The Act
14.The Act is in three parts:
Part 1 makes changes to the way the National Health Service (NHS) is managed and funded, including the renaming of HAs as Strategic Health Authorities, the distribution and allocation of functions between Strategic Health Authorities and PCTs and the allocation of funding in England. For Wales, it deals with the establishment and funding of LHBs and a duty to devise health and well-being strategies. Part 1 also extends the role of CHI, reforms the structures for patient and public involvement in the NHS, and provides for joint working between NHS bodies and the prison service.
Part 2 covers the regulation of the health care professions: the establishment and functions of the Council for the Regulation of Health Care Professionals; the transfer of some ‘fitness to practise’ appeals from the Privy Council to the High Court; and a modification of the powers conferred by section 60 of the Health Act as it affects the regulation of the pharmacy profession.
Part 3 deals with various miscellaneous and supplementary provisions.
15.Part 1 is concerned with the NHS. It changes the structure of the health service in both England and Wales and the way in which it is funded. It changes the ways in which patients and the public are involved in the management of the NHS in England and the ways in which the NHS works with the prison service. It extends the role of CHI. Sections 1 to 5 relate to the structural change in England. Section 1 changes the name of HAs in England to Strategic Health Authorities. Many functions of HAs will, as part of these changes, be re-allocated to PCTs who will become the lead NHS organisation in assessing need, planning and securing all health services and improving health. Provision is made to give the Secretary of State power to make regulations containing requirements to carry out consultation before making an order relating to Strategic Health Authorities. Section 2 places upon the Secretary of State a duty to create PCTs for all areas of England, and makes provision to allow for PCTs which straddle Strategic Health Authority boundaries. Section 2 also removes the existing option for the Assembly to establish PCTs in Wales which has never been exercised and which is to be replaced in this Act by a power to establish LHBs (seesection 6). Section 3 makes further provision to underpin this changed role by creating a power for the Secretary of State to delegate his own health functions directly to PCTs.
16.Section 4 contains amendments relating to Personal Medical Services (“PMS”); Personal Dental Services (“PDS”) and Local Pharmaceutical Services (“LPS”) to take account of the replacement of HAs by Strategic Health Authorities and also the transfer of certain PMS, PDS and LPS functions from HAs to PCTs.
17.Section 5 addresses a further consequence of the devolution of functions to PCTs by providing for the responsibility of recognising Local Representative Committees (“LRCs”) in England to become a PCT function.
18.Section 6 allows for the establishment of LHBs in Wales to exercise health functions as directed by the Assembly.
19.Sections 7 to 10 change the way in which NHS bodies are funded, as a consequence of the devolution of functions from HAs to PCTs in England and the creation of LHBs in Wales. Section 7 provides for the funding of Strategic Health Authorities and section 8 provides for PCTs to be funded directly by the Secretary of State rather than by HAs. It also gives power to make payments based on performance direct to PCTs rather than through the HA. Section 9 provides for the funding of LHBs. Section 10 makes further provision relating to the expenditure of NHS organisations.
20.Sections 11 to 14 clarify the extent of the duty of quality on NHS bodies and extend the role of CHI. As a result of the Act’s provisions, CHI will be able to inspect NHS bodies, service providers, and bodies providing NHS services on their behalf and recommend to the Secretary of State that special measures are taken where services are of unacceptably poor quality or there are significant failings in the way a body providing NHS services is being run. The Act enables certain of CHI’s functions to be carried out by what will be known as the Office for Information on Health Care Performance.
21.Sections 15 to 22 complete the new arrangements to reform public and patient involvement in the NHS started in the HSC Act. Sections 15 to 19 establish statutory Patients’ Forums, one for every PCT and every NHS trust in England, and set out provisions for their functions and operation. These bodies are intended to ensure that patients’ views are taken into account by those delivering NHS services. PCT Patients’ Forums will, in addition, promote wider community involvement in local health decisions and commission and provide Independent Advocacy Services. Section 20 establishes CPPIH which will have a role at national level in terms of issuing guidance and training on involvement issues, and advising the Secretary of State and other bodies, facilitating the co-ordination of Patients’ Forum activities and setting and monitoring quality standards for Patients’ Forums and providers of Independent Advocacy Services. Section 21 provides for a referral process by overview and scrutiny committees to the Secretary of State for Health and to the Assembly. In the light of these new provisions section 22 abolishes CHCs in England only, but not in Wales. It also abolishes ACHCEW, and ensures that the Assembly may continue to exercise the power to establish a new body to advise and assist CHCs in Wales.
22.Section 23 mirrors for the prison service the arrangements set out in section 31 of the Health Act for the NHS to work jointly with other bodies.
23.Section 24 introduces a duty on each LHB, once created, and each Local Authority in Wales to formulate health and well-being strategies in Wales.
24.Part 2 of the Act concerns the regulation of the health care professions. Sections 25 to 29 deal with the establishment of the Council and set out its duties and functions. The purpose of the Council is to co-ordinate the work of the regulatory bodies, formulate principles of good regulation, encourage regulatory bodies to conform to these principles and act in the interests of patients and the public.
25.Sections 30 to 34 make changes to some ‘fitness to practise’ appeals procedures, moving them from the Judicial Committee of the Privy Council to the High Court (or its Scottish and Northern Irish equivalents). They also bring greater consistency to the route taken by appeals against registration decisions. The professions affected by the changes in these sections are medical practitioners; dentists; opticians; osteopaths and chiropractors.
26.Section 35 extends the powers conferred by section 60 of the Health Act (which deals with the modification of legislation governing the regulation of health care professions) to bring those powers in respect of pharmacy more into line with those for other professions.
27.Part 3 of this Act includes a number of miscellaneous and supplementary provisions.
28.Annex A to this document sets out the existing legal framework for the NHS prior to implementation of this Act. Annex B sets out the effects of the Act in relation to Wales only.
