps in January 2009, setting out its intentions for personal health budgets, including direct payments.(6)

19.Direct payments have been used in lieu of social care services for some time. Social care direct payments are payments for individuals to purchase services from various providers directly, to meet their social care needs. The Act allows for a similar model of direct payments to be used for health care.

20.Section 11 in Chapter 3 of Part 1 of the Act amends the National Health Service Act 2006 (NHS Act) to allow the Secretary of State to make monetary payments to patients in lieu of providing them with health care services. In practice the intention is to delegate this power to local NHS organisations, generally Primary Care Trusts (PCTs), though some Strategic Health Authorities or Special Health Authorities may also wish to use direct payments. Initially, the power will be available under regulations in pilot schemes only.

21.Direct payments for health care will allow patients to purchase health care services directly from a variety of providers, including private organisations and the voluntary sector.

22.The Act provides powers to allow the Secretary of State to make regulations to govern the operation of direct payments and direct payment pilot schemes. The regulations may make provision about the persons who might receive direct payments, potentially appropriate health conditions and the services in respect of which payments could be made. The regulations may also specify categories of patients who would not be able to access direct payments for health care, or services that could not be purchased. The regulations may provide for the necessary monitoring in order to ensure accountability and that direct payments are effective in meeting the health outcomes agreed between a patient and the NHS. Provision could also be made for money to be recouped in the event of a large surplus or misuse of direct payments.

23.The Government intends that every pilot scheme will be reviewed. The Government intends that the pilot programme as a whole should be reviewed by an independent person, the review should be published, and it should examine a range of issues. These include the administration of direct payments, the effect of direct payments on cost or quality of care, and the effect of direct payments on the behaviour of patients, carers or people providing services. Provision for review of a pilot scheme must be made in regulations.

24.Following a review there is an order making power, subject to approval by each House of Parliament under the affirmative resolution procedure, to remove the requirement that payments be made through a pilot scheme so that direct payments could become more generally available while still following rules in a framework established by regulations.

Chapter 4 - Innovation

25.High Quality Care for All stated the Government’s intention to create prizes for innovation that directly benefits patients and the public. Section 14 will enable the Secretary of State to make payments to promote innovation in the provision of health services.


Department of Health (2007). – Our NHS, Our Future - NHS Next Stage Review Interim Report. Department of Health, London. Available at: [2]


Department of Health (2008). High Quality Care for All - NHS Next Stage Review Final Report,. CM 7432. Department of Health, London.

Available at: [3]


Department of Health (2008). The National Health Service Constitution – A Draft for Consultation, July 2008. Department of Health, London.


Department of Health (2009). The NHS Constitution for England, 21 January 2009. Department of Health, London. Available at:

Department of Health (2009). The Handbook to the NHS Constitution for England, 21 January 2009. Department of Health, London. Available at: [5]


Department of Health (2007), Personal Health Budgets: First Steps, Department of Health, London. Available at: [6]

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