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Amendments to the Health Bill [H.L.]

Health Bill [H.L.] -
Amendments to be debated in the House of Lords

Here you can browse the Marshalled List of ] Amendments to the Health Bill [H.L.] to be moved on Report in the House of Lords.

 The amendments have been marshalled in accordance with the order of 11th March 1999, as follows-- 
 Clauses 1 and 2
Schedule 1
Clauses 3 to 14
Schedule 2
Clauses 15 to 47
Schedule 3
Clauses 48 to 50
Schedules 4 and 5
Clauses 51 to 54
 
 [Amendments marked * are new or have been altered] 
Amendment
No.
 
  
Clause 2
 
  
BY THE BARONESS HAYMAN
 
1     Page 1, line 15, at end insert ("with a view, in particular, to their--
    (a)  providing or arranging for the provision of services under this Part of this Act,
    (b)  exercising functions in relation to the provision of general medical services under Part II of this Act, and
    (c)  providing services in accordance with section 28C arrangements.")
 
  
BY THE EARL HOWE
THE LORD McCOLL OF DULWICH
THE LORD ASTOR OF HEVER
 
2     Page 1, line 17, at end insert ("and following a majority vote by the members of the Primary Care Group concerned after consultation with all health care professionals that would be covered by the Primary Care Trust.") 
  
BY THE LORD CLEMENT-JONES
THE BARONESS THOMAS OF WALLISWOOD
THE EARL HOWE
 
3     Page 1, line 17, at end insert--
        ("(  )  For the purposes of this Act "a Primary Care Trust" means a body corporate, established by a PCT order, which is responsible for promoting and improving the health of its local community in the context of a plan prepared under section 21 of the Health Act 1999.")
 
4     Page 2, line 6, at end insert--
        ("(  )  In making regulations about consultation requirements regard shall be had to the interests of key partners in the delivery of NHS healthcare and the promotion of health.")
 
5     Page 2, line 6, at end insert--
        ("(  )  Before the Secretary of State shall make a PCT order he must, except in exceptional circumstances, be satisfied in respect of the relevant Primary Care Trust that the majority of the members of the Primary Care Group or Groups for the equivalent area have agreed to the making of the PCT order.")
 
  
BY THE LORD CLEMENT-JONES
THE BARONESS THOMAS OF WALLISWOOD
THE EARL HOWE
THE LORD ASTOR OF HEVER
 
6     Page 2, line 27, at end insert--
        ("(  )  Appropriate arrangements shall be made with a view to securing that a Primary Care Trust's functions are exercised with due regard to the principle that there should be equality of opportunity for all people."")
 
  
Schedule 1
 
  
BY THE LORD CLEMENT-JONES
THE BARONESS THOMAS OF WALLISWOOD
THE EARL HOWE
 
7     Page 42, line 5, at end insert--
 
    ("(2)  The number of persons referred to in sub-paragraph (1)(c) above shall include representatives of key partners in the delivery of NHS healthcare and the promotion of health in the locality.")
 
  
BY THE EARL HOWE
THE LORD McCOLL OF DULWICH
THE LORD ASTOR OF HEVER
 
8     Page 42, line 37, after ("members") insert (,provided that not more than half of the membership appointments are vacant,") 
  
BY THE LORD CLEMENT-JONES
THE BARONESS THOMAS OF WALLISWOOD
THE EARL HOWE
THE LORD ASTOR OF HEVER
 
9     Page 44, line 26, after ("promote") insert ("equal opportunities and") 
  
BY THE EARL HOWE
THE LORD MCCOLL OF DULWICH
THE LORD ASTOR OF HEVER
 
10     Page 44, line 27, at end insert (", including details of the proportion of income spent on administration.") 
  
BY THE LORD CLEMENT-JONES
THE BARONESS THOMAS OF WALLISWOOD
 
11     Page 44, line 32, leave out ("may") and insert ("must") 
  
Clause 3
 
  
BY THE EARL HOWE
THE LORD McCOLL OF DULWICH
THE LORD ASTOR OF HEVER
 
12     Page 2, line 38, at end insert (", including an identified minimum sum to meet the need for investment in primary care") 
  
BY THE BARONESS HAYMAN
 
13     Page 2, leave out lines 39 to 45 
  
BY THE EARL HOWE
THE LORD McCOLL OF DULWICH
THE LORD ASTOR OF HEVER
 
14     Page 4, line 33, at end insert--
        ("(9)  The Secretary of State shall provide guidance to Primary Care Trusts regarding appropriate levels of expenditure on research and development, training and tertiary services."")
 
  
After Clause 3
 
  
BY THE BARONESS HAYMAN
 
15     Insert the following new Clause-- 
     (".--(1) After Schedule 12 to the 1977 Act there is inserted--Expenditure of Health Authorities and Primary Care Trusts.
 SCHEDULE 12A 
 EXPENDITURE OF HEALTH AUTHORITIES AND PRIMARY CARE TRUSTs 
 Health Authorities: general Part II expenditure 
 
        1.--(1) In section 97 above and this Schedule, general Part II expenditure, in relation to a Health Authority, means expenditure of the authority which--
      (a)  is attributable to the payment of remuneration to persons providing services in pursuance of Part II of this Act, and
      (b)  is not excluded by sub-paragraph (2) below.
        (2)  Expenditure is excluded if it is attributable to--
      (a)  the reimbursement of expenses of persons providing services in pursuance of Part II which are designated expenses incurred in connection with the provision of the services (or in giving instruction in matters relating to the services),
      (b)  remuneration referable to the cost of drugs,
      (c)  remuneration paid to persons providing additional pharmaceutical services (in accordance with directions under section 41A above), in respect of such of those services as are designated, or
      (d)  remuneration of a designated description which is determined by the Health Authority and paid to persons providing general medical services in pursuance of Part II.
 
 Health Authorities: main expenditure 
 
        2.--(1) In section 97 above, main expenditure, in relation to a Health Authority and the year in question, means--
      (a)  expenditure of the authority mentioned in sub-paragraph (2) below,
      (b)  any other expenditure of the authority attributable to the performance of their functions in that year (other than general Part II expenditure and remuneration referable to the cost of drugs), and
      (c)  expenditure attributable to remuneration referable to the cost of drugs for which the authority are accountable in that year (whether paid by them or another authority).
        (2)  The expenditure referred to in sub-paragraph (1)(a) above is expenditure attributable to--
      (a)  the reimbursement in that year of expenses of persons providing services in pursuance of Part II which are designated expenses incurred in connection with the provision of the services (or in giving instruction in matters relating to the services),
      (b)  remuneration paid in that year to persons providing additional pharmaceutical services (in accordance with directions under section 41A above), in respect of such of those services as are designated, or
      (c)  remuneration of a designated description which is determined by the Health Authority and paid in that year to persons providing general medical services in pursuance of Part II.
        3.--(1) For each financial year, the Secretary of State shall apportion, in such manner as he thinks appropriate, among all Health Authorities the total of the remuneration referable to the cost of drugs which is paid by each Health Authority in that year.
        (2)  A Health Authority are accountable in any year for remuneration referable to the cost of drugs to the extent (and only to the extent) that such remuneration is apportioned to them under sub-paragraph (1) above.
        (3)  Where in any financial year any remuneration referable to the cost of drugs for which a Health Authority are accountable is paid by another Health Authority, the remuneration is to be treated (for the purposes of sections 97 and 97A above) as having been paid by the first authority in the performance of their functions.
        (4)  The Secretary of State may, in particular, exercise his discretion under sub-paragraph (1) above--
      (a)  so that any apportionment reflects, in the case of each Health Authority, the financial consequences of orders for the provision of drugs, being orders which in his opinion are attributable to the authority in question,
      (b)  by reference to averaged or estimated amounts.
        (5)  The Secretary of State may make provision for any remuneration referable to the cost of drugs which is paid by a Health Authority other than the Health Authority which are accountable for the payment to be reimbursed in such manner as he may determine.
 
 PCTs: general Part II expenditure 
 
        4.--(1) In section 97C above and this Schedule, general Part II expenditure, in relation to a Primary Care Trust, means expenditure of the trust which--
      (a)  is attributable to the payment of remuneration to persons providing services in pursuance of Part II of this Act, and
      (b)  is not excluded by sub-paragraph (2) below.
        (2)  Expenditure is excluded if it is attributable to--
      (a)  the reimbursement of expenses of persons providing services in pursuance of Part II which are designated expenses incurred in connection with the provision of the services (or in giving instruction in matters relating to the services), or
      (b)  remuneration of a designated description which is determined by the Health Authority within whose area the area of the trust falls and paid to persons providing general medical services in pursuance of Part II.
 
 PCTs: main expenditure 
 
        5.--(1) In section 97C above, main expenditure, in relation to a Primary Care Trust and the year in question, means--
      (a)  expenditure of the trust mentioned in sub-paragraph (2) below, and
      (b)  any other expenditure of the trust attributable to the performance of its functions in that year (other than general Part II expenditure),
    and is to be treated as including any expenditure apportioned to the trust for that year under paragraph 6 below.
        (2)  The expenditure referred to in sub-paragraph (1)(a) above is expenditure attributable to--
      (a)  the reimbursement in that year of expenses of persons providing services in pursuance of Part II which are designated expenses incurred in connection with the provision of the services (or in giving instruction in matters relating to the services), or
      (b)  remuneration of a designated description which is determined by the Health Authority within whose area the area of the trust falls and paid in that year to persons providing general medical services in pursuance of Part II.
        6.--(1) For each financial year, a Health Authority may apportion, to such extent and in such manner as they think appropriate, among the Primary Care Trusts whose areas fall within their area, the remuneration referable to the cost of drugs for which the authority are accountable in that year.
        (2)  Where in any financial year--
      (a)  any remuneration referable to the cost of drugs for which the Health Authority are accountable is paid (whether by them or another Health Authority), and
      (b)  that remuneration is apportioned to a Primary Care Trust under sub-paragraph (1) above,
    that remuneration is to be treated for the purposes of sections 97C and 97D as having been paid by the trust in the performance of its functions.
 
 Interpretation 
 
        7.--(1) In this Schedule--
      designated" means designated in writing by the Secretary of State (and different designations may be made for different purposes),
      drugs" includes medicines and listed appliances (within the meaning of section 41 above),
      pharmaceutical services" does not include additional pharmaceutical services.
        (2)  The Secretary of State shall determine what remuneration paid by Health Authorities to persons providing pharmaceutical services is to be treated for the purposes of this Schedule as remuneration referable to the cost of drugs.
        (3)  The Secretary of State may treat all remuneration paid by Health Authorities to such persons, so far as it is met by an NHS trust or Primary Care Trust under section 103(3) below, as remuneration referable to the cost of drugs for those purposes."
    (2)  Section 97 of the 1977 Act is amended as follows--
    (a)  subsection (2) is omitted,
    (b)  in subsection (3), at the end there is inserted "in that year",
    (c)  for subsections (3A) and (3B) there is substituted--
        (3BB)  Schedule 12A to this Act (which defines "general Part II expenditure" and "main expenditure" for the purposes of, and supplements, this section and section 97C below) shall have effect".
    (3)  Section 103(3) of the 1977 Act (special arrangements as to payment of remuneration) is amended as follows--
    (a)  in paragraph (a), for the words from "the Health Authority" to the end of that paragraph there is substituted "a Health Authority so determined in respect of the whole or any part of that remuneration",
    (b)  in paragraph (b), for "that" there is substituted "the whole or (as the case may be) that part of the".
    (4)  This section has effect for the financial years 1999-2000 and subsequent financial years.")
 
  
Clause 4
 
  
BY THE EARL HOWE
THE LORD McCOLL OF DULWICH
THE LORD ASTOR OF HEVER
 
16     Page 4, leave out lines 40 to 44 
  
Clause 6
 
  
BY THE BARONESS HAYMAN
 
17     Page 6, line 14, leave out ("(3B)") and insert ("(3BB)") 
18     Page 6, leave out line 38 and insert-- 
 
      ("amount,
 
 by an amount not exceeding that sum".") 
  
After Clause 6
 
  
BY THE BARONESS HAYMAN
 
19     Insert the following new Clause-- 
     (".--(1) Before section 44 of the 1977 Act there is inserted--Indemnity cover for Part II services.
 Indemnity cover 
 Indemnity cover.     43C.--(1) Regulations may make provision for the purpose of securing that, in prescribed circumstances, prescribed Part II practitioners hold approved indemnity cover.
 
    (2)  The regulations may, in particular, make provision as to the consequences of a failure to hold approved indemnity cover, including provision--
    (a)  for securing that a person is not to be added to any list unless he holds approved indemnity cover;
    (b)  for the removal from a list prepared by a Health Authority of a Part II practitioner who does not within a prescribed period after the making of a request by the Health Authority in the prescribed manner satisfy the Health Authority that he holds approved indemnity cover.
    (3)  For the purposes of this section--
    approved body" means a person or persons approved in relation to indemnity cover of any description, after such consultation as may be prescribed, by the Secretary of State or by such other person as may be prescribed;
    approved indemnity cover" means indemnity cover made--
          (a)  on prescribed terms; and
          (b)  with an approved body;
    indemnity cover", in relation to a Part II practitioner (or person who proposes to provide Part II services), means a contract of insurance or other arrangement made for the purpose of indemnifying him and any person prescribed in relation to him to any prescribed extent against any liability which--
          (a)  arises out of the provision of Part II services in accordance with arrangements made by him with a Health Authority under this Part of this Act; and
          (b)  is incurred by him or any such person in respect of the death or personal injury of a person;
    list" has the same meaning as in section 46 below;
    Part II practitioner" means a person whose name is on a list;
    Part II services" means general medical services, general dental services, general ophthalmic services or pharmaceutical services;
    personal injury" means any disease or impairment of a person's physical or mental condition and includes the prolongation of any disease or such impairment;
and a person holds approved indemnity cover if he has entered into a contract or arrangement which constitutes approved indemnity cover.
 
    (5)  The regulations may provide that a person of any description who has entered into a contract or arrangement which is--
    (a)  in a form identified in accordance with the regulations in relation to persons of that description; and
    (b)  made with a person or persons so identified,
is to be treated as holding approved indemnity cover for the purposes of the regulations."
 
     (2)  In section 29A of the 1977 Act (medical lists), at the beginning of subsection (3) there is inserted "Subject to any provision made under section 43C below,".
 
    (3)  In section 36 of that Act (regulations as to arrangements for general dental services), in subsection (1)(b), after "below" there is inserted "to any provision made under section 43C below".
 
    (4)  In section 39 of that Act (regulations as to arrangements for general ophthalmic services), in subsection (1)(b), after "subject" there is inserted "to any provision made under section 43C below".")
 
  
Clause 7
 
  
BY THE BARONESS MASHAM OF ILTON
THE LORD CLEMENT-JONES
THE EARL HOWE
THE LORD McCOLL OF DULWICH
 
20     Page 7, line 17, at end insert--
        ("(  )  The power conferred by subsection (1) shall be exercised so as to enable patients resident in an area covered by a body referred to in that subsection to be referred out of that area where appropriate for the purpose of receiving specialist hospital treatment and after-care.")
 
  
BY THE EARL HOWE
THE LORD McCOLL OF DULWICH
THE LORD ASTOR OF HEVER
 
21     Page 7, line 28, at end insert--
 
    ("(4)  The Secretary of State may direct NHS Trusts to establish that number of consultant posts recommended centrally in order to deliver a consultant-based service.
 
    (5)  In pursuance of subsection (4) the Secretary of State shall establish the appropriate mechanism to ensure that agreement is reached centrally on the relationship between the number of junior staff in training and the number of consultants required.")
 
22     Page 8, leave out lines 22 to 30 
  
Clause 8
 
  
BY THE EARL HOWE
THE LORD McCOLL OF DULWICH
THE LORD ASTOR OF HEVER
 
23     Page 9, line 2, at end insert--
 
    ("(  )  The functions which shall be specified in an order under subsection (1) above include a duty to comply with any direction the Secretary of State may make in respect of the establishment of an occupational health service.")
 
 
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