HEALTH AND CARE BILL EXPLANATORY NOTES What these notes do These Explanatory Notes relate to the Health and Care Bill as introduced in the House of Commons on 6 July 2021 (Bill 140). • These Explanatory Notes have been prepared by the Department of Health and Social Care in order to assist the reader of the Health and Care Bill and to help inform debate on it. They do not form part of the Health and Care Bill and have not been endorsed by Parliament. • These Explanatory Notes explain what each part of the Health and Care Bill will mean in practice; provide background information on the development of policy; and provide additional information on how the Health and Care Bill will affect existing legislation in this area. • These Explanatory Notes might best be read alongside the Health and Care Bill. They are not, and are not intended to be, a comprehensive description of the Health and Care Bill. Bill 140–EN 58/2 Table of Contents Subject Page of these Notes Overview of the Health and Care Bill 10 Policy Background 11 Merging NHS England, Monitor and NHS Trust Development Authority 11 Mandate and financial directions to NHS England 12 Funding for service integration 14 The NHS Payment Scheme 14 Capital spending limits over Foundation Trusts 15 New NHS Trusts 16 Integrated Care Boards and Integrated Care Partnerships 17 Triple Aim 17 Duty to Cooperate 18 Joint Appointments 18 Joint Committees 18 Collaborative Commissioning 18 Secretary of State’s duty to report on workforce systems 19 Abolition of LETBs 20 Information 20 Secretary of State power to direct NHS England 24 Power of Direction – Secretary of State Public Health functions 25 Reconfigurations 25 Transfer of functions between Arm’s Length Bodies 27 Special Health Authority Time Limits 28 Procurement of clinical healthcare services 29 Competition 29 Patient Choice 30 Health Service Safety Investigation Body 31 International Healthcare 32 Adult Social Care Assurance 34 Hospital Discharge 36 2 These Explanatory Notes relate to the Health and Care Bill as introduced in the House of Commons on 6 July 2021 (Bill 140) Professional Regulation 36 Medical Examiners 39 Hospital Food Standards 39 Advertising of less healthy food and drink 40 Food information for consumers: power to amend retained EU law 42 Medicine Information Systems 43 Water Fluoridation 45 Territorial extent and application 46 Commentary on provisions of the Bill 47 Part 1: Health Service in England: Integration, Collaboration and Other Changes 47 NHS England 47 Clause 1: NHS Commissioning Board renamed NHS England 47 Schedule 1: Renaming of NHS Commissioning Board 47 Clause 2: Power to Require Commissioning of Specialised Services 47 Clause 3: NHS England Mandate 48 Clause 4: NHS England: Effect of Decisions 48 Clause 5: Public involvement and consultation: carers and representatives 49 Clause 6: Support and Assistance by NHS England 49 Clause 7: Exercise of functions relating to provision of services 50 Clause 8: Preparation of consolidated accounts for providers 51 Clause 9: Funding for service integration 51 Clause 10: Payments in respect of quality 52 Clause 11: Secondments to NHS England 52 Integrated Care Boards 53 Clause 12: Role of Integrated Care Boards 53 Clause 13: Establishment of Integrated Care Boards 53 Schedule 2: Integrated care boards: constitution etc. 54 Clause 14: People for whom integrated care boards have core responsibility 58 Integrated Care Boards: Functions 58 Clause 15: Commissioning hospital and other health services 58 Clause 16: Commissioning primary care services etc. 59 Schedule 3: Conferral of primary care functions on integrated care boards etc. 59 3 These Explanatory Notes relate to the Health and Care Bill as introduced in the House of Commons on 6 July 2021 (Bill 140) Clause 17: Transfer schemes in connection with transfer of primary care functions 61 Clause 18: Commissioning arrangements: conferral of discretions 62 Clause 19: General functions 62 Integrated Care Partnerships 69 Clause 20: Integrated care partnerships and strategies 69 Integrated Care System: Financial Controls 70 Clause 21: NHS England’s financial responsibilities 70 Clause 22: Expansion of NHS England’s duties in respect of expenditure 72 Clause 23: Financial Responsibilities of integrated care boards and their partners 72 Clause 24: Expansion of financial duties of integrated care boards and their partners 73 Integrated care system: further amendments 73 Clause 25: Integrated Care System: further amendments 73 Merger of NHS bodies etc. 74 Clause 26: Abolition of Monitor and transfer of functions to NHS England 74 Schedule 5: Abolition of Monitor and transfer of its functions 74 Clause 27: Exercise by NHS England of new regulatory functions 74 Clause 28: Modification of standard license conditions 74 Clause 29: Abolition of NHS Trust Development Authority 75 Clause 30: Merger of bodies: consequential amendment 75 Clause 31: Transfer schemes in connection with abolished bodies 75 Clause 32: Transfer schemes under section 31: taxation 75 Secretary of State’s functions 75 Clause 33: Report on assessing and meeting workforce needs 75 Clause 34: Arrangements for exercise of public health functions 76 Clause 35: Power of direction: public health functions 76 Clause 36: Power of Direction: investigation functions 77 Clause 37: General power to direct NHS England 78 Clause 38: Reconfiguration of services: intervention powers 80 Schedule 6: Intervention powers over the reconfiguration of NHS services 80 NHS Trusts 82 Clause 39: NHS trusts in England 82 Clause 40: Removal of power to appoint trust funds and trustees 82 4 These Explanatory Notes relate to the Health and Care Bill as introduced in the House of Commons on 6 July 2021 (Bill 140) Clause 41: Sections 39 and 40: consequential amendments 82 Schedule 7: NHS trusts in England and removal of power to appoint trustees; consequential amendments 82 Clause 42: Licensing of NHS Trusts 83 Clause 43: NHS Trusts: effect of decisions 83 Clause 44: Oversight and support of NHS trusts 83 Clause 45: Directions to NHS trusts 84 Clause 46: Recommendations about restructuring of NHS trusts 84 Clause 47: Intervention in NHS Trusts 84 Clause 48: NHS Trusts: conversion to NHS foundation trusts and dissolution 85 Clause 49: Appointment of chair of NHS trusts 85 Clause 50: Financial Objectives for NHS trusts 85 NHS Foundation Trusts 86 Clause 51: Licensing of NHS Foundation Trusts 86 Clause 52: Capital Spending Limits for NHS Foundation Trusts 86 Clause 53: Accounts, annual reports, and forward plans 87 Clause 54: NHS foundation trusts: joint exercise of functions 87 Clause 55: NHS foundation trusts: mergers, acquisitions and separations 87 Clause 56: Transfers on dissolution on NHS foundation trusts 88 Clause 57: NHS foundation trusts: wider effect of decisions 88 NHS Trusts and NHS Foundation Trusts: transfer schemes 89 Clause 58: Transfer schemes between trusts 89 Clause 59: Trust special administrators 90 Schedule 8: Trust special administrators: NHS trusts and NHS foundation trusts 90 Joint Working and Delegation of Functions 96 Clause 60: Joint working and delegation arrangements 96 Schedule 9: References to functions: treatment of delegation arrangements etc 98 Collaborative Working 99 Clause 62: Repeal of duties to promote autonomy 100 Clause 63: Guidance about joint appointments 100 Clause 64: Co-operation by NHS bodies etc 100 Clause 65: Wider Effect of decisions: licensing of health care providers 101 NHS Payment Scheme 102 5 These Explanatory Notes relate to the Health and Care Bill as introduced in the House of Commons on 6 July 2021 (Bill 140) Clause 66: The NHS payment scheme 102 Schedule 10: The NHS payment scheme 102 Patient Choice and Provider Selection 104 Clause 67: Regulations as to patient choice 104 Schedule 11: Patient choice: undertakings by integrated care boards 105 Clause 68: Procurement regulations 106 Clause 69: Procurement and patient choice: consequential amendments etc 106 Competition 107 Clause 70: Duty to provide assistance to the CMA 107 Clause 71: Mergers of providers: removal of CMA powers 107 Clause 72: Removal of functions relating to competition etc. 108 Schedule 12: Removal of CMA functions relating to competition etc 108 Clause 73: Removal of CMA’s involvement in licensing etc. 108 Miscellaneous 109 Clause 74: Special Health Authorities: removal of 3 year limit 109 Clause 75: Tidying up etc provisions about accounts of certain NHS bodies 109 Clause 76: Repeal of spent powers to make transfer schemes 110 Clause 77: Abolition of Local Education and Training Boards 111 Clause 78: Hospital Patients with care and support needs: repeals etc 111 Part 2: Health and Adult Social Care Information 111 Clause 79: Information standards 112 Clause 80: Sharing anonymous health and social care information 113 Clause 81: General duties of the Health and Social Care Information Centre etc 114 Clause 82: Collection of information from private health care providers 114 Clause 83: Collection of information about adult social care 115 Clause 84: Enforcement of duties against private providers 116 Clause 85: Medicine Information Systems 117 Part 3: Secretary of State’s Powers to Transfer or Delegate Functions 122 Clause 86: Relevant bodies 123 Clause 87: Power to transfer functions between bodies 123 Clause 88: Power to provide for exercise of functions of Secretary of State 124 Clause 89: Scope of powers 124 6 These Explanatory Notes relate to the Health and Care Bill as introduced in the House of Commons on 6 July 2021 (Bill 140) Clause 90: Transfer