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Amendments to the Health and Social Care (Community Health and Standards) Bill

Health and Social Care (Community Health and Standards) Bill


MARSHALLED
LIST OF AMENDMENTS
TO BE MOVED
IN COMMITTEE


      The amendments have been marshalled in accordance with the Instruction that the House will be invited to agree on 6th October—

Clause 1
Schedule 1
Clause 2
Schedule 2
Clauses 3 to 25
Schedule 3
Clauses 26 to 34
Schedule 4
Clauses 5 to 37
Schedule 5
Clauses 38 to 40
Schedule 6
Clause 41
Schedule 7
Clause 42
Schedule 8
Clauses 43 to 143
Schedule 9
Clauses 144 to 146
Schedule 10
Clauses 147 to 180
Schedule 11
Clauses 181 to 183
Schedule 12
Clauses 184 to 186
Schedule 13
Clauses 187 to 192
Schedule 14
Clauses 193 to 198

[Amendments marked * are new or have been altered]

Amendment
No.

 

Before Clause 1

 

THE BARONESS CUMBERLEGE
THE LORD ALDERDICE
THE LORD DESAI
THE BARONESS FINLAY OF LLANDAFF

1*Insert the following new Clause—
  "NHS Agency for England
(1)  There shall be a body corporate to be known as the NHS Agency for England (referred to in this Act as the "English Agency") for the purpose of carrying out the functions transferred or assigned to it by or under this Act.
(2)  The functions of the English Agency are performed on behalf of the Crown."
2*Insert the following new Clause—
  "Appointment of members etc.
(1)  The English Agency shall consist of a chairman, a deputy chairman and ten other members, appointed by the Secretary of State.
(2)  Five members of the English Agency shall be non-executive members.
(3)  The chairman of the Agency shall appoint a chief executive who shall be an executive member of the English Agency.
(4)  An appointment under subsection (3) shall be subject to the approval of the Secretary of State.
(5)  Before an appointment is made under subsection (1) or (3) regard shall be had to the skill and experience of the prospective appointee.
(6)  The Secretary of State may by regulations prescribe the constitution of the English Agency."
3*Insert the following new Clause—
  "Functions of the English Agency
(1)  The functions of the English Agency shall be to—
(a)  allocate funds to health authorities and primary care organisations;
(b)  set standards for the provision of services for NHS patients;
(c)  manage the performance of health authorities and primary care organisations, including the setting of targets for service provision;
(d)  negotiate pay and allowances for NHS staff; and
(e)  carry out such other functions relating to the NHS as the Secretary of State may delegate to it.
(2)  The Secretary of State may by regulations amend the functions of the Agency specified in subsection (1).
(3)  Regulations under subsection (2) shall not be made unless they have been laid in draft before and approved by a resolution of each House of Parliament.
(4)  The Secretary of State may give directions to the English Agency on strategic matters relating to its functions."
4*Insert the following new Clause—
  "Transfer of functions, property, rights and liabilities to the English Agency
(1)  The Secretary of State may make one or more schemes to assign to the English Agency such of his functions as are necessary for the discharge of the duties specified in section (Functions of the English Agency).
(2)  The Secretary of State may make one or more schemes to assign to the English Agency such property, rights and liabilities as attach to the discharge of the duties specified in section (Functions of the English Agency).
(3)  On the date appointed by the transfer schemes made under subsections (1) and (2) ("the transfer date"), the functions, property, rights and liabilities which are the subject of the scheme shall by virtue of this subsection become the functions, property, rights and liabilities of the English Agency."
5*Insert the following new Clause—
  "Grants to the English Agency
(1)  The Secretary of State shall out of moneys provided by Parliament make to the English Agency grants of such amounts as he thinks necessary for the performance of its functions.
(2)  The English Agency shall—
(a)  keep proper accounts and proper accounting records, and
(b)  prepare in respect of each accounting year a statement of accounts giving a true and fair view of the state of affairs and the income and expenditure of the Agency,
  in such form as the Secretary of State may direct."
6*Insert the following new Clause—
  "Annual and other reports to Parliament etc.
(1)  The English Agency shall prepare a report on its activities and performance during each financial year.
(2)  Reports under subsection (1) shall be laid before Parliament.
(3)  The English Agency may from time to time lay other reports before Parliament on any aspect of its work."
 

THE LORD CLEMENT-JONES
THE BARONESS BARKER

7*Insert the following new Clause—
  "Considerations applying to the exercise of powers
(1)  This section applies to the exercise of all powers and functions under this Part of this Act by—
(a)  the Secretary of State,
(b)  the regulator,
(c)  an NHS foundation trust,
(d)  the governors of an NHS foundation trust,
(e)  the members of a foundation trust,
(f)  an applicant under section 4 or 5,
(g)  any trustees appointed under section 22.
(2)  The paramount consideration for those mentioned in subsection (1) above in the exercise of all powers and functions under this Part of this Act shall be the securing and advancement of the health and welfare of the people of England and Wales through the provision of an equitable accessible comprehensive health service free at the point of delivery and integrated with social services.
(3)  The persons mentioned in subsection (1) must have regard to the following matters (among others)—
(a)  the health needs of those who have received or may receive health services provided by the applicant or NHS foundation trust in question,
(b)  the health needs of those who have received or may receive health services provided by other trusts within the area of the same Strategic Health Authority or by a clinical network of which the applicant or the foundation trust is a part,
(c)  the views of the public constituency of the applicant or NHS foundation trust in question,
(d)  the direct or indirect health impact of the exercise of any powers or functions on the health of the population served by the applicant or the NHS foundation trust in question,
(e)  the equitable distribution of resources across the health service.
(4)  For the purposes of this section "clinical network" shall mean a network of different NHS providers working together within a single supervisory structure to agreed protocols and standards of care.""
 

Clause 1

 

THE EARL HOWE
THE BARONESS NOAKES

8Page 1, line 7, leave out "England" and insert "the United Kingdom"
 

THE LORD BLACKWELL

9Page 1, line 7, at end insert ", including provision by means of commissioning other organisations"
 

THE EARL HOWE
THE BARONESS NOAKES
THE LORD CLEMENT-JONES

 The above-named Lords give notice of their intention to oppose the Question that Clause 1 stand part of the Bill.
 

After Clause 1

 

THE EARL HOWE
THE BARONESS NOAKES

10Insert the following new Clause—
  "Review of democratically accountable governance
(1)  It shall be the duty of the Secretary of State to establish an independent review body to carry out the functions specified in subsections (4) to (6).
(2)  The Secretary of State shall appoint at least nine members of the independent review body.
(3)  The independent review body shall elect a chairman from amongst its members.
(4)  The independent review body shall prepare reports containing proposals relating to the establishment of a local, democratically accountable system of governance for NHS foundation trusts and Primary Care Trusts.
(5)  The independent review body may in particular make proposals in accordance with the provisions of subsection (4) relating to—
(a)  methods of securing wider public participation in the governance of NHS foundation trusts, and Primary Care Trusts;
(b)  methods of increasing public awareness and access to information about the governance of NHS foundation trusts and Primary Care Trusts; and
(c)  the membership of public benefit corporations.
(6)  The independent review body must—
(a)  lay a copy of any report prepared in accordance with the provisions of this section before Parliament, and
(b)  once they have done so, send a copy of it to—
(i)  the Secretary of State, and
(ii)  the regulator."
 

Schedule 1

 

THE LORD CLEMENT-JONES
THE BARONESS BARKER

11Page 108, line 12, leave out paragraph 3
 

THE EARL HOWE
THE BARONESS NOAKES

12Page 108, line 12, at end insert "are entitled to free care from the National Health Service and"
13Page 108, line 12, at end insert "are over 18 years of age and"
14Page 108, line 20, leave out sub-paragraph (3)
15Page 108, line 20, leave out sub-paragraph (3) and insert—
"(3)      Where less than 50 per cent of the patients of a corporation live in the area specified under sub-paragraph (1)(a), the constitution shall provide for members of the corporation to be individuals who live outside that area and who have attended any of the corporation's hospitals as patients (including individuals attending as the carer of a patient) ("the patient constituency").
(3A)      Where sub-paragraph (3) does not apply, the constitution may also provide for the public constituency to include individuals who live outside the area specified by sub-paragraph (1)(a) and who have attended any of the corporation's hospitals as patients (including individuals attending as the carer of a patient)."
 

THE LORD CLEMENT-JONES
THE BARONESS BARKER

16Page 108, line 20, leave out "may" and insert "shall"
17Page 108, line 21, after "who" insert "are attending or"
 

THE EARL HOWE
THE BARONESS NOAKES

18Page 108, line 21, leave out from "have" to end of line 22 and insert "been patients of any of the corporation's hospitals (including individuals who have been the carer of a patient)"
 

THE LORD CLEMENT-JONES
THE BARONESS BARKER

19Page 108, line 21, after "as" insert "NHS"
20Page 108, line 22, leave out "a" and insert "an NHS"
 

THE EARL HOWE
THE BARONESS NOAKES

21Page 108, line 22, at end insert—
"(   )      A "carer", for the purposes of sub-paragraph (3), means an individual aged 16 or over who provides or intends to provide substantial care on a regular basis for the patient and does not provide the care in question—
(a)  by virtue of a contract of employment or other contract with any person; or
(b)  as a volunteer for a voluntary organisation as defined in the National Assistance Act 1948 (c. 29)."
22Page 108, line 23, leave out sub-paragraph (4)
 

THE LORD CLEMENT-JONES
THE BARONESS BARKER

23Page 109, line 3, leave out paragraph 4
 

THE LORD PEYTON OF YEOVIL

24Page 109, line 3, after "minimum" insert "and a maximum"
 

THE EARL HOWE
THE BARONESS NOAKES

25Page 109, line 3, after first "of" insert "50"
26Page 109, line 5, leave out sub-paragraph (1)
 

THE LORD CLEMENT-JONES
THE BARONESS BARKER

27Page 109, line 5, leave out paragraph 5
 

THE LORD HUNT OF KINGS HEATH

28Page 109, line 5, leave out from "may" to second "to" in line 6 and insert "become a member of a public benefit corporation on an application made"
 

THE EARL HOWE
THE BARONESS NOAKES

29Page 109, line 7, leave out sub-paragraph (2)
 

THE LORD CLEMENT-JONES
THE BARONESS BARKER

30Page 109, line 10, leave out paragraph 6
 

THE EARL HOWE
THE BARONESS NOAKES

31Page 109, line 10, at end insert—
"(   )  The principal role of the board of governors is to advise the board of directors of the corporation as to its forward plans."
 

THE LORD PEYTON OF YEOVIL

32Page 109, line 11, leave out sub-paragraph (2)
 

THE LORD CLEMENT-JONES
THE BARONESS BARKER

33Page 109, line 11, leave out "members" and insert "employees"
34Page 109, line 13, leave out from "board" to end of line 14 and insert "shall be appointed by the stakeholders as provided for in paragraph 8A of this Schedule"
 

THE EARL HOWE
THE BARONESS NOAKES

35Page 109, line 17, at end insert "using an electoral system to be specified in regulations made by the Secretary of State"
36Page 109, line 29, leave out sub-paragraph (2)
37Page 109, line 32, at end insert "or patient constituency"
38Page 109, line 35, at end insert "and if the corporation provides goods and services for more than one Primary Care Trust, the right of appointment shall be given to the Primary Care Trust or Primary Care Trusts for which the greatest value of services is provided"
39Page 109, line 43, leave out sub-paragraph (6)
 

THE LORD CLEMENT-JONES
THE BARONESS BARKER

40Page 109, line 44, at end insert—
 "8A   (1)   The stakeholders who may appoint members of the board for the purposes of paragraph 6 shall include—
(a)  the employees of the corporation;
(b)  the Primary Care Trusts for which the corporation provides goods or services;
(c)  the principal local authorities that cover, in whole or in part, the area specified for the purpose in the constitution.
(2)      Each of the stakeholders shall appoint no more than 30 per cent of the board's members.
(3)      The members appointed by the stakeholders shall co-opt at least one member to the board who is an individual who has attended any of the corporation's hospitals as a patient (including an individual attending as the carer of a patient).
(4)      The members appointed by the stakeholders shall have power to co-opt at least one, but no more than five members of the board who are, in their view, representative of charitable, voluntary, community or private bodies that have an interest in the services provided by the corporation's hospitals.
(5)      If any of the corporation's hospitals includes a medical or dental school provided by a university, at least one member of the board is to be appointed by that university.
(6)      A member of the board of governors appointed by the stakeholders may hold office for a period of three years.
(7)      A member of the board of governors co-opted by the stakeholder members may hold office for a period of one year.
(8)      The Secretary of State shall, by order, make regulations to specify the arrangements by which the stakeholders in sub-paragraph (1) shall appoint members to the board of governors."
 

THE EARL HOWE
THE BARONESS NOAKES

41Page 110, line 8, leave out "corporation" and insert "board of governors"
42Page 110, line 17, at end insert—
"(   )  the election of the chairman of the board,"
 

THE LORD CLEMENT-JONES
THE BARONESS BARKER

43Page 110, line 18, at end insert "including failure to subscribe to the core values of the trust"
 

THE EARL HOWE
THE BARONESS NOAKES

44Page 110, line 19, leave out sub-paragraph (2)
 

THE LORD CLEMENT-JONES
THE BARONESS BARKER

45Page 110, line 27, after "directors," insert "along with healthcare professionals which should include the director of nursing,"
 

THE BARONESS FINLAY OF LLANDAFF
THE BARONESS EMERTON

46Page 110, line 27, leave out from "directors" to end of line 28 and insert "including the chief executive, finance director and a clinical representative from each of the medicine, nursing and allied health professions"
 

THE EARL HOWE
THE BARONESS NOAKES

47Page 110, line 28, at end insert "and another a person practising as a clinician in the corporation"
48Page 110, line 29, at end insert—
"(   )      A majority of the board is to comprise the directors referred to in sub-paragraph (1)(b)."
49Page 110, line 37, at end insert—
"(   )      A person may not be appointed as a non-executive director if he is a member or chairman of the board of governors."
50Page 110, line 37, at end insert—
 "   (1)   The board of directors shall establish a nominations committee with the function of recommending the appointment or removal of the chairman and non-executive directors.
(2)      The nominations committee shall ensure that selection procedures used to arrive at recommendations for the appointment of the chairman and non-executive directors are in accordance with best practice for such appointments.
(3)      The nominations committee shall make its recommendations to the board of governors."
51Page 110, line 38, leave out "at a general meeting"
52Page 110, line 38, after "meeting" insert "on the recommendation of the nominations committee"
 

THE LORD CLEMENT-JONES
THE BARONESS BARKER

53Page 110, line 42, leave out "non-executive directors" and insert "board of governors"
 

THE LORD HUNT OF KINGS HEATH

54*Page 110, line 43, leave out sub-paragraph (3) and insert—
"(3)  It is for a committee consisting of the chairman, the chief executive and the other non-executive directors to appoint or remove the executive directors."
 

THE EARL HOWE
THE BARONESS NOAKES

55Page 110, line 43, after "for" insert "the board of directors on the recommendation of"
56Page 111, line 2, leave out "voting at a general meeting"
57Page 111, line 3, leave out "at a general meeting"
 

THE LORD HUNT OF KINGS HEATH

58Page 111, line 8, at end insert "but the constitution may make provision for those matters to be decided pending the establishment of such a committee"
 

THE EARL HOWE
THE BARONESS NOAKES

59Page 111, line 8, at end insert—
"(   )      The committee referred to in sub-paragraph (2) shall make a report each year on the matters referred to in that sub-paragraph to the board of governors."
60Page 111, line 8, at end insert—
      "The chief executive shall be the Accounting Officer of the corporation."
 

THE LORD HUNT OF KINGS HEATH

61Page 111, line 8, at end insert—
  "Initial directors of former NHS trusts
 17A   (1)   This paragraph applies, where the application for authorisation is made under section 4, to the exercise of the powers mentioned in paragraph 16 to appoint the initial non-executive directors and the initial chief executive.
(2)      The power to appoint the initial chairman of the corporation is to be exercised by appointing the chairman of the NHS trust, if he wishes to be appointed.
(3)      The power to appoint the other initial non-executive directors of the corporation is to be exercised, so far as possible, by appointing any of the non-executive directors of the NHS trust (other than the chairman) who wish to be appointed.
(4)      A person appointed in accordance with sub-paragraph (2) or (3) is to be appointed for the unexpired period of his term of office as chairman or (as the case may be) non-executive director of the NHS trust; but if, on any such appointment, that period is less than 12 months, he is to be appointed for 12 months.
(5)      The power to appoint the initial chief executive of the corporation is to be exercised by appointing the chief officer of the NHS trust, if he wishes to be appointed.
(6)      Paragraph 16(4) does not apply to the appointment of any executive director of the NHS trust as an initial executive director of the corporation."
 

THE LORD CLEMENT-JONES
THE BARONESS BARKER

62Page 111, line 13, at end insert "and their interests"
63Page 111, line 14, at end insert "and their interests"
 

THE EARL HOWE
THE BARONESS NOAKES

64Page 111, line 15, after second "of" insert "the members of the board of governors and"
65Page 111, line 15, at end insert—
"(   )      The register of interests referred to in sub-paragraph (1)(d) shall include relevant financial information and any political affiliations within the previous five years."
 

THE LORD CLEMENT-JONES
THE BARONESS BARKER

66Page 111, line 36, leave out paragraph 21 and insert—
      "A public benefit organisation shall be audited by an auditor appointed by the Audit Commission."
 

THE EARL HOWE
THE BARONESS NOAKES

67Page 111, line 37, leave out sub-paragraph (2) and insert—
"(2)      The board of governors shall appoint an auditor each year at a general meeting of the board.
(2A)      If an auditor resigns after he has been appointed, the board of governors must appoint another auditor to act until the next general meeting of the board at which an appointment may be made formally."
68Page 111, line 39, leave out sub-paragraph (3) and insert—
"(3)      The persons eligible for appointment as auditor under sub-paragraph (1) are—
(a)  the National Audit Office;
(b)  the Audit Commission;
(c)  a person eligible for appointment under section 25 of the Companies Act 1989 (c. 40)."
69Page 112, line 1, leave out paragraph (b)
70Page 112, leave out line 5 and insert "act as an audit committee with the following functions—
(a)  to monitor the integrity of the accounts of the corporation, including reviewing significant financial reporting judgements;
(b)  to review the corporation's internal control system and risk management systems;
(c)  to monitor and review the effectiveness of the corporation's internal audit functions; and
(d)  to monitor the exercise of the auditor's functions, including monitoring and reviewing the auditor's independence, objectivity and effectiveness."
 

THE EARL HOWE
THE BARONESS NOAKES
THE LORD CLEMENT-JONES
THE BARONESS BARKER

71Page 112, line 8, leave out "with the approval of the Treasury"
 

THE EARL HOWE
THE BARONESS NOAKES

72Page 112, line 14, leave out sub-paragraph (4)
73Page 112, line 18, leave out "with the approval of the Treasury"
74Page 112, line 21, leave out "with the approval of the Treasury"
 

THE LORD CLEMENT-JONES
THE BARONESS BARKER

75Page 112, line 26, at end insert—
"(3A)      In addition to the requirement to present a true and fair view, the annual accounts shall, in respect of any public benefit corporation that is a NHS foundation trust, contain—
(a)  a statement indicating the level of income (expressed as both an amount, and as a proportion of total income for the financial year to which the accounts relate) received by the public benefit corporation and derived from private charges, and
(b)  a statement, in accordance with section 15(2), that the proportion of income derived from private charges for the financial year to which the accounts relate does not exceed the proportion in the base year.
(3B)      Any public benefit corporation that is a NHS foundation trust, before the accounts and audit referred to in paragraph 22(1) are finalised, shall—
(a)  make available, for a period of no less than 25 working days, a copy of the draft statement of accounts, including the draft auditor's report, in a suitable venue for inspection and copying by members of the public;
(b)  on request, while the draft statement is available, make available for inspection and copying copies of all books, deeds, contracts, bills, vouchers and receipts relating to the draft statement.
(3C)      On request, the appointed auditor of the public benefit corporation shall make himself available on no less than two working days for questioning on the draft statement.
(3D)      The first of these occasions shall be no later than five working days after the period of public inspection of the draft statement has ended.
(3E)      Members of the public shall be able to lodge objections to any part of the draft statement providing that the auditor has previously received written notice of such proposed objections and the grounds on which they are able to be made.
(3F)      The objections shall be discussed on the occasions that the appointed auditor is available for public questioning.
(3G)      The public benefit corporation shall take reasonable steps to inform the public in good time about the availability of the draft statement of accounts and matters related to their scrutiny.
(3H)      A public benefit corporation shall, so soon as reasonably possible after conclusion of the audit referred to in paragraph 22(2), and in any event before the date falling six months after the end of the financial year to which the accounts relate—
(a)  publish by means other than merely by reference in the documents of meetings, committees or sub-committees of the body, the accounts (whether or not such accounts have been audited); and
(b)  provide a copy of such accounts (whether or not such accounts have been audited) to any person so requesting a copy and on payment of a reasonable sum."
 

THE EARL HOWE
THE BARONESS NOAKES

76Page 112, line 28, leave out "any" and insert "the"
77Page 112, line 38, at end insert—
"(   )      The report shall contain a breakdown of the costs incurred by the public benefit corporation running elections and managing the membership."
 

THE LORD CLEMENT-JONES
THE BARONESS BARKER
THE BARONESS FINLAY OF LLANDAFF

78Page 112, line 38, at end insert—
"(   )  A public benefit corporation is to evaluate the impact of its services on the local health economy and present an annual report of that evaluation to the regulator in terms of—
(a)  the effects of foundation trusts' status on the quality of care in non-foundation trust NHS services,
(b)  how foundation trust status affects the efficiency of local NHS services,
(c)  levels of access to a comprehensive range of NHS services,
(d)  the level and quality of engagement with stakeholders in non-foundation trust NHS services and the representation of interests of non-members of the Trust,
(e)  how NHS foundation trust status affects the governance of non-foundation trust NHS organisations.
(f)  The impact and effect of NHS foundation trusts' status on the recruitment and retention of essential and specialist healthcare staff in non-foundation trust healthcare organisations."
 

THE EARL HOWE
THE BARONESS NOAKES

79Page 113, line 3, at end insert ", such periods to be coterminous with those in paragraph 23(5)"
80Page 113, line 5, leave out "in respect of each financial year"
81Page 113, line 5, at end insert—
"(   )      The information referred to in sub-paragraph (1) shall cover such periods and deal with such matters as the regulator shall specify."
82Page 113, line 12, leave out "any" and insert "the"
 

THE LORD CLEMENT-JONES
THE BARONESS BARKER
THE BARONESS FINLAY OF LLANDAFF

83Page 113, line 13, at end insert ", to include a report on the evaluation of impacts of the NHS foundation trust on the local health economy"

 
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6 October 2003