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Health and Social Care (Community Health and Standards) Bill


Health and Social Care (Community Health and Standards) Bill
Part 3 — Recovery of NHS charges

77

 

157     

Appeal against a certificate or a waiver decision

(1)   

An appeal against a certificate may be made by the person to whom the

certificate was issued on one or more of the following grounds—

(a)   

that an amount (or amounts) specified in the certificate is (or are)

incorrect,

5

(b)   

that an amount (or amounts) so specified takes (or take) into account—

(i)   

treatment which is not NHS treatment received by the injured

person, as a result of his injury, at a health service hospital,

(ii)   

ambulance services which are not NHS ambulance services

provided to the injured person as a result of his injury, or

10

(iii)   

treatment as mentioned in sub-paragraph (i) and ambulance

services as mentioned in sub-paragraph (ii),

(c)   

that the payment on the basis of which the certificate was issued is not

a compensation payment.

(2)   

No appeal may be made until—

15

(a)   

the claim against the person to whom the certificate was issued, which

gives rise to the compensation payment, has been finally disposed of,

and

(b)   

payment of the amount (or amounts) specified in the certificate has

been made to the Secretary of State or the Scottish Ministers (as the case

20

may be), subject to subsection (4) and sections 158(6) and 159(5).

(3)   

For the purposes of subsection (2)(a), if an award of damages in respect of a

claim has been made under or by virtue of—

(a)   

section 32A(2)(a) of the Supreme Court Act 1981 (c. 54),

(b)   

section 12(2)(a) of, or paragraph 10(2)(a) of Schedule 6 to, the

25

Administration of Justice Act 1982 (c. 53), or

(c)   

section 51(2)(a) of the County Courts Act 1984 (c. 28),

   

(orders for provisional damages in personal injury cases), the claim is to be

treated as having been finally disposed of.

(4)   

The Secretary of State or the Scottish Ministers may, on an application by the

30

person to whom the certificate was issued, waive the requirement in

subsection (2)(b) that payment of the amount (or amounts) specified in the

certificate be made before making an appeal.

(5)   

The Secretary of State or the Scottish Ministers may only grant a waiver if it

appears to him or them that payment of the amount (or amounts) specified in

35

the certificate would cause exceptional financial hardship.

(6)   

An appeal against a decision of the Secretary of State or the Scottish Ministers

on an application under subsection (4) (referred to in this section and sections

158 and 159 as a “waiver decision”) may be made by the person to whom the

certificate was issued.

40

(7)   

Regulations may make provision—

(a)   

as to the manner in which, and the time within which, an appeal against

a certificate or waiver decision may be made,

(b)   

as to the procedure to be followed if an appeal against a certificate or

waiver decision is made,

45

(c)   

as to the circumstances in which appeals may be consolidated

(including the consolidation of an appeal against a certificate issued by

 

 

Health and Social Care (Community Health and Standards) Bill
Part 3 — Recovery of NHS charges

78

 

the Secretary of State with an appeal against a certificate issued by the

the Scottish Ministers), and

(d)   

for the purpose of enabling an appeal against a certificate to be treated

as an application for a review under section 156.

158     

Appeal tribunals

5

(1)   

The Secretary of State or the Scottish Ministers must refer to an appeal tribunal

constituted under Chapter 1 of Part 1 of the Social Security Act 1998 (c. 14) an

appeal against—

(a)   

a certificate, or

(b)   

a waiver decision.

10

(2)   

In determining an appeal against a certificate, the tribunal must take into

account any decision of a court relating to the same, or any similar, issue

arising in connection with the injury in question.

(3)   

On an appeal against a certificate, the tribunal may—

(a)   

confirm the amount or amounts specified in the certificate,

15

(b)   

specify any variations which are to be made on the issue of a fresh

certificate under subsection (4), or

(c)   

declare that the certificate is to be revoked.

(4)   

When the Secretary of State or the Scottish Ministers (as the case may be) has

or have received the decision of the tribunal on an appeal against a certificate,

20

he or they must in accordance with that decision—

(a)   

confirm the certificate,

(b)   

issue a fresh certificate, or

(c)   

revoke the certificate.

(5)   

Subsections (5) and (6) of section 152 apply to certificates issued under

25

subsection (4)(b) above as they apply to certificates issued under section 151.

(6)   

On an appeal against a waiver decision, the tribunal may—

(a)   

confirm the decision, or

(b)   

waive the requirement in question.

(7)   

Regulations under section 157 may (among other things) provide for the non-

30

disclosure of medical advice or medical evidence given or submitted following

a reference under subsection (1).

159     

Appeal to Social Security Commissioner

(1)   

An appeal may be made to a Commissioner against any decision of an appeal

tribunal under section 158 on the ground that the decision was erroneous in

35

point of law.

(2)   

An appeal under this section may be made by—

(a)   

the Secretary of State or the Scottish Ministers (as the case may be), or

(b)   

the person to whom the certificate was issued.

(3)   

If an appeal is made under this section, subsections (7) to (12) of section 14 of

40

the 1998 Act apply to the appeal as they apply to an appeal under that section

(reading references to a tribunal as references to an appeal tribunal constituted

as mentioned in section 158(1)).

 

 

Health and Social Care (Community Health and Standards) Bill
Part 3 — Recovery of NHS charges

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(4)   

In a case in which subsection (7) or (8)(b) of section 14 of the 1998 Act applies

by virtue of subsection (3) above to an appeal against a decision of an appeal

tribunal under subsection (3) of section 158, subsections (2) to (4) of that section

apply as they apply to an appeal determined on a reference under subsection

(1)(a) of that section.

5

(5)   

In a case in which subsection (7) or (8)(b) of section 14 of the 1998 Act applies

by virtue of subsection (3) above to an appeal against a decision of an appeal

tribunal under subsection (6) of section 158, the appeal tribunal may—

(a)   

confirm the waiver decision, or

(b)   

waive the requirement in question.

10

(6)   

In a case in which subsection (8)(a) of section 14 of the 1998 Act applies by

virtue of subsection (3) above to an appeal against a decision of an appeal

tribunal under subsection (3) of section 158, subsection (4) of that section

applies as if the references to the decision of the tribunal on an appeal against

a certificate were references to the decision of the Commissioner on an appeal

15

under this section.

(7)   

In this section—

   

“Commissioner” has the same meaning as in Chapter 2 of Part 1 of the

1998 Act, and

   

“the 1998 Act” means the Social Security Act 1998 (c. 14).

20

Information

160     

Provision of information

(1)   

If compensation is sought in consequence of any injury suffered by an injured

person, such information with respect to the circumstances of the case as may

be prescribed must be given by the following persons to the Secretary of State

25

or the Scottish Ministers (as the case may require)—

(a)   

the person against whom the claim is made and anyone acting on

behalf of that person, whether or not proceedings have been

commenced,

(b)   

the injured person or, if the injured person has died, his personal

30

representative,

(c)   

anyone not within paragraph (a) who is, or is alleged to be, liable to any

extent in respect of the injury,

(d)   

if the claim is not made by the injured person, the person by whom it is

made,

35

(e)   

anyone acting on behalf of the person within any of paragraphs (b) to

(d),

(f)   

the responsible body of each health service hospital at which the

injured person has received NHS treatment as a result of his injury,

(g)   

any ambulance trust which provided NHS ambulance services as a

40

result of his injury.

(2)   

A person who is required to give information under this section must do so—

(a)   

in the prescribed manner, and

(b)   

within the prescribed period.

(3)   

Regulations under this section may, in particular, require the provision of

45

information about any NHS treatment which an injured person has received at

 

 

Health and Social Care (Community Health and Standards) Bill
Part 3 — Recovery of NHS charges

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a health service hospital and any NHS ambulance services provided to the

injured person.

(4)   

In this section—

   

“ambulance trust”—

(a)   

in relation to England or Wales, means—

5

(i)   

a National Health Service trust established under section 5

of the National Health Service and Community Care Act

1990 (c. 19), or

(ii)   

an NHS foundation trust,

(b)   

in relation to Scotland, means a Special Health Board

10

established under section 2(1)(b) of the 1978 Act;

   

“responsible body”, in relation to a health service hospital, means—

(a)   

in the case of a hospital vested in—

(i)   

a National Health Service trust established under section 5

of the National Health Service and Community Care Act

15

1990 or section 12A of the 1978 Act, or

(ii)   

a Primary Care Trust,

   

the trust, and

(b)   

in any other case, the body responsible for the management of

the hospital.

20

161     

Use of information held by the Secretary of State or the Scottish Ministers etc.

(1)   

Subsection (2) applies to information which is held—

(a)   

by the Secretary of State, or

(b)   

by a person providing services to the Secretary of State in connection

with the provision of those services,

25

   

for the purposes of, or for any purpose connected with, the exercise of

functions under the Social Security (Recovery of Benefits) Act 1997 (c. 27).

(2)   

The information may—

(a)   

be used for the purposes of, or for any purpose connected with, the

exercise of functions under this Part, and

30

(b)   

be supplied to a qualifying person for use for those purposes.

(3)   

In subsection (2), “qualifying person” means—

(a)   

in the case of information held by the Secretary of State—

(i)   

a person providing services to the Secretary of State, or

(ii)   

the Scottish Ministers or a person providing services to the

35

Scottish Ministers, or

(b)   

in the case of information held by a person providing services to the

Secretary of State—

(i)   

the Secretary of State or another person providing services to

the Secretary of State, or

40

(ii)   

the Scottish Ministers or a person providing services to the

Scottish Ministers.

(4)   

Subsection (5) applies to information which is held—

(a)   

by the Secretary of State or the Scottish Ministers, or

(b)   

by a person providing services to the Secretary of State or the Scottish

45

Ministers in connection with provision of those services,

 

 

Health and Social Care (Community Health and Standards) Bill
Part 3 — Recovery of NHS charges

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for the purposes of, or for any purpose connected with, the exercise of

functions under this Part.

(5)   

The information may—

(a)   

be used for the purposes of, or for any purpose connected with, the

exercise of functions under the Social Security (Recovery of Benefits)

5

Act 1997 (c. 27), and

(b)   

be supplied to a qualifying person for use for those purposes.

(6)   

In subsection (5), “qualifying person” means—

(a)   

in the case of information held by the Secretary of State, a person

providing services to the Secretary of State,

10

(b)   

in the case of information held by the Scottish Ministers, the Secretary

of State or a person providing services to the Secretary of State,

(c)   

in the case of information held by a person providing services to the

Secretary of State, the Secretary of State or another person providing

services to the Secretary of State,

15

(d)   

in the case of information held by a person providing services to the

Scottish Ministers, the Secretary of State or a person providing services

to the Secretary of State.

Payments to hospitals or ambulance trusts

162     

Payment of NHS charges to hospitals or ambulance trusts

20

(1)   

If the Secretary of State receives or the Scottish Ministers receive a payment of

relevant NHS charges under section 150(2)—

(a)   

if the payment relates only to NHS treatment received at a health

service hospital, he or they must pay the amount received to the

responsible body of the health service hospital,

25

(b)   

if the payment relates only to the provision of NHS ambulance services,

he or they must pay the amount received to the relevant ambulance

trust,

(c)   

if the payment relates to NHS treatment received at more than one

health service hospital, he or they must divide the amount received

30

among the responsible bodies of the hospitals concerned in such

manner as he considers or they consider appropriate,

(d)   

if the payment relates to NHS treatment received at one or more health

service hospitals and the provision of NHS ambulance services, he or

they must divide the amount received among the responsible body or

35

bodies of the hospital or hospitals and any relevant ambulance trusts

concerned in such manner as he considers or they consider appropriate.

(2)   

Subsection (1) does not apply to any amount received by the Secretary of State

or the Scottish Ministers under section 150(2) which he is or they are required

to repay in accordance with regulations under section 153(2).

40

(3)   

Regulations under this section may—

(a)   

make provision for the manner in which and intervals at which any

payments due under this section are to be made,

(b)   

make provision for cases where the responsible body of the health

service hospital or relevant ambulance trust concerned has ceased to

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exist (including provision modifying this Part).

 

 

Health and Social Care (Community Health and Standards) Bill
Part 3 — Recovery of NHS charges

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(4)   

Any amounts received under this section by the responsible bodies of the

health service hospitals concerned must be used for the purposes of providing

goods and services for the benefit of patients receiving NHS treatment at those

hospitals.

(5)   

Any amounts received under this section by the relevant ambulance trusts

5

concerned must be used for the purposes of NHS ambulance services.

(6)   

In this section—

   

“relevant ambulance trust”—

(a)   

in relation to England or Wales, means—

(i)   

the National Health Service trust established under section

10

5 of the National Health Service and Community Care Act

1990 (c. 19), or

(ii)   

the NHS foundation trust,

   

which is designated by the Secretary of State for the purposes of

this section in relation to the health service hospital to which the

15

injured person was taken for treatment,

(b)   

in relation to Scotland, means the Special Health Board,

established under section 2(1)(b) of the 1978 Act, which is

designated by the Scottish Ministers for the purposes of this

section in relation to the health service hospital to which the

20

injured person was taken for treatment;

   

“responsible body” has the meaning given in section 160(4).

Miscellaneous and general

163     

Regulations governing lump sums, periodical payments etc

(1)   

Regulations may make provision (including provision modifying this Part)—

25

(a)   

for cases to which section 150(2) applies in which two or more

compensation payments in the form of lump sums are made by the

same person in respect of the same injury,

(b)   

for cases to which section 150(2) applies in which an agreement is

entered into for the making of—

30

(i)   

periodical compensation payments (whether of an income or

capital nature), or

(ii)   

periodical compensation payments and lump sum

compensation payments,

(c)   

for cases in which the compensation payment to which section 150(2)

35

applies is an interim payment of damages which a court orders to be

repaid.

(2)   

Regulations made by virtue of subsection (1)(a) may (among other things)

provide—

(a)   

for giving credit for amounts already paid, and

40

(b)   

for the payment by any person of any balance or the recovery from any

person of any excess.

(3)   

Regulations may make provision modifying the application of this Part in

relation to cases in which a payment into court is made and, in particular, may

provide—

45

 

 

Health and Social Care (Community Health and Standards) Bill
Part 3 — Recovery of NHS charges

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(a)   

for the making of a payment into court to be treated in prescribed

circumstances as the making of a compensation payment,

(b)   

for application for, and issue of, certificates.

164     

Liability of insurers

(1)   

If a compensation payment is made in a case where—

5

(a)   

a person is liable to any extent in respect of the injury, and

(b)   

the liability is covered to any extent by a policy of insurance,

   

the policy is also to be treated as covering any liability of that person under

section 150(2).

(2)   

Liability imposed on the insurer by subsection (1) cannot be excluded or

10

restricted.

(3)   

For that purpose excluding or restricting liability includes—

(a)   

making the liability or its enforcement subject to restrictive or onerous

conditions,

(b)   

excluding or restricting any right or remedy in respect of the liability,

15

or subjecting a person to any prejudice in consequence of his pursuing

any such right or remedy, or

(c)   

excluding or restricting rules of evidence or procedure.

(4)   

Regulations may in prescribed cases limit the amount of the liability imposed

on the insurer by subsection (1).

20

(5)   

This section applies in relation to policies of insurance issued before (as well as

those issued after) the date on which it comes into force.

(6)   

References in this section to policies of insurance and their issue include

references to contracts of insurance and their making.

165     

Power to apply Part 3 to treatment at non-health service hospitals

25

(1)   

Regulations may make provision for this Part to apply, with such

modifications as may be prescribed, if—

(a)   

a person makes a compensation payment as mentioned in section

150(1)(a), but

(b)   

the person to or in respect of whom the payment is made has—

30

(i)   

received treatment as a result of the injury at a qualifying

hospital under an NHS arrangement,

(ii)   

been provided with NHS ambulance services as a result of the

injury for the purpose of taking him to a qualifying hospital for

treatment under an NHS arrangement (unless he was dead on

35

arrival at that hospital), or

(iii)   

received treatment as mentioned in sub-paragraph (i) and been

provided with NHS ambulance services as mentioned in sub-

paragraph (ii),

   

(subject to subsection (2)).

40

(2)   

Subsection (1)(b) does not apply where the person to or in respect of whom the

payment is made receives, or is taken to a hospital for, treatment which would

be provided as mentioned in paragraph (a), (b) or (d) of section 150(7) if it were

provided at a health service hospital.

 

 

 
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