|Health And Social Care Bill - continued||House of Lords|
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Clause 71: Interpretation
358. This clause gives definitions of terms used in the Bill. In particular it provides that "regulations" means regulations made by the relevant authority. It also defines "the relevant authority".
Clause 72: Minor and Consequential amendments and repeals
359. Clause 72 gives effect to amendments made in Schedule 5 and the repeals specified in Schedule 6. Schedule 5 makes minor and consequential amendments resulting from provisions in the Bill. Schedule 6 repeals provisions of enactments listed in that schedule.
Clause 73: Powers of National Assembly for Wales for Wales under amended Acts
360. Clause 73 provides that in the National Assembly for Wales (Transfer of Functions) Order 1999 any reference to an Act amended by the Bill
Clause 74: Financial provisions
361. Clause 74 provides for expenditure relating to the Act to be paid out of money provided by Parliament.
Clause 75: Short title commencement and extent
362. Clause 75 gives the short title of the Bill and makes provisions for commencement and extent.
FINANCIAL AND PUBLIC SERVICE MANPOWER EFFECTS OF THE BILL
363. The proposals relating to free nursing care would lead to considerable additional public spending. Other proposals in the Bill will result in much smaller levels of additional expenditure, or transfer the costs around the public expenditure system as existing functions are exercised in new ways. The details of the financial and manpower consequences are set out below.
364. Significant increases in health and social services expenditure have been provided for in the Year 2000 Spending Review. NHS expenditure will grow in real terms by 5.8% in each of the next three years. Social services will see real terms increases of 3.4% on average, over the next three years. The additional expenditure associated with this Bill will be met within these planned increases.
Part 1 The National Health Service
365. Clauses 2 and 3 provide new powers for the provision of a more flexible performance fund to reward performance. While these powers do not in themselves require any additional expenditure the NHS Plan proposes the provision of a performance fund to underpin the system of earned autonomy. £500m will be available to reward the performance of the NHS in 2003/04.
366. Clause 4 provides for the Secretary of State to invest in companies to establish public private partnerships to provide facilities and services to the NHS. The intention is to invest £50m between 2001/02 and 2003/04 in NHS LIFT, a public private partnership to invest in primary care facilities. This public investment is to underpin a much larger fund of up to £1bn to be raised by NHS LIFT for primary care improvements.
367. Clause 7 expands the remit of local authority overview and scrutiny committees to cover health services. Local authorities will be expected to absorb the costs of this additional function. As the powers are essentially permissive the exact costs involved will depend on local decisions as to the level of NHS scrutiny it engages in.
368. Clauses 12 -19 establish new Patients Forums as part of a new system to engage and involve patients in decisions about their local health services. Non statutory Patient Advocacy and Liaison Services (PALS) and Independent Local Advisory Forums (ILAFs) will complete the new arrangements and CHCs will be abolished. The new arrangements will require additional investment over that provided for CHCs. A further £10m is to be made available annually over the next three years on top of the £23m currently committed to funding CHCs. Health Authorities, NHS trusts and Primary Care Trusts will also be expected to contribute to the running of the PALS service from their main allocations.
369. Clause 21 abolishes the Medical Practices Committee resulting in a potential saving in public expenditure. Medical Practices Committee staff will be absorbed elsewhere in the Department of Health. Health Authorities will take on the Medical Practices Committee's major function of declaring GP vacancies in a particular area. Health Authorities are already required to produce a report when applying to the MPC for a vacancy to be declared, and will be expected to take on the rest of this function within existing costs.
370. Clause 23 abolishes the NHS Tribunal. Clauses 25 -34 set out the replacement arrangements. Health Authorities will take on responsibility for maintaining lists of all Family Health Service practitioners entitled to practices in the NHS, and for removing and suspending practitioners from those lists. There will be additional costs associated with establishing new lists, these are to be met within existing provision. The ongoing cost implications of these changes will depend on the numbers of suspension, and removals made by each Health Authority. The current funding for the NHS Tribunal will be made available to cover the additional costs of the FHSAA in hearing appeals against Health Authority decisions to remove practitioner, from their lists.
Part 2 Pharmaceutical Services
371. Clauses 35 - 48 provide for the establishment of Local Pharmaceutical Services, where the Health Authority agrees the provision of local pharmaceutical services on the basis of a local contract. LPS schemes are intended as a way by which Health Authorities may make better use of resources, through making more cost effective arrangements for pharmaceutical and related health services in place of, or in addition to an existing provision. There will be some additional costs for Health Authorities associated with setting up schemes, the exact amount will depend on the number of such schemes and the extent of any financial assistance that Health Authorities provide for preparatory work.
372. Clause 50 provides for an extension to the range of professionals able to prescribe prescription only medicines on the NHS. While these provisions could lead to an increase in prescribing it is expected that the new prescribing will largely replace prescribing by other professionals, and should reduce the need for patients to attend multiple consultation.
Part 3 Care Trusts and Partnership arrangements
373. Care Trusts are intended to build on partnership arrangements between health and social services to deliver more effective, integrated services. It is not anticipated that they will lead to additional expenditure overall although there may be some initial start up costs.
Part 4 Social Care
374. Clause 56 is intended to lead to the NHS taking responsibility for nursing care, as a result of local authorities no longer purchasing nursing care. As local authority services are currently means tested and NHS services free, transferring nursing care to the NHS will lead to increased public expenditure. It is anticipated that the additional full year costs of providing free nursing care will be £165m. Initial costs will be higher as existing recipients of local authority commissioned nursing care will need to be assessed. These costs are additional to existing public expenditure on nursing care by local authorities and by the Department of Social Security for people with preserved rights.
375. Clause 57 transfers to local authorities responsibility for the provision of services for people with preserved rights to higher levels of income support. To support this change of responsibility the £528m the Government would expect to spend on social security benefits for this group, will be made available to local authorities in 2002/03. A further £86m will also be made available to local authorities to cover the shortfall between preserved rights benefits levels and the actual costs of care, together with the costs of assessment and case management.
376. Clause 61 enables local authorities to enter into a deferred payment arrangement with a person entering care, so that the local authority picks up the costs of the placement to be reimbursed through a charge on the resident's home on its eventual sale. There will be a substantial initial cost to this policy which will reduce over time as charges start to balance the costs of new residents' care. To help local authorities meet these costs a special grant of £15m / £30m / £40m is to be provided in each of the next three years.
Part 5 Miscellaneous and Supplementary
377. Clause 68 allows for the extension of prescribing rights to professional groups beyond Doctors and Nurses and for an advisory committee to recommend the granting of applications for prescribing rights. Initial costs for training and the advisory committee are estimated at £5.5m spread over three years.
SUMMARY OF THE REGULATORY APPRAISAL
378. Many of the provisions of the Health and Social Care Bill relate to the provision of the National Health Service and the legal framework within which that service is provided. A limited number of measures will have an indirect effect on businesses.
379. The first three proposals (accreditation by Health Authorities of all organisations providing out-of-hours GP services; local pharmaceutical services and cross boundary dispensing) are not primarily regulatory in purpose or effect. They neither impose, remove, nor reform any regulatory burdens. Instead they are concerned with the relationship between the NHS and those people who provide medical services on its behalf, and the legal framework within which that relationship operates.
380. The accreditation by Health Authorities of all out-of-hours GP service providers was recommended by the recent independent review and subsequent Report Raising Standards for Patients, New Partnerships in Out-of-Hours Care. Organisations will be required to meet a set of nationally defined quality standards before being granted accreditation. The intention is to improve the quality and the speed of service provision by all organisations in order to provide better protection for patients. The main effect of the proposal will be on GP practices and GP Co-operatives, and a limited number of commercial companies who provide out-of-hours GP services. The proposed quality standards are grounded firmly in current best practice. They are derived from observations made on visits to existing out-of-hours providers and from submissions to the Review from GPs and GP organisations, out-of-hours service providers and Health Authorities. Many of the organisations that provide out-of-hours services are already delivering these high standards of service within existing resources.
381. The first pharmacy proposal will provide the legislative framework within which Health Authorities will be able to negotiate individual agreements with pharmacies and others for the provision of NHS pharmaceutical services, initially on a pilot basis. The new agreement will be known as "local pharmaceutical services". Participation in LPS arrangements will be voluntary. The second proposal will permit cross boundary provision of pharmaceutical services. This will ultimately remove the obstacles to pharmacies wishing to dispense NHS prescriptions through "e-pharmacy". There could be indirect costs and benefits for retail activities associated with the provision of NHS pharmaceutical services, but at this stage it is not possible to make any assessment of its likely indirect impact.
382. The proposals for long term care will not impose direct costs on businesses providing health and social care. They will however have some effect on the market within which these businesses operate and their administrative arrangements.
383. The proposals for free nursing care involve the responsibility for arranging these services passing to the NHS. In some cases this may mean that District Nursing services take on some of the care needs of people in residential care, or in other cases the NHS will simply contract with the nursing home for the nursing elements of the residents care. Transfer of preserved rights could prove of assistance to providers as preserved rights payments have not kept pace with the fees paid under local authority contracts in recent years. The moves to allow cross border placements are essentially deregulatory.
EUROPEAN CONVENTION ON HUMAN RIGHTS
384. Section 19 of the Human Rights Act 1998 requires the Minister in charge of a Bill in either House of Parliament to make a statement, before second reading, about the compatibility of the provisions of the Bill with the Convention rights (as defined by section 1 of that Act). Lord Hunt of Kings Heath, the Parliamentary Under Secretary for Health in the Lords has made the following statement:
"In my view the provisions of the Bill are compatible with the Convention rights."
COMMENCEMENT AND EXTENT
385. Clause 75 provides that this Bill extends only to England and Wales, except sections 57 to 59 and 66 (preserved rights), section 68 (prescribing rights) and 69 to 71 and 75 (supplementary provisions) which also extend to Scotland.
386. Some technical provisions of the Bill will come into force on Royal Assent together with those conferring powers to make orders or regulations. The other provisions of the Bill will come into force on such a day, or days, as the relevant authority may appoint by order.
OUTLINE OF THE EXISTING LAW
387. The following paragraphs provide a brief description of the current legislative framework for the NHS and social services. The legislative framework for the NHS in England and Wales is mostly set out in the National Health Service Act 1977 ("the 1977 Act"). This has been amended quite substantially by various enactment's, notably by the National Health Service and Community Care Act 1990 ("the 1990 Act"), the Health Authorities Act 1995 ("the 1995 Act"), the National Health Service (Primary Care) Act 1997 ("the Primary Care Act") and the Health Act 1999 ("the Health Act").
388. The legislative framework for social services in England and Wales is set out in the National Assistance Act 1948, the National Health Service Act 1977 ("the 1977 Act"), the National Health Service and Community Care Act 1990 ( "the 1990 Act") and the Community Care (Direct Payments) Act 1996 ( the "Direct Payments Act").
389. This Annex describes the existing legislation about the NHS. Annex B describes the existing legislation about social care; and Annex C describes other relevant legislation.
Existing legislation about the NHS
National Health Service Act 1977
390. Under the 1977 Act, the NHS is essentially split into two different systems. The first is the system which consists primarily in the provision of health care in hospitals. It also covers those services described as "community health services", for example the services provided by district nurses, midwives or health visitors in clinics or individuals' homes, and the provision of medical services to pupils in state schools. This system is the subject of Part 1 of the 1977 Act. The responsibility for securing the provision of these services to patients rests with the Secretary of State, although under his powers in section 16C (formerly section 13) of the 1977 Act he has delegated most of his functions to Health Authorities. Health Authorities enter into arrangements with bodies known as NHS trusts for the provision by the Trusts of hospital and community health services.
391. The other main part of the NHS structure is what might be described as "the NHS on the high street". This is dealt with under Part 2 of the 1977 Act which governs the arrangements made by Health Authorities for the provision of services by the following professionals: general medical practitioners (GPs)(i.e. family doctors), general dental practitioners (GDPs), ophthalmic opticians and ophthalmic medical practitioners (also known as optometrists), and pharmacists. They respectively provide what are termed general medical services (GMS)(section 29ff), general dental services (GDS)(section 35ff), general ophthalmic services (GOS)(sections 38-40) and pharmaceutical services (PhS)(sections 41-43) respectively. The remainder of Part 2 contains other provisions relevant to the provision of these "high street" services, which are often referred to as family health services.
392. The 1990 Act, the Primary Care Act and the Health Act introduced a number of changes to these systems of health care. Broadly speaking, these changes were as follows:
(a) the 1990 Act introduced what is known as the internal market; by creating a divide between the planning and purchase of Part 1 services, on the one hand, and the provision of those services, on the other:
(b) the Primary Care Act in effect enabled what were previously Part 2 services to be delivered, not under Part 2, but under a more flexible system within Part 1 of the Act - these changes applied only to doctors and dentists, and not the other family health services practitioners; and
(c) the Health Act made a number of changes, but in particular provided for the abolition of GP fund-holding (introduced by the 1990 Act), the establishment of Primary Care Trusts (a new type of NHS body to both commission and provide NHS care) and new arrangements to improve the quality of NHS services and co-operation between NHS bodies and local authorities.
393. The two systems, Part 1 and Part 2, are very different. It should be noted that despite the changes introduced by the Primary Care Act the provision of Part I services is distinct from the provision of services under Part 2. The changes proposed in this Bill will not alter this divide. The following is a more detailed description of the two systems.
Part I system - hospital and community health services
394. The system provided for under Part 1 of the 1977 Act (and Part 1 of the 1990 Act - discussed below) is the system under which all of the NHS, apart from family health services, is provided, including its hospitals. The core duty to ensure the provision of a health service is laid upon the Secretary of State (1977 Act, section 1) in extremely broad terms, and is supplemented by the provisions of the sections 2 to 5.
395. Section 3 sets out those general services which it is the Secretary of State's duty to provide to such extent as he considers necessary to meet all reasonable requirements. Most of the services that may be described as hospital and community health services are included under this section.
396. Section 5(1) and (1A) impose duties on the Secretary of State to provide medical and dental services to state school pupils. This is the basis for what is described as the school nursing service.
397. Section 2 confers wide ranging powers for the Secretary of State to provide such services as are appropriate to discharge any duty imposed on him by the Act (including his general duty under section 1), and to do any other thing whatsoever which is calculated to facilitate, or is conducive to or incidental to, the discharge of any duty imposed on him by the Act. Further miscellaneous powers relating to specific matters are conferred by section 5(2) (for example, the conduct and assistance of research and development (section 5(2)(d)).
398. Sections 8 to 18 of the 1977 Act go on to provide for the administration of the NHS. These sections have been substantially amended since 1977, most recently by the Health Act. As amended, they provide for the setting up of Health Authorities (section 8), Special Health Authorities (section 11) and Primary Care Trusts (section 16A, as inserted by section 2 of the Health Act). Health Authorities, Special Health Authorities and Primary Care Trusts are independent statutory bodies, although their membership is determined in accordance with regulations (and in the case of Special Health Authorities, the establishment order) and some of the appointments to their membership are made by the Secretary of State. Health Authorities and Primary Care Trusts are established for territorial purposes. Each Health Authority is established for such area of England and Wales as set out in the establishment order made under section 8. The entire area of England and Wales is covered by Health Authorities. Each Primary Care Trust is established for the area specified in its establishment order under section 16A(3). Each Primary Care Trust area is wholly contained within the area of a Health Authority, but there is no requirement for total coverage. Some areas of England are covered by Primary Care Trusts, others are not. There are no Primary Care Trusts in Wales, as the relevant provisions of the Health Act have yet to be brought into force in Wales. Special Health Authorities are established for specific functional purposes - they are established for the purpose of performing any functions of the Secretary of State which he may then direct them to perform under section 16C.
399. The Secretary of State may direct a Health Authority or Special Health Authority to exercise his functions (section 16C, formerly 13, of the 1977 Act). A Health Authority may direct a Primary Care Trust established in their area to exercise those of its functions which it is permitted to delegate (section 17A, inserted by section 12 to the Health Act). The Secretary of State may direct Health Authorities that delegable Health Authority functions are or are not to be exercisable by Primary Care Trusts, or are to be exercisable by Primary Care Trusts to any specified extent (section 17A(4)). The Secretary of State may also give directions to a Health Authority, Special Health Authority or Primary Care Trust about the exercise of any of their functions (section 17). A Health Authority may also give directions to a Primary Care Trust about the exercise of any functions which the Health Authority has directed the Primary Care Trust to exercise (section 17B). These Directions may be given by regulations or by instrument in writing (section 18). There is very little further prescription in primary legislation as to what the Secretary of State must do or how he must do it in relation to the provision of that part of the NHS which is not concerned with family health services. It will be seen that this way of providing services is a great deal more flexible than the regulatory system envisaged under Part II. There are probably historical reasons for this, but those reasons are no longer relevant.
400. Health Authorities may, in accordance with regulations and any relevant directions, delegate their functions (whether Part I or Part II) to each other, or to committees or others (section 16 of the 1977 Act (as substituted by paragraph 9 of Schedule 5 to the Health Act)). Similar provision is made for Primary Care Trusts (section 16B of the 1977 Act (as inserted by section 2(1) of the Health Act)). Regulations have been made under both provisions.
401. Health Authorities and Special Health Authorities are funded under the provisions of section 97, as substituted by paragraph 47 of Schedule 1 to the 1995 Act and amended by section 36 of the Primary Care Act and by sections 4 and 8 of the Health Act. Health Authorities are paid money in each year under section 97(1) and section 97(3). Section 97(1) concerns the remuneration of persons providing Part II services and is not cash-limited (in other words the Secretary of State must pay whatever it has cost the Health Authority, and he cannot impose a ceiling on the expenditure). Under section 97(3) a Health Authority is paid money not exceeding the amount allotted to them by the Secretary of State. This amount is allotted towards meeting their "main expenditure" which includes all expenditure attributable to the performance of their Part I functions, and all their administrative costs. The money paid in respect of Part I services is therefore ultimately cash-limited. To enforce the cash-limits set by the Secretary of State, Health Authorities have various financial duties imposed upon them by section 97A of the 1977 Act (as substituted by paragraph 48 of the 1995 Act and amended by paragraph 23 of Schedule 2 to the Primary Care Act).
402. Primary Care Trusts are funded by Health Authorities under section 97C of the 1977 Act, as inserted by section 3 of the Health Act. There is a similar distinction between cash-limited and non-cash-limited funding. PCTs are also subject to a set of financial duties similar to those for HAs.
NHS TRUST Part II system - family health services
403. The system provided for under Part II of the Act is quite different. The broad structure of the Part II system is similar for doctors, dentists, persons providing ophthalmic services and persons providing pharmaceutical services. The existing system will first be described as it refers to doctors. The different arrangements as they apply to the other professional groups will be set out later.
General Medical Services
404. Under section 29 of the 1977 Act, it is the duty of each Health Authority in accordance with regulations to arrange for medical practitioners to provide personal medical services for all persons in the area who wish to take advantage of the arrangements. These services are described as general medical services (GMS). A principal feature of the system as it operates in practice is that (apart from certain exceptional cases) it is not the Health Authority itself which provides the GMS; instead, it enters into separate statutory arrangements with independent practitioners for the provision of those services. GPs are not employees of the Health Authority; they are independent professionals who undertake to provide GMS in accordance with the body of regulations governing that activity. Those Regulations are currently the National Health Service (General Medical Services) Regulations 1992 (S.I. 1992/635) as amended.
405. The remainder of 1977 section 29 sets out certain things which must or may appear in the Regulations. Section 30 deals with the matter of applications by medical practitioners to be included in what is known as the "medical list": that is the list kept by each Health Authority of GPs who provide GMS in its area. Sections 31 and 32 provide for each GP on a medical list to have undergone vocational training. Section 33 provides for the system for admitting GPs to medical lists. Section 34 provides for regulations to be made relating to the Medical Practices Committee ("MPC"), which has a role in admitting GPs to the medical list. The MPC is set up under section 7 of the 1977 Act. Sections 29A and 29B (as inserted by section 32 of the Primary Care Act) make further provision relating to medical lists and vacancies.
406. It is the duty of each Health Authority, in accordance with the Regulations, to administer the arrangements made for the provision of GMS and other family health services (section 15 of the 1977 Act). The Health Authority must also perform such management and other functions relating to those services as may be prescribed.
407. In contrast to the Part I system, therefore, the duty to make arrangements for those services is conferred directly upon Health Authorities, rather than upon the Secretary of State. Nonetheless, in exercising functions under Part II, Health Authorities may be the subject of Secretary of State directions issued under section 17 of the 1977 Act. Health Authorities are able to delegate their Part II functions in accordance with regulations made under section 16 of the Act.
408. Subject to any Secretary of State directions under section 17A(4) of the 1977 Act, Health Authorities may direct Primary Care Trusts to exercise their functions in relation to GMS, but not in relation to other Part II services (see section 17A(3) of the Act). The Secretary of State has directed Health Authorities that they may delegate only a limited range of GMS functions to Primary Care Trusts.
409. This broad structure of the Part II system is similar for dentists, persons providing ophthalmic services and persons providing pharmaceutical services, but there are significant differences, most notably relating to persons providing ophthalmic and pharmaceutical services.
410. The provision for dentists (section 35 of the 1977 Act) is in very similar terms to that for doctors in section 29, although it will be noted that the duty upon the Health Authority is subtly different. In the case of doctors, the Health Authority must arrange for sufficient PMS to be provided for everybody in the area who wishes to take advantage of the arrangements. In the case of dentists this duty is not quite the same: the duty is not to arrange the provision of GDS for everybody in the area who wishes to have GDS, but rather to arrange with dentists in the area that any person for whom those dentists have undertaken to provide GDS receive the promised GDS. There is also no equivalent of the MPC to control the entry of GDPs to dental lists; and there is no equivalent of section 29(2)(c) of the 1977 Act (which provides for the assignment of patients to doctors). However, subject to that, the systems are by no means dissimilar: there exists a dental list of GDPs who undertake to provide GDS. There is a system of dental vocational training (although it has been introduced by regulations and not by primary legislation). The relationship between the Health Authority and the GDP is (usually) again a statutory one between a Health Authority and an independent professional. Unlike the case of GPs, however, there is in regulations provision in the case of dentists for the employment of salaried dentists at health centres. These dentists are employed by the Health Authority, and represent one of the rare occasions when it is the Health Authority itself which provides the services in question via its employees.
411. So far as chemists and opticians are concerned, opticians are provided for in section 38 of the 1977 Act, again according to the same scheme whereby the Health Authority makes statutory arrangements with independent practitioners (who, in this case, might be individuals or bodies such as companies). However, the range of services to be provided by opticians is very much smaller. The only content now surviving of general ophthalmic services ("GOS") is sight testing for children, for persons whose resources are less than their requirements, and for other prescribed persons.
412. For pharmaceutical services ("PhS"), provided for under section 41 of the 1977 Act the arrangements are again made by Health Authorities with independent persons or bodies. The system is governed by regulations; but the duty this time is to arrange for the provision, to persons who are present in the Health Authority's area, of drugs, medicines and listed appliances which are prescribed for them by health service doctors, dentists, or nurses, and of such other services as may be prescribed. So far as PhS are concerned, there are detailed regulations (made under sections 42 and 43) relating to entry on to a pharmaceutical list.
413. Sections 43A and 43B of the 1977 Act, as substituted by section 10 of the Health Act, provide a structure for the remuneration of persons providing Part II services. Section 10 of the Health Act has, however, yet to be brought into force. Neither have the original sections 43A and 43B inserted by the Health and Social Security Act 1984 (c.48) been commenced. In effect the original sections inserted by the 1984 Act must be complied with because of section 7 of the Act, which provides that a determination of remuneration made before the coming into force of those provisions is deemed to be validly made if regulations authorising it could have been made had that provision been in force at that time. It is therefore not open to the Secretary of State or anyone else to make a determination which is inconsistent with the provisions of sections 43A and 43B as inserted by the 1984 Act. What in fact happens is that the Secretary of State makes and publishes a determination for each of the professions, which takes the form of the separate document referred to in each of the sets of Regulations governing the four professions. These determinations therefore have the force of law, although they are not subject to any further degree of formality or Parliamentary procedure. The revised version of sections 43A and 43B, substituted by section 10 of the Health Act, were intended to provide a new framework to govern the remuneration of Part II practitioners, but have yet to be brought into force.
414. Each profession has in each Health Authority area a local representative committee (called the Local Medical Committee, the Local Dental Committee, and so on). These represent local practitioners and are provided for under sections 44 and 45 of the 1977 Act.
415. Practitioners may be removed or suspended from the list in which their names are included by the NHS Tribunal, which is provided for under sections 46-49 of the 1977 Act. The NHS Tribunal is an independent body which hears representations by Health Authorities and others against family health service practitioners, that is people with whom Health Authorities have made arrangements for the provision of general medical, general dental, general ophthalmic or pharmaceutical services under Part II of the NHS Act 1977. Health Authorities (and others) may make representations that to allow a person to continue to be family health service practitioner would be prejudicial to efficiency of the service in question. The Tribunal may direct that a practitioner's name is to be removed from one or more lists of people with whom Health Authorities have made arrangements for the provision of family health services. A person who has been removed from a list is no longer entitled to provide the service in question. The NHS Tribunal may also disqualify a person from involvement in any capacity in the provision of family health services.
416. The powers of the NHS Tribunal were extended by the National Health Service (Amendment) Act 1995, amongst other things to give it powers of interim suspension from lists. The powers of the NHS Tribunal were further extended by section 40 of the Health Act 1999, in particular to extend its jurisdiction to people who have acted fraudulently towards or in connection with the NHS (although this section has yet to be brought into force).
417. The remainder of Part II contains a number of miscellaneous provisions.
|© Parliamentary copyright 2001||Prepared: 21 February 2001|