Health Bill
With this it will be convenient to discuss the following: Government new clause 97—Care and support: involvement of others and visitors. New clause 1—National Maternity Commissioner— “(1) The Secretary of State must, within six months of the passing of this Act, appoint a National Maternity Commissioner, situated within the Department of Health and Social Care. (2) The functions of the National Maternity Commissioner are to— (a) oversee NHS maternity services; (b) act as an independent voice for women and families; (c) ensure lessons are learned from identified failures and that the recommendations of maternity reviews are acted upon; (d) promote consistency, safety and accountability across NHS maternity services; and (e) advise the Secretary of State on matters relating to the safety, quality and provision of maternity services in England. (3) The person appointed as Commissioner must— (a) be a person with knowledge, expertise and experience relevant to the discharge of functions of the role; (b) have first-hand experience of working in maternity services, so far as reasonably possible; and (c) not be a sitting Member of Parliament.” This new clause would require the Secretary of State to appoint a maternity commissioner within the Department of Health and Social Care to oversee national maternity services. New clause 2—Assessment of risks posed by contracts with non-UK based suppliers— “(1) Within six months of the passing of this Act, the Secretary of State must conduct and lay before Parliament a risk assessment of all contracts between NHS organisations and suppliers based outside of the UK. (2) In conducting an assessment under this section, the Secretary of State must— (a) pay particular regard to contracts which provide technology companies with access to confidential patient data; (b) consult national security experts on the risks posed to UK sovereignty by such contracts; (c) consider risks associated with the sharing of confidential patient data with organisations based outside of the UK; (d) assess public and NHS staff attitudes to relevant suppliers and any implications such attitudes may have on the use and effectiveness of products or services provided under the contract; and (e) consider the background of relevant suppliers, known contracts with other states and organisations, and any relevant ethical considerations. (3) Where any significant risk is identified, the Secretary of State must set out the Government’s intentions to manage and mitigate such risks, including its intention to use or develop domestic technologies, systems or products in place of those provided under the relevant contract.” This new clause would require the government to publish a risk assessment of contracts between NHS organisations and suppliers based outside of the UK. New clause 3—Duty on the Secretary of State to prioritise domestic suppliers— In the National Health Service Act 2006, after section 1CC (inserted by section 6 of this Act) insert— 1CD Duty to prioritise domestic suppliers (1) In exercising functions in relation to the health and care service, the Secretary of State must prioritise the awarding of any contract that will involve the handling of NHS patient data to suppliers based in the United Kingdom. (2) The Secretary of State may only seek to procure technology and information systems which will handle NHS patient data from suppliers based outside of the United Kingdom where a viable domestic alternative does not exist. (3) Before signing any contract for the procurement of technology and information systems which will handle NHS patient data with a supplier based outside of the United Kingdom, the Secretary of State must consult with— (a) patient groups, (b) national security experts, and (c) staff unions, on the proposed contract and lay a report on such a consultation before Parliament. (4) Where it is proposed to sign a contract for the procurement of technology and information systems which will handle NHS patient data with a supplier based outside of the United Kingdom, the Secretary of State must arrange for a motion agreeing to the signing of such a contract to be tabled in each House of Parliament, and no such contract may be signed where a motion for its agreement is negatived by either House of Parliament. (5) If a contract is awarded for the procurement of technology and information systems which will handle NHS patient data with a supplier based outside of the United Kingdom, the Secretary of State must place a statement before both Houses of Parliament setting out whether the Government is taking, or is planning to take, steps to develop or support long-term domestic alternatives to the systems provided by the contract.” This new clause would place a duty on the Secretary of State to prioritise domestic, UK-based, suppliers for technology systems and contracts handling NHS patient data, and places restrictions on the signing of contracts for such systems with non-UK based suppliers. New clause 4—NHS Digital Sovereignty Strategy— “(1) The Secretary of State must, within 12 months of the passing of this Act, publish a strategy (“an NHS Digital Sovereignty Strategy”) which sets out the Government's approach to maintaining the security and resilience of relevant NHS information systems by— (a) assessing, managing and mitigating risks— (i) associated with foreign interference, (ii) arising from reliance on foreign-supplied technologies, and (b) preventing over-reliance on foreign providers by building domestic capacity. (2) For the purposes of this section, a “relevant information system” is an information system with access to NHS patient data. (3) An NHS Digital Sovereignty Strategy published under this section must— (a) include risks associated with— (i) hardware, (ii) software, (iii) supply chains, and (iv) procurement processes; (b) include a specific focus on security and resilience in digital procurement processes, detailing how the Government intends to reduce strategic dependencies on foreign-owned service providers to mitigate the risk of systemic disruption; (c) include a commitment to prioritise the use of technologies developed in the UK by UK organisations in relevant information systems to reduce reliance on foreign technologies; (d) recommend steps to support and develop sufficient domestic capability where it does not currently exist; (e) where risks are identified, state how the Government intends to address these risks by supporting the use or development of domestic technologies or systems.” This new clause would require the Government to publish an NHS Digital Sovereignty Strategy setting out how it intends to address risks to relevant information systems posed by foreign interference and reliance on foreign technologies, including by supporting the use of domestic technologies. New clause 5—Health Data Charter— “(1) The Secretary of State must, within 6 months of the passing of this Act, establish an independent body (to be known as the "Sovereign Health Data Trust”) for the purpose of creating a Health Data Charter. (2) The membership of the Trust should include— (a) people with a diverse range of backgrounds; and (b) health data experts, clinicians and patient representatives. (3) The Charter must— (a) set out the fundamental principles and responsibilities for assessing whether a data sharing partnership is in the interest of the public and the NHS; (b) include the primary goal of protecting people’s privacy and their data from exploitation, while promoting trust in data systems and the handling of health data; (c) ensure patients have control of their data, including providing relevant opt-outs; (d) provide that all health data is held anonymously and accessed through a trusted research environment; (e) set out ways to retain and protect the value of health data in England, including providing measures to invest a share of the income generated from new medicines or treatments developed with that health data to be invested back into the NHS; (f) be designed in such a way as to render it interoperable with the European Health Data Space in technical terms, including through the promotion of Findable, Accessible, Interoperable and Reusable (FAIR) data principles within the NHS. (4) The Sovereign Health Data Trust will— (a) hold continuous oversight of all health data and oversee the trusted research environment; (b) have power to recall or restrict an organisation’s access to data if it has reason to believe that the data is not being used for public or patient benefit; (c) ensure that all data sharing arrangements with a non-NHS organisation are transparent, with all health data contracts entered into by a public body made publicly available; (d) publish detailed minutes of all meetings discussing potential uses of health data; and (e) ensure all health data collection and sharing initiatives are preceded by public consultation, involvement and awareness.” New clause 6—Maternity Safety— “(1) The Secretary of State must ensure that every NHS maternity unit is rated “good” or “outstanding” by the CQC. (2) The Secretary of State must, within 6 months of the passage of this Act, establish a scheme to support NHS trusts to deliver the requirement under subsection (1), which includes— (a) 24/7 consultant obstetrician cover on every labour ward, (b) one-to-one midwifery care, (c) a Director of Midwifery in every maternity service, (d) ringfenced maternity service development funding, and (e) a dedicated neonatal workforce plan. (3) Within 12 months of the commencement of the scheme under subsection (2), and every 12 months thereafter, an annual report should be laid before both Houses of Parliament on the effectiveness of the scheme.” This new clause would place a duty on the Secretary of State to create a scheme to ensure that every maternity unit in the country achieves a “good” or “outstanding” rating by the CQC. New clause 7—Healthy life expectancy target— “(1) Within six months of the passage of this Act, the Secretary of State must— (a) make regulations to set a statutory target for improving overall healthy life expectancy for the population of Great Britain, and (b) publish a cross-governmental strategy, renewed every 24 months, to set out how the target set by regulations under subsection (1)(a) will be achieved. (2) The strategy under subsection (1)(b) must be laid before both Houses of Parliament. (3) Upon publication of a strategy under subsection (1)(b) the Secretary of State must make a statement before the House of Commons regarding progress made towards the target set by subsection (1)(a).” This new clause would require the Secretary of State to make regulations to establish a statutory target for healthy life expectancy in Great Britain and publish a strategy every two years setting out how this target will be achieved. New clause 8—Impact of trade deals on the NHS— “(1) Any trade negotiation which would require NHS spending or funding to exceed £100 million must be laid before Parliament by the Secretary of State in the form of regulations subject to the affirmative procedure. (2) Before laying regulations under subsection (1) the Secretary of State must publish an impact assessment about how the trade negotiation will affect NHS frontline services and patients.” This new clause would require any trade negotiation which would require NHS spending or funding to exceed £100 million to be laid before Parliament by the Secretary of State in the form of regulations subject to the affirmative procedure. New clause 11—Duty as respects waiting times for women’s health— “In the National Health Service Act 2006, after section 1CC (inserted by section 6 of this Act) insert— “1CD Duty as respects waiting times for women’s health The Secretary of State must exercise functions in relation to the health service with a view to ensuring that average waiting times for the diagnosis and elective treatment of conditions primarily affecting women do not exceed the overall average waiting times for NHS diagnosis and elective treatment.”” This new clause would ensure that the average waiting time for diagnosis and treatment for elective conditions for women’s health issues do not exceed the average wait time for wider NHS elective treatment. New clause 12—Inquiry into women’s health outcomes— (1) The Secretary of State must, within six months of the passing of this Act, commission an independent inquiry into women’s health provision and outcomes in England. (2) Any inquiry established under subsection (1) must consider— (a) the causes of— (i) poorer health outcomes, and (ii) disparities in patient safety, for women; (b) the effectiveness of existing commissioning arrangements in meeting the needs of women, and (c) recommendations to assist the Secretary of State in discharging the duty to reduce inequalities in health outcomes under section 1C of the National Health Service Act 2006. (3) The Secretary of State must lay a report on the findings of the inquiry before Parliament within the period of 12 months beginning with the day on which this Act is passed.” This new clause would establish an inquiry into the poorer health outcomes faced by women. New clause 15—Public Health Committee— (1) The Secretary of State must establish a Public Health Committee within six months of the passage of this Act to ensure a cross-governmental focus and consideration of the promotion of public health in government policy and address national health inequalities. (2) The Public Health Committee under subsection (1) must— (a) include at least one minister from each government Department in its membership, (b) include all cabinet ministers in its membership, (c) be chaired by the Prime Minister, (d) meet once in each annual quarter. (3) Under subsection 2(b), cabinet members must attend at least three quarters of the Public Health Committee's meetings each year. (4) Each government Department must publish an annual report on their department's consideration of public health in its policy and the extent of joint policy formulation with other government Departments. (5) The Secretary of State must establish a Health Creation Unit to support the Public Health Committee. (6) The Health Creation Unit must submit an annual report on its activities, decision-making and cross-government progress to the Liaison Committee.” This new clause would establish a Public Health Committee and Health Creation Unit to promote public health and cross-government policy making. New clause 16—Duty to promote public health— “All Ministers of the Crown have a duty to consider health outcomes and the promotion and protection of public health when exercising their duties.” This new clause will place a duty on all ministers to consider health outcomes and the promotion of public health when exercising their duties. New clause 17—Arrangement between the United States of America and the United Kingdom on pharmaceutical pricing— “(1) The Arrangement between the United States of America and the United Kingdom on pharmaceutical pricing may be ratified only if— (a) a Minister of the Crown has laid before the House of Commons a copy of the Arrangement, and (b) the Arrangement has been approved by a resolution of the House of Commons on a motion moved by a Minister of the Crown. (2) Before tabling a motion under subsection (1)(b) the Secretary of State must publish and lay before the House of Commons an impact assessment on the potential effects on the health service of implementation of the Arrangement.” This new clause would require the Arrangement between the United States of America and the United Kingdom on pharmaceutical pricing to be brought before the House for a vote. New clause 18—Access to dental provision: Dental deserts— “(1) Within six months beginning on the day on which this Act is passed, the Secretary of State must establish a scheme to improve access to dental provision (“the Scheme”). (2) The purpose of the Scheme is to end dental deserts. (3) A dental desert is defined as any local authority area with fewer than ten active dental practices per 100,000 people. (4) The Scheme must make provision to support integrated care boards to— (a) guarantee emergency access to an NHS dentist, (b) provide free dental check-ups for— (i) children, (ii) mothers within one year of having given birth, (iii) pregnant women, and (iv) low-income households, (c) guarantee dental appointments for persons commencing— (i) surgery, (ii) chemotherapy, or (iii) transplant procedures. (5) The Secretary of State must, before publishing the Scheme, issue a reformed dental contract. (6) The Secretary of State must, within six months of the establishment of the scheme, publish a dental workforce plan to support delivery of the scheme.” This new clause would establish a scheme to support integrated care boards to end dental deserts. New clause 21—GP representation on integrated care boards— “(1) An integrated care board must include as a member at least one individual who— (a) is a registered medical practitioner, and (b) has current or recent experience of providing primary medical services under Part 4 of the National Health Service Act 2006. (2) In appointing a member under subsection (1) an integrated care board must have regard to the member’s potential contribution to improving— (a) patient journeys across services, (b) coordination and continuity of care, (c) prevention and population health management, and (d) integration of services at neighbourhood level.” This new clause would ensure that each integrated care board includes at least one member who is a registered medical practitioner, and has current or recent experience of providing primary medical services under Part 4 of the National Health Service Act 2006. New clause 22—Duty to engage primary care providers in integrated care boards— “(1) An integrated care board must take all reasonable steps to secure the meaningful involvement of primary care providers in the exercise of its functions relating to— (a) service redesign, (b) integration of health services, (c) development of neighbourhood health services, and (d) population health planning. (2) In this section, “primary care providers” includes— (a) providers of primary medical services, (b) community pharmacy contractors, (c) providers of primary dental services, and (d) providers of ophthalmic services. (3) Under subsection (1), “meaningful involvement” includes— (a) involvement at an early stage in the development of ICB proposals, (b) provision of sufficient information to enable informed participation of primary care providers in ICB functions, (c) opportunities for primary care providers to influence ICB decision making, and (d) opportunities for primary care providers to deliver feedback on how their views have been taken into account in the delivery of ICB functions. (4) An integrated care board must publish an annual statement describing— (a) how it has complied with this section, and (b) the impact of primary care providers’ involvement on decisions taken by the ICB. (5) The Secretary of State may issue guidance about the application of this section to which integrated care boards must have regard.” This new clause ensures a certain range of primary care providers are consulted by integrated care boards in the development of their healthcare plans. New clause 23—Duty of care for victims of domestic abuse and violence against women and girls— “The Secretary of State and integrated care boards have a duty of care to consider the needs of victims of domestic abuse and violence against women and girls when exercising their functions in relation to the provision of healthcare services.” This new clause would place a duty of care on the Secretary of State and integrated care boards to consider the needs of victims of domestic abuse and violence against women and girls when exercising their functions in relation to the provision of healthcare services. New clause 25—Continuity of care and clinical responsibility— “(1) The Secretary of State must by regulations ensure that every patient has access to a named NHS General Practitioner. (2) Regulations under this section must make provision for pregnant women to have access to a named clinician for the period of their pregnancy. (3) Regulations under this section are subject to the affirmative procedure.” New clause 29—Senior leadership training at NHS trusts— “(1) Within six months of the passage of this Act, the Secretary of State must publish a review on the effectiveness of training for senior leadership in NHS trusts on— (a) workplace culture standards, (b) addressing bullying, and (c) addressing discrimination on the basis of— (i) sex, (ii) race, and (iii) any other protected characteristic which the Secretary of State considers appropriate. (2) Within one month of the publication of the review under subsection (1), the Secretary of State must publish guidance based on the review for the Department of Health and Social Care to administer to NHS trusts.” New clause 32—Privacy by design in NHS Single Patient Record and Federated Data Platform architecture— “(1) The Secretary of State must ensure that there is privacy by design as part of the delivery of the NHS Federated Data Platform architecture. (2) For the purposes of subsection (1), privacy by design includes— (a) patient data anonymisation outside its usage by clinicians and within the National Data Integration Tenant; and (b) patient consent for the processing of personal information by NHS.” New clause 33—NHS ownership of connection software— “(1) The Secretary of State must ensure that there is NHS ownership of any data connector software architecture used as part of the delivery of the NHS Single Patient Record or Federated Data Platform. (2) In this section, a data connector means an interface or connection between the NHS Federated Data Platform and any other health system.” New clause 34—Retendering of contract for the NHS Federated Data Platform— “The Secretary of State must, before February 2027, commence a competitive retendering for the contract to provide the NHS Federated Data Platform.” New clause 35—NHS contracting for IT or data services— “(1) The Secretary of State must, within six months of the passing of this Act, by regulations establish a governance framework for the contracting of any IT or data services by the Department of Health and Social Care or any NHS organisation. (2) The framework established under subsection (1) must include the following provisions— (a) a party may not bid for any contract for services where such services have previously been provided by the party on a free trial basis; (b) the automatic extension of contracts should be subject to audit by the National Audit Office; (c) contract terms must include provision for the department or NHS organisation to take ownership of any bespoke system built or developed by the contractor during the delivery of the contract; (d) the department or NHS organisation must, at the end of the contract period (or following any extensions) conduct a competitive retendering process; and (e) where a retendering process takes place under subsection (2)(d), the contractor may not assist in the preparation of the contract specification. (3) Regulations under this section are to be made by statutory instrument subject to the affirmative procedure.” New clause 36—Transition strategy for the abolition of NHS England— “(1) The Secretary of State must, before the abolition of NHS England takes effect, prepare and lay before Parliament a report setting out a transition strategy for the abolition of NHS England (the "strategy"). (2) The strategy must— (a) identify and map critical functions and areas of expertise currently exercised by NHS England, including clinical, operational, analytical and patient engagement capabilities; (b) assess the risk of loss of knowledge, skills and organisational capacity arising from the abolition of NHS England; (c) set out the steps the Secretary of State proposes to take to ensure the retention and effective transfer of such functions, expertise, knowledge and skills; and (d) assess the likely impact of the transition on the delivery of key health programmes and services, including cancer services. (3) The Secretary of State must, at intervals of not more than 12 months, lay before Parliament a report on the implementation of the transition strategy. (4) A report under subsection (3) must include— (a) progress on workforce retention; (b) arrangements for the transfer of knowledge, expertise and institutional capability; and (c) any identified gaps in capability and the steps being taken to address them.” This new clause would require the Secretary of State to prepare and lay before Parliament a formal transition strategy before the abolition of NHS England, setting out how critical functions and expertise will be identified, retained and transferred. It would also require the Secretary of State to report to Parliament at least annually on the implementation of that strategy. New clause 38—General Ophthalmic Services: national framework, tariff and protected funding— “(1) The Secretary of State must by regulations establish and maintain a national service specification for the primary ophthalmic services referred to in section 115 of the National Health Service Act 2006 (in this section referred to as general ophthalmic services, "GOS"), setting out the minimum standards of access and provision that integrated care boards are required to secure. (2) Regulations under subsection (1) must establish and maintain a national tariff for GOS, setting out the prices at which GOS must be commissioned by integrated care boards. (3) An integrated care board must commission GOS in accordance with the national service specification and national tariff established under subsections (1) and (2), and may not exercise any discretion to vary, restrict or reduce provision below the standards so specified. (4) The Secretary of State must ensure that funding for GOS is allocated to integrated care boards as a ring-fenced, protected funding stream, which— (a) may not be applied by an integrated care board to purposes other than GOS; and (b) may not be reduced by an integrated care board in order to meet expenditure requirements in respect of other services. (5) In determining any expenditure limits or resource allocations for integrated care boards under the National Health Service Act 2006, the Secretary of State must calculate and separately identify the GOS component of each board's allocation. (6) The Secretary of State must lay before Parliament a report in each calendar year assessing the extent to which integrated care boards have complied with their obligations under this section.” New clause 39—Community equipment and wheelchair services: standards, performance and outcomes— “(1) Each integrated care board must publish standards which apply in its area in relation to the assessment for and supply of community equipment and wheelchair services. (2) Each integrated care board must monitor its performance against the standards under subsection (1). (3) Each integrated care board must publish an annual report including— (a) performance against the standards under subsection (1), (b) waiting times for the assessment for and supply of community equipment and wheelchair services, (c) the number and proportion of people waiting longer than 18 weeks for such equipment or services, (d) outcomes achieved for people by the provision of community equipment and wheelchair services, and (e) steps taken by the integrated care board to improve the assessment for, and supply of, community equipment and wheelchair services. (4) For the purposes of this section— “community equipment and wheelchair services” means equipment, aids, home adaptations or appliances provided to support a person’s independence, safety, care or daily living at home or in the community, including hoists, hospital beds, pressure-relieving mattresses, commodes, shower chairs, walking frames, grab rails, ramps, specialist seating, postural support equipment, associated mobility equipment, and wheelchairs.” This new clause would require each integrated care board must publish standards which apply in its area in relation to the assessment for and supply of community equipment and wheelchair services and publish an annual report on their adherence to these standards. New clause 40—Regulation of online fertility services— “(1) The Human Fertilisation and Embryology Act 1990 is amended as follows. (2) After section 5 insert— “5A. Regulation of online fertility services (1) The Human Fertilisation and Embryology Authority shall be responsible for the licensing of organisations providing online fertility services in England and Wales. (2) The Secretary of State may by regulations make further provision regarding the arrangements for the licensing of organisations under subsection (1). (3) Regulations made under subsection (2) are subject to the affirmative procedure.”” This new clause would implement a recommendation of the Human Fertilisation and Embryology Authority to extend its regulatory remit to include organisations providing online fertility services. New clause 43—Duty to reduce variation in clinical research funding— “In exercising functions in relation to the health service, the Secretary of State must have regard to the need to— (a) reduce inequalities between the people of England with respect to their ability to access clinical research opportunities and participate in clinical trials, and (b) reduce regional variation in the distribution of clinical research funding across England.” This new clause would require the place a duty on the Secretary of State to reduce inequalities across England with respect to access to clinical research opportunities and participate in clinical trials and the distribution of clinical research funding across. Amendment 46, in schedule 12, page 151, leave out paragraph 98. This amendment is consequential on NC67. New clause 48—National Maternity and Neonatal Investigation final report and recommendations— “(1) The Secretary of State must, within six months of the passing of this Act, publish a response to the final report and recommendations of the National Maternity and Neonatal Investigation. (2) The response under subsection (1) must include an action plan covering each of the recommendations of the Investigation. (3) The action plan must have regard for hospitals— (a) where negligent care has been identified in the provision of maternity and neonatal services, or (b) where risk factors have been identified that are associated with potential negligent care in the provision of maternity and neonatal services. (4) The Secretary of State must report to Parliament each year on the progress made in delivering the action plan.” This new clause would require the Secretary of State to produce an action plan in response to the final report and recommendations of the National Maternity and Neonatal Investigation. New clause 50—Independence of appointments— “The Secretary of State must make provision to ensure that operational decisions regarding the appointment, suspension or removal of— (a) chairs and directors of NHS trusts and NHS foundation trusts, and (b) chief executives of integrated care boards, are made exclusively by persons employed in the civil service, upon strictly merit-based criteria.” This new clause would ensure that any decisions over NHS trusts and ICB leadership are made by civil servants, rather than the Secretary of State, to ensure appointments are made on merit. New clause 51—Accident and Emergency: waiting times” “(1) Within six months beginning on the day on which this Act is passed, the Secretary of State must make provision relating to Accident and Emergency Department admission. (2) Provision under subsection (1) must by regulations amend the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012 to place a right in the NHS Constitution for England for every patient to be admitted into an Accident and Emergency Department within 12 hours of approval of their admission being made. (3) The Secretary of State must establish and implement an Accident and Emergency Scheme (“the Scheme”) to support NHS hospital trusts to achieve the requirement set out in subsection (2). (4) The Scheme must consider— (a) creating safety-net social care beds, (b) increasing step-down care, (c) publishing a dedicated accident and emergency care workforce plan, and (d) mandating a qualified clinician is present in every Accident and Emergency waiting room. (5) The Secretary of State must have due regard to the final report of the Independent Commission on Adult Social Care in establishing the scheme.” This new clause gives patients a new right in the NHS constitution to be admitted into A&E within 12 hours from decision to admit and requires the Secretary of State to introduce a scheme to achieve this. New clause 53—Right to a GP appointment— “(1) The Secretary of State must by regulations, within six months of the passing of this Act, establish a scheme to provide every patient with the right to a GP appointment within seven days of seeking one, or 24 hours if urgent. (2) The Secretary of State must amend the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012 to make the right under subsection (1) a right in the NHS constitution. (3) The Secretary of State may review the scheme every three years from the day on which this Act is passed and amend it through regulations made by statutory instrument. (4) A statutory instrument under this section may not be made unless a draft has been laid before and approved by a resolution of each House of Parliament. (5) For the purposes of this section— “GP appointment” means an appointment with an appropriate clinician within a GP practice. “Urgent” means the current definition under GP triaging protocols.” This new clause requires the Secretary of State to give patients a new right in the NHS constitution to receive a GP appointment within 7 days, or 24 hours if urgent, and establishes a scheme to deliver this. New clause 54—Duty to identify and record unpaid carers— “After section 14Z44 of the NHS Act 2006 insert— “Duty to identify and record unpaid carers (1) An integrated care board must take reasonable steps to identify persons within its area who are unpaid carers. (2) An integrated care board must make arrangements to ensure that NHS bodies and providers of NHS services within its area— (a) maintain appropriate systems for recording whether a person is an unpaid carer, (b) use consistent coding standards for the recording of unpaid carers in health records, (c) review and update records relating to unpaid carers at appropriate intervals, and (d) ensure that the identification and recording of unpaid carers forms part of— (i) primary care registration processes, (ii) hospital discharge procedures, (iii) care planning processes, and (iv) other relevant patient contact pathways. (3) For the purposes of this section, "unpaid carer" means a person who provides or intends to provide care for another person otherwise than by virtue of a contract or other voluntary work.”” This new clause would introduce a duty for integrated care boards to identify and record unpaid carers when they come into contact with NHS services. New clause 55—Duty to promote the health and wellbeing of carers— “After section 14Z44 of the NHS Act 2006 insert— “Duty to promote the health and wellbeing of carers (1) Each integrated care board must exercise its functions with a view to improving and maintaining the physical health, mental health, and wellbeing of carers within its area. (2) In exercising its duties under this section, an integrated care board must have regard to— (a) reduction of health inequalities experienced by carers, (b) prevention of deterioration in carers’ physical and/or mental health, (c) involvement of carers in decisions relating to the care of persons for whom they provide care, and (d) the need to ensure carers are able to access appropriate preventative and other health services and support. (3) An integrated care board must take reasonable steps to ensure that NHS bodies and providers of NHS services within its area— (a) consider the health and wellbeing needs of carers in care planning and discharge processes, (b) involve carers appropriately in decisions relating to care and treatment, and (c) provide carers with information about support available to them for their health and wellbeing. (4) In preparing a Joint Forward Plan, an integrated care board must include— (a) an assessment of the health and wellbeing needs of carers within its area, (b) steps the integrated care board proposes to take to improve outcomes for carers, and (c) measures for reducing inequalities experienced by carers. (5) For the purposes of this section, “unpaid carer"” means a person who provides or intends to provide care for another person otherwise than by virtue of a contract or other voluntary work.”” This new clause would introduce a duty for integrated care boards to promote the health and wellbeing of carers. New clause 56—National Respite Care Scheme— “(1) Within six months of the passage of this Act, the Secretary of State must establish a National Respite Care Scheme. (2) The scheme under subsection (1) must make provision for— (a) where a local authority carries out an assessment of the needs of an unpaid carer, under any enactment for the time being in force in England, it must assess whether the unpaid carer is able to take sufficient breaks from their caring responsibilities, (b) unpaid carers to receive support to take breaks from their caring responsibilities to— (i) maintain their physical and mental health and emotional wellbeing, (ii) participate in work, education, training or recreation, and (iii) participate in family and community life, (c) a carer to receive appropriate support if a local authority carrying out an assessment under subsection (2)(a) determines that a carer is unable to take sufficient breaks from caring. (3) Under subsection (2), “support” may include— (a) replacement care for the cared-for person; (b) respite services; (c) any other steps a local authority considers appropriate as support. (4) The Secretary of State must provide sufficient support to local authorities to ensure the scheme under subsection (1) is delivered in every local authority. (5) For the purposes of this section— “unpaid carer” means a person who provides or intends to provide care for another person otherwise than by virtue of a contract or other voluntary work; “parent carer” has the same meaning as in section 17ZD of the Children Act 1989; “young carer” has the same meaning as in section 96 of the Children and Families Act 2014.” New clause 57—Integrated Care Boards: Scrutiny Committee— “(1) Each integrated care board must establish a Scrutiny Committee. (2) Each Committee established under subsection (1) must— (a) oversee the operation of the integrated care board, (b) ensure accountability of the integrated care board with regards to— (i) allocation of resources; (ii) grievance and complaint management; (iii) innovation and service redesign in line with Government objectives; (iv) delivery of services; (v) integration with social care; (vi) advancing public health objectives; (vii) issues relating to workforce or estate; and (viii) any other issues as designated by the Secretary of State. (c) have the power to undertake inquiries into innovation on services delivery and outcomes. (3) The Committee must comprise— (a) Members of Parliament representing constituencies in the area covered by the integrated care board, (b) Chairs of local government health and social care committees in the area covered by the integrated care board, (c) representatives from Healthwatch England or any patient participation network designated by the Secretary of State, and (d) Representatives from trade unions including— (i) two representatives from unions involved in negotiations on Agenda for Change, and (ii) one representative from a trade union representing doctors or dentists. (4) The Committee must meet six times each year. (5) The Chair of the Committee must be elected at an annual general meeting of the Committee. (6) The Committee must report to the Board of the integrated care board. (7) The Chair and Chief Executive of each integrated care board and leaders of health providers and services must attend a meeting of a Committee when requested to do so. (8) Each Committee will report to the Secretary of State for Health and Social Care.” New clause 66—Maternity services: safe staffing levels— “(1) The Secretary of State must ensure that maternity staffing levels are sufficient to ensure all residents in England can access a staffed maternity unit within 45 minutes of their home. (2) The Secretary of State must ensure adequate workforce planning, including through delivery of a consultant obstetrician and gynaecologist recruitment and retention plan, to ensure that maternity units are not required to close as a result of staffing issues. (3) The Secretary of State must lay before Parliament an annual report on the progress made on national maternity staffing levels under this section.” This new clause would ensure that no maternity units are forced to close as a result of staffing issues and that every person in England has access to a maternity unit within 45 minutes of their home. New clause 67—Workforce planning and supply— “(1) After section 1 of the National Health Service Act 2006 insert— “1ZA Secretary of State’s duty as to workforce planning and supply (1) The Secretary of State must promote in England a comprehensive system of workforce planning and supply designed to secure that there are sufficient people with the necessary skills and experience to provide services as part of the health service. (2) In meeting the requirement under subsection (1), the Secretary of State must exercise the functions conferred by this Act so as to secure that the workforce needs of the health service are assessed and met. (3) The Secretary of State retains ministerial responsibility to Parliament for workforce planning and supply for the health service in England.” (2) For section 1GA of the National Health Service Act 2006 substitute— “Workforce strategy (1) The Secretary of State must prepare and publish a strategy setting out how the Secretary of State proposes to discharge the duty under section 1ZA. (2) The strategy must include— (a) an assessment of the current workforce of the health service; (b) projections of the workforce required to meet the needs of the health service over periods of five, ten and fifteen years beginning with the day on which the strategy is published; (c) an assessment of the expected supply of people available to meet those requirements; (d) an assessment of any difference between the projected workforce requirements and expected workforce supply; (e) the measures that the Secretary of State proposes to take to address any such difference; and (f) an assessment of the financial and other resources required to implement those measures. (3) In preparing or revising the strategy, the Secretary of State must consult— (a) integrated care boards; (b) NHS trusts and NHS foundation trusts; (c) persons providing services as part of the health service; (d) trade unions representing persons employed or otherwise engaged in the provision of those services; (e) professional bodies and professional regulators; (f) persons concerned with the provision of education and training for the workforce; (g) persons representing patients; and (h) such other persons as the Secretary of State considers appropriate. (4) The first strategy under this section must be published before the end of the period of 12 months beginning with the day on which this section comes into force. (5) The Secretary of State must— (a) review the strategy before the end of the period of five years beginning with the day on which it was last published, and (b) following each review, publish a revised strategy. (6) The Secretary of State may revise the strategy before the end of that period if the Secretary of State considers it appropriate to do so. (7) The Secretary of State must lay before Parliament a copy of each strategy published under this section. (8) The Secretary of State must have regard to the strategy when exercising functions in relation to the health service.”” This new clause places responsibility for workforce planning and supply for the health service in England on the Secretary of State, including ministerial responsibility to Parliament. It also requires the Secretary of State to publish a strategy setting out projected workforce requirements and supply, and the measures and resources needed to meet those requirements. New clause 69—Self-care— “In the National Health Service Act 2006, after section 1C insert— “1CA Duty as to self-care In exercising functions in relation to the health service, the Secretary of State must have regard to the importance of— (a) promoting self-care and improving health literacy as part of the prevention of illness and the improvement of health and wellbeing; (b) supporting people to manage self-treatable conditions independently where appropriate; and (c) the role of community pharmacy in supporting self-care and prevention and helping people to access appropriate care.”” This new clause would require the Secretary of State, when exercising functions in relation to the health service, to have regard to the importance of promoting self-care and improving health literacy, supporting people to manage self-treatable conditions, and the role of community pharmacy in supporting self-care and prevention. New clause 74—Protection of pharmacy staff during provider failure— “(1) The Secretary of State must establish arrangements to protect the pay and essential employment protections of staff employed by a provider of pharmaceutical services where the provider— (a) becomes insolvent, (b) ceases to provide pharmaceutical services, (c) has its arrangements for providing pharmaceutical services suspended or terminated, or (d) is otherwise unable to meet its obligations to its employees. (2) Arrangements under subsection (1) must provide for— (a) the continuation, so far as reasonably practicable, of payment of wages to affected staff, (b) the preservation of essential employment protections during the period of emergency intervention, (c) the maintenance of staffing necessary for the safe provision of pharmaceutical services, and (d) the transfer, continuation or replacement of employment arrangements where necessary to secure continuity of pharmaceutical services. (3) The Secretary of State may make payments to, or in respect of, affected staff for the purposes of this section. (4) The Secretary of State may recover from the failed provider any sums paid under subsection (3). (5) Arrangements under this section must be capable of operating at the same time as arrangements made under section 133 of the National Health Service Act 2006 to secure alternative provision of pharmaceutical services. (6) The Secretary of State must publish guidance about the operation of arrangements under this section.” This new clause would protect pharmacy staff's pay and essential employment rights when a provider fails, while supporting continuity of services. New clause 75—Integrated primary care teams— “(1) Each integrated care board must make arrangements to promote the provision of joined-up primary care services across general practice, primary dental services and pharmaceutical services. (2) Arrangements under subsection (1) must, so far as reasonably practicable, provide for— (a) general practitioners, dentists, pharmacists and other relevant primary care professionals to work together as part of integrated local primary care teams; (b) the sharing of relevant patient information between those professionals through secure and interoperable digital systems; (c) the use of common or interoperable care records, so that relevant clinical information can be accessed by an authorised professional involved in a patient's care; (d) appropriate mechanisms for referral and communication between general practice, dental practices and community pharmacies; (e) the reduction of duplication in assessments, prescribing, referrals and administrative processes; and (f) improved continuity and coordination of care for patients with multiple or ongoing health needs. (3) In exercising its functions under this section, an integrated care board must have regard to the need to ensure that patients can move between general practice, primary dental services and pharmaceutical services without unnecessary duplication, delay or loss of relevant clinical information. (4) The Secretary of State may by regulations make provision about— (a) minimum interoperability standards for systems used by providers of primary medical, dental and pharmaceutical services; (b) standards for the secure exchange of patient information; (c) common data standards and clinical terminology; (d) electronic referrals and communications between providers; and (e) such other matters as the Secretary of State considers necessary to support integrated primary care. (5) Regulations under subsection (4) must include appropriate safeguards for patient confidentiality, information governance and the lawful processing of personal data. (6) In this section— “primary care team” means a group of health professionals and providers working together to provide or coordinate primary care services; “primary dental services” has the meaning given by section 98C of the National Health Service Act 2006; and “pharmaceutical services” includes services provided under Part 7 of that Act.” This new clause would promote joined-up working between GPs, dentists and pharmacists to improve coordination and continuity of care. New clause 79—Voluntary sector role in neighbourhood health plans— “(1) In preparing a neighbourhood health plan, a responsible local authority and integrated care board must take and demonstrate reasonable steps to ensure the plan is co-produced with meaningful involvement by the local voluntary, community and social enterprise sector in that area, including the development, design, implementation, monitoring and evaluation of the plan. (2) In meeting the requirement under subsection (1) a local authority and integrated care board must in particular have regard to— (a) organisations representing people with lived experience of health conditions; (b) organisations working with underserved or marginalised populations; and (c) the role of voluntary, community and social enterprise organisations in delivering community-based services. (3) The responsible local authority and integrated care board must demonstrate how they have ensured ongoing and meaningful representation of voluntary, community and social enterprise organisations across the governance, decision-making and commissioning arrangements relating to neighbourhood health plans at all stages of the planning process.” This new clause would require local authorities and integrated care boards to take and demonstrate reasonable steps to ensure neighbourhood health plans are co-produced with meaningful involvement by the local voluntary, community and social enterprise sector in the local area. New clause 80—Power to enable reservation and prioritisation of contracts for the voluntary, community and social enterprise sector— “(1) In exercising their commissioning functions, integrated care boards must take reasonable steps to secure the participation of voluntary, community and social enterprise organisations in the provision of services. (2) The Secretary of State must through regulations enable integrated care boards to reserve and/or prioritise contracts to be delivered by voluntary, community and social enterprise organisations as part of their commissioning process. (3) Circumstances in which contracts may be appropriate to be reserved or prioritised under subsection (2) include— (a) services that are, or could be, community-based; (b) services that are intended to reach populations that are underserved, marginalised, or experiencing health inequalities; or (c) where voluntary, community and social enterprise organisations are best placed to deliver person-centred and/or culturally competent care. (4) In exercising functions under this section, integrated care boards must have regard to— (a) the need to reduce health inequalities; (b) the importance of securing equitable access to services across different areas; and (c) the sustainability of voluntary, community and social enterprise provision.” This new clause would require integrated care boards to take reasonable steps to secure the participation of voluntary, community and social enterprise organisations in the provision of services through the ICB commissioning process. New clause 85—Duties on integrated care boards regarding education, health and care plans— “(1) The Secretary of State must exercise the powers in Part 3 of the Children and Families Act 2014 (children with special education needs) with a view to securing that integrated care boards (“ICBs”) are subject to the same relevant requirements as local authorities in relation to the duty to secure the specified special educational provision for a child or young person in the preparation of education, health and care plans (“EHC plans”) under that Part. (2) For the purposes of subsection (1), the relevant requirements are— (a) that the special educational provision set out in section F of an EHC plan meets the needs identified by an EHC needs assessment; (b) that ICBs can be required to provide such special educational provision; (c) that ICBs must provide such special educational provision from the date the EHC plan is finalised or issued; (d) that ICBs are subject to appeals to the First-tier Tribunal in accordance with section 51 of the Children and Families Act 2014; and (e) that any duty on ICBs to provide such special educational provision does not impact upon an ICB’s duty to arrange health care provision, where this is required by an EHC plan.” This new clause would require the Secretary of State to make regulations placing a statutory duty on integrated care boards to ensure that where an EHC plan specifies special education provision, they are subject to the same duty as local authorities to ensure that this is arranged for the child or young person. New clause 90—Duty to reduce health inequalities— “(1) Section 2B of the National Health Service Act 2006 (functions of local authorities and Secretary of State as to improvement of public health) is amended as follows. (2) In the heading, after “health” insert “and reduction of health inequalities”. (3) In subsection (2)— (a) for “may” substitute “must”; and (b) after “England” insert “and reducing health inequalities between the people of England”. (4) In subsection (3), after paragraph (g) insert— “(h) collaborating with any government department or local authority.” (5) After subsection (5) insert— “(6) In this section, “health inequalities between the people of England” means health inequalities between persons, or persons of different descriptions, living in England or in different parts of England. (7) In this section, “health inequalities” means inequalities in respect of life expectancy or general state of health which are wholly or partly a result of differences in respect of general health determinants. (8) In subsection (7), “general health determinants” include— (a) standards of housing, transport services or public safety; (b) environmental factors, including air quality and access to green space and bodies of water; (c) employment prospects, earning capacity and any other matters that affect levels of prosperity; (d) the degree of ease or difficulty with which persons have access to public services; (e) the use, or level of use, of tobacco, alcohol or other substances, and any other matters of personal behaviour or lifestyle, that are or may be harmful to health; and (f) any other matters that are determinants of life expectancy or the state of health of persons generally, other than genetic or biological factors. (9) In subsection (2), the reference to reducing health inequalities includes mitigating any increase in health inequalities which would otherwise be occasioned by the exercise of the Secretary of State’s functions.”” New clause 91—Health improvement and health inequalities strategy— “(1) The Secretary of State must, within six months beginning on the day on which this Act is passed, publish a health improvement and health inequalities strategy. (2) In preparing the strategy, the Secretary of State must consult such persons as the Secretary of State considers appropriate. (3) The strategy must include— (a) long-term targets relating to health improvement and the reduction of health inequalities in England throughout a person's life; (b) provision for the establishment of a public authority with functions relating to the additional monitoring of, and reporting on, progress towards the targets included in the strategy in accordance with paragraph (a); and (c) such other provision as the Secretary of State considers appropriate. (4) The long-term targets included in the strategy in accordance with subsection (3)(a) must include— (a) at least one target relating to the improvement of the health of persons under the age of 18 in England; and (b) at least one target relating to the improvement of the health of persons aged 18 or over in England. (5) A Minister of the Crown must, in exercising the Minister’s functions, have regard to the strategy. (6) The Secretary of State must prepare and publish a report on the implementation of the strategy— (a) within 12 months of the publication of the strategy; and (b) at intervals of no more than 12 months thereafter. (7) In this section, “health inequalities” means inequalities in respect of life expectancy or general state of health which are wholly or partly a result of differences in respect of general health determinants.” New clause 93—State of NHS Dentistry report— “(1) The Secretary of State must publish and lay before Parliament a report on the state of NHS dentistry in England (“the State of Dentistry Report”) at least once every two years. (2) The State of Dentistry Report must include an assessment of— (a) access to NHS dental services and levels of unmet need; (b) the adequacy, distribution and sustainability of the NHS dental workforce, including general dental services, community dental services, hospital dental services, dental public health consultants and dental academia; (c) geographical inequalities in access to NHS dental services and oral health outcomes; (d) inequalities in access to NHS dental services and oral health outcomes between different socioeconomic groups and populations, including but not limited to people living in care homes and people experiencing homelessness; (e) demand and waiting times for dental treatment in community dental services and secondary care; (f) the extent to which inadequate access to NHS dental services contributes to avoidable pressure on other parts of the NHS, including primary medical care, urgent and emergency care, hospital services and the prescribing of medicines; and (g) the measures required to address any deficiencies or inequalities identified under paragraphs (a) to (f). (3) The report must include such indicators as the Secretary of State considers appropriate for assessing each of the matters set out in subsection (2), and those indicators must, wherever appropriate, be presented in a manner that enables comparisons to be made between different areas and populations and over time, including by reference to population size, full-time equivalent workforce and other relevant measures. (4) In preparing the report, the Secretary of State must have regard to the need to ensure that NHS dental services are sufficient to meet the current and projected need for dental care in England. (5) The Secretary of State must, within six months of publishing a State of Dentistry Report, set out the measures the Government intends to take in response to the findings of the report. (6) The Secretary of State must make arrangements for each State of Dentistry Report, and the Government's response to it, to be debated in each House of Parliament. (7) The first State of Dentistry Report must be published within 12 months of the passing of this Act.” This new clause would require the Secretary of State to publish and lay before Parliament a regular report on the state of NHS dentistry in England, assessing access to and unmet need for NHS dental services, workforce capacity and distribution, geographical and wider inequalities, and the pressure that inadequate access to NHS dental services places on other parts of the NHS. It would also require the Government to respond to each report and ensure that both the report and response are debated in Parliament. New clause 104—NHS-funded In Vitro Fertilisation— “(1) Within six months of the passage of this Act, the Secretary of State must by regulations make arrangements for the standardised provision of NHS-funded In Vitro Fertilisation (IVF). (2) Provision under this section must, in accordance with any existing NICE guidelines, set requirements for all integrated care boards in England relating to NHS-funded IVF. (3) Requirements under subsection (2) include— (a) standardisation of the minimum number of rounds of IVF available to one individual, and (b) standardisation of the maximum and minimum age at which an individual can access IVF.” This new clause would require the Secretary of State to make regulations standardising NHS-funded IVF provision across all integrated care boards in England, in accordance with existing NICE guidelines, including the number of rounds available to an individual and the age limits for access. New clause 106—Report on the duty to co-operate— “(1) Within six months beginning on the day on which this Act is passed, the Secretary of State must lay a report before both Houses of Parliament on— (a) the operation of the duty to co-operate under section 72 of the National Health Service Act 2006 (co-operation between NHS bodies) and section 82 of that Act (co-operation between NHS bodies and local authorities), and (b) the impact of those duties on the integration of health and social care in England. (2) The report under subsection (1) must consider co-operation between— (a) relevant NHS bodies, and (b) relevant NHS bodies and local authorities, in the delivery and commissioning of health and social care. (3) Within six months of the report under subsection (1) being laid, the Secretary of State must— (a) make provision to update guidance on the duty to co-operate, and (b) implement actions to strengthen integration in the report which the Secretary of State considers most appropriate.” This new clause would place a requirement on the Secretary of State to report to Parliament, within six months of the Act passing, on how well NHS bodies and local authorities are working together to integrate health and social care in England. It would also place a requirement on the Secretary of State to update the related guidance and take action to strengthen this cooperation six months later. New clause 108—NHS ethical and sustainable procurement framework— “(1) Within six months beginning on the day on which this Act is passed, the Secretary of State must conduct a review of the NHS’s ethical and sustainable procurement framework. (2) Following the review under subsection (1), the Secretary of State must by regulations ensure that contracting authorities can exclude companies from bidding for a tender on the basis of any proven— (a) involvement in violations of international law and/or, (b) breaches of internationally accepted standards of business conduct including— (i) the UN Guiding Principles and, (ii) OECD Guidelines for Multinational Enterprises.” New clause 109—Artificial intelligence governance and auditing— “(1) Within 12 months beginning on the day on which this Act is passed, the Secretary of State must publish guidance on the— (a) governance, (b) monitoring, (c) assurance, and (d) audit of artificial intelligence (AI) systems used in health and care settings. (2) The guidance under subsection (1) must include— (a) requirements for healthcare organisations to maintain an inventory of AI systems used in clinical and operational processes, (b) requirements for proportionate monitoring, by the healthcare organisations, of AI systems throughout their operational lifecycle, including safety, performance and effectiveness, (c) processes for identifying, investigating and responding to material deterioration in AI system performance, (d) arrangements for documenting accountability and decision-making responsibilities relating to AI deployment and use, (e) expectations regarding transparency, reporting, and ability to audit AI enabled services. (3) Each health and care setting required to implement guidance under this section must designate a senior individual who is responsible for— (a) the monitoring, assurance and audit of AI systems under subsection (1) in their health or care setting; (b) supporting AI providers and vendors to perform their post market surveillance as required; (c) addressing the governance of legacy AI systems; and (d) addressing the governance and impact of decommissioning of AI systems. (4) The Care Quality Commission must have regard to the guidance published under subsection (1) when exercising its functions. (5) The Care Quality Commission should assess whether providers have appropriate arrangements in place for the— (a) governance, (b) monitoring, and (c) safe use of artificial intelligence systems, and may require evidence that such arrangements are operating effectively.” New clause 119—Report into digital health services in rural and coastal areas— “(1) The Secretary of State must publish a report on the equality of access to and quality of digital health services in rural and coastal areas within 12 months of the passing of this Act. (2) The report under subsection (1) must include an action plan to ensure rural and coastal practices are able to provide remote consultations and electronic prescription services.” This new clause would require the Secretary of State to publish a report on equality of access to and quality of digital health services in rural and coastal areas. New clause 120—Farmer friendly accredited general practice scheme— “(1) The Secretary of State must create a farmer friendly accredited general practice scheme to recognise and resource GP practices that proactively reach farming communities. (2) The scheme under subsection (1) should be modelled on Royal College of GPs’ Veteran Friendly Accreditation scheme. (3) The Secretary of State must instruct the CQC to develop clear guidance for the farmer friendly accredited general practice scheme which supports delivery of care in non-clinical community settings with proportionate hygiene protocols that reflect the setting.” This new clause places a duty on the Secretary of State to create a farmer friendly accredited general practice scheme. New clause 121—Continuity of specified national diabetes programmes— “(1) The Secretary of State must secure that the programmes listed in subsection (2) continue to be provided, to at least the same extent as immediately before the abolition of NHS England. (2) The programmes referred to in subsection (1) are— (a) the NHS Diabetes Prevention Programme; (b) the NHS Type 2 Diabetes Path to Remission Programme; (c) national provision for continuous glucose monitoring (CGM) for people with diabetes; (d) the national roll-out of hybrid closed loop (“artificial pancreas”) technology for people with type 1 diabetes; (e) the National Diabetes Audit programme, including the National Diabetes Footcare Audit and the National Diabetes Inpatient Safety Audit; (f) any other programme specified for the purposes of this section in regulations made by the Secretary of State. (3) Before making a scheme under section 2 for the transfer of property, rights or liabilities relating to a programme listed in subsection (2) the Secretary of State must publish a statement explaining how continuity of that programme is to be maintained. (4) Before the end of the period of 12 months beginning with the day on which this section comes into force, and at least once every subsequent period of 12 months, the Secretary of State must lay before Parliament a report on the provision of the programmes listed in subsection (2), including information on patient access, waiting times and outcomes. (5) Regulations under subsection (2)(f) are subject to annulment in pursuance of a resolution of either House of Parliament.” This new clause would require the Secretary of State to maintain existing national diabetes prevention, treatment and audit programmes following the abolition of NHS England, to explain how continuity will be secured before transferring related functions, and to report annually to Parliament on their provision. New clause 122—Report on effect of abolition of NHS England on diabetes services— “(1) Before the end of the period of 12 months beginning with the day on which section 1 comes into force, and no less frequently than every 12 months thereafter for the following 3 years, the Secretary of State must publish and lay before Parliament a report assessing the effect of the abolition of NHS England on the planning, funding and delivery of diabetes prevention, treatment and care services in England. (2) A report under subsection (1) must include an assessment of— (a) any change in funding allocated to diabetes prevention, treatment and care programmes; (b) any change to the operation or continuation of national clinical audits relating to diabetes; (c) the impact on patient access to diabetes technology, including glucose monitoring and insulin delivery systems; (d) the impact on workforce capacity in specialist diabetes services.” This new clause would require the Government to monitor and report to Parliament on the impact of NHS England's abolition specifically on diabetes services. New clause 133—England and Wales cross-border healthcare: statement of values and principles— “(1) The Secretary of State and each integrated care board must, in exercising functions relating to the provision or commissioning of health services to persons residing in an area of England or Wales close to the border between England and Wales, have regard to the 2018 England / Wales Cross-border Healthcare Services: Statement of Values and Principles. (2) For the purposes of this section, “the England / Wales Cross-border Healthcare Services: Statement of Values and Principles” means the statement published by NHS England and the Welsh Ministers on 6 November 2018, or a revised statement designated by regulations under subsection (3). (3) The Secretary of State may by regulations designate a revised version of the Statement for the purposes of this section. (4) Before making regulations under subsection (3), the Secretary of State must consult— (a) the Welsh Ministers; (b) each integrated care board whose area is close to the border between England and Wales; (c) each Local Health Board whose area is close to the border between England and Wales; and (d) such organisations representing patients affected by cross-border healthcare arrangements as the Secretary of State considers appropriate. (5) Regulations under subsection (3) are to be made by statutory instrument. (6) A statutory instrument containing regulations under subsection (3) may not be made unless a draft of the instrument has been laid before and approved by a resolution of each House of Parliament.” This new clause would require the Secretary of State and integrated care boards to have regard to the England / Wales Cross-border Healthcare Services: Statement of Values and Principles when exercising relevant functions in areas close to the England-Wales border. It would also enable the Secretary of State to designate a revised version of the Statement, following consultation with the Welsh Ministers, relevant integrated care boards and Local Health Boards, and organisations representing patients affected by cross-border healthcare arrangements. New clause 134—England and Wales cross-border healthcare arrangements— “(1) The Secretary of State must, within 18 months of the passing of this Act, seek to agree with the Welsh Ministers a revised England / Wales Cross-border Healthcare Services: Statement of Values and Principles. (2) In preparing the revised Statement under subsection (1), the Secretary of State must consider— (a) the effectiveness of existing arrangements for the provision and commissioning of cross-border health care services; (b) the interests of patients who live in England or Wales and receive, or may receive, health services on the other side of the border; (c) arrangements for the commissioning and funding of cross-border healthcare services; (d) arrangements for resolving disputes between relevant bodies in England and Wales; and (e) the appropriate means of placing the principles governing England and Wales cross-border health care services on a statutory footing. (3) The Secretary of State must, within two years of the passing of this Act— (a) publish the revised Statement agreed under subsection (1), or, where no revised Statement has been agreed, publish a report setting out the steps taken to seek such agreement and the reasons why agreement has not been reached; (b) lay the revised Statement or report before Parliament; and (c) lay before Parliament proposals for placing the principles governing England and Wales cross-border healthcare services on a statutory footing.” This new clause would require the Secretary of State to seek agreement with the Welsh Ministers on a revised England / Wales Cross-border Healthcare Services: Statement of Values and Principles within 18 months of the passing of the Act. It would also require the Secretary of State, within two years, to lay the revised Statement, or a report where agreement has not been reached, before Parliament and to bring forward proposals for placing the principles governing England and Wales cross-border healthcare services on a statutory footing. New clause 135—Reporting on mortality inequalities for autistic people and people with learning disabilities— “(1) Within 12 months of the passage of this Act, the Secretary of State must prepare and publish a report on the mortality inequalities experienced by autistic people and people with a learning disability. (2) The report under subsection (1) must specify targets for reducing mortality inequalities between people without a learning disability and autistic people and people with any learning disability. (3) Within 3 months of the publication of the report under subsection (1) the Secretary of State must make regulations which require ICBs to publish an annual report which includes— (a) mortality rates for— (i) autistic people, (ii) people with any learning disability, (iii) people without a learning disability. (b) identification of any areas in which data collection on mortality inequalities experienced by autistic people and people with learning disabilities is inadequate, (c) a review of the reasons for any inequalities in mortality rates, (d) a plan for reducing inequalities in mortality rates between people without a learning disability and autistic people and people with any learning disability. (4) Regulations under subsection (3) must make provision for the annual reports to continue for as long as mortality inequalities between people without a learning disability and autistic people and people with any learning disability exist. (5) The Secretary of State must publish an annual report summarising the information in the ICB reports under subsection (3), identifying national trends in— (a) mortality rates, (b) reasons for inequalities in mortality rates, (c) potential actions to reduce inequalities in mortality rates.” This new clause would require the Secretary of State to publish a report on the mortality inequalities experienced by autistic people and people with a learning disability and make provision for ICBs to publish annual reports on such inequalities in their area and proposed actions for remedying such inequalities. New clause 136—North Cornwall: Dental appointments— “(1) Within one year beginning on the date on which this Act is passed, the Secretary of State must ensure that there is adequate provision of NHS dentistry in North Cornwall. (2) Adequate provision under subsection (1) means— (a) access to urgent dental appointments for any person with an urgent need, and (b) improved access to routine dental appointments. (3) The Secretary of State must explain any failure to meet the requirement set out in subsection (1) at a public event in the local area.” This new clause places a duty on the Secretary of State to ensure there is adequate provision of NHS dental appointments in North Cornwall. New clause 144—Prioritising British citizens for the UK foundation programme— “(1) The Medical Training (Prioritisation) Act 2026 is amended as follows. (2) In section 4, after subsection (4) insert— “(4A) A person is within this subsection if they— (a) are a British citizen, and (b) hold a primary medical qualification from an international branch campus of a higher education institution in the United Kingdom.”” This new clause amends the Medical Training (Prioritisation) Act 2026 so that British citizens who have studied at international branch campuses of UK higher education institutions can be prioritised for foundation programme training places. New clause 145—Response to the Hughes Report: options for redress for those harmed by valproate and pelvic mesh— “The Secretary of State must, within 30 days of the day on which this Act is passed, publish the Government’s response to the Hughes Report.” This new clause would require the Secretary of State to publish the Government’s response to the Hughes Report within 30 days of this Act being passed. New clause 152—Requirement for merit-based job allocations for doctors— “(1) The Medical Training (Prioritisation) Act 2026 is amended as follows. (2) In section 1, at end insert— “(2) Applicants eligible under this section shall be prioritised based on merit, determined by reference to the applicant’s— (a) qualifications, (b) professional competence, (c) clinical experience, (d) skills, and (e) ability to perform the duties of the post.” (3) In section 2, after subsection (1) insert— “(1A) Applicants eligible under subsection (1) shall be prioritised based on merit, determined by reference to the applicant’s— (a) qualifications, (b) professional competence, (c) clinical experience, (d) skills, and (e) ability to perform the duties of the post.” (4) In section 3, after subsection (1) insert— “(1A) Applicants eligible under subsection (1) shall be prioritised based on merit, determined by reference to the applicant’s— (a) qualifications, (b) professional competence, (c) clinical experience, (d) skills, and (e) ability to perform the duties of the post.”” New clause 153—Redundancies— “The Secretary of State must publish, within 12, 24, and 48 months of the passage of this Act, the number of persons— (a) employed by the Department for Health and Social Care, and (b) made redundant following the abolishment of NHS England under subsection (1) of this Act.” This new clause would require the Secretary of State to publish the number of staff in the Department for Health and Social Care and the number of people made redundant following the abolishment of NHS England. New clause 154—Medical training places— “The Secretary of State must increase the number of medical school training places to 15,000 by the year 2031-32.” This new clause would put a duty on the Secretary of State to double the number of medical school training places. New clause 155—Self-care and health literacy in neighbourhood health plans— “(1) Guidance issued by the Secretary of State under section 14Z58 of the National Health Service Act 2006 as amended by section 24(4) of this Act (neighbourhood health plan) must require that every neighbourhood health plan includes arrangements for— (a) supporting self-care and self-management, including by enabling people to manage minor and long-term conditions, and conditions that are self-limiting, themselves where it is safe and appropriate to do so; (b) improving health literacy and ensuring that people living or working in the area have access to trusted, quality-assured information, advice and digital tools to support them in managing their own health and wellbeing; (c) facilitating access to community pharmacy services, including pharmacy services that support self-care, the management of minor ailments and medicines optimisation; (d) supporting patients to access the most appropriate level of care for their needs, including through patient-facing digital services connected to any system established under section 250E of the National Health Service Act 2006 (single patient record); and (e) reducing avoidable demand on NHS services through the promotion of self-care and prevention. (2) In preparing guidance under section 14Z58 of the National Health Service Act 2006 as amended by section 24(4) of this Act, the Secretary of State must have regard to— (a) improving health literacy, (b) the role of community pharmacy as an accessible point of contact for self-care support and health advice, and (c) the contribution of digital tools and patient-facing services to enabling self-care, self-management and appropriate care navigation. (3) The Secretary of State must, within 12 months of the date on which this Act is passed, publish a self-care strategy for England (the "self-care strategy") which must set out— (a) the national framework within which neighbourhood health plans will be required to embed self-care and self-management, including the management of self-limiting conditions, as a core component of local health and care services; (b) the steps the Secretary of State will take to promote self-care and health literacy as part of the prevention and early intervention agenda across the NHS; (c) the role of community pharmacy in delivering the self-care strategy, including the services and information that community pharmacy is expected to provide in support of self-care; (d) the role of patient-facing digital services, including any system established under section 250E of the National Health Service Act 2006, in supporting self-care, self-management and navigation to appropriate care; (e) the steps the Secretary of State will take to reduce avoidable demand on NHS services through the promotion of self-care; and (f) the measurable outcomes against which progress in implementing the self-care strategy will be assessed, and the arrangements for reporting on progress. (4) The Secretary of State must lay the self-care strategy before Parliament on the day on which it is published and must review and update it at least every three years. (5) In this section— “neighbourhood health plan” has the same meaning as in section 24 of this Act; “self-care” means the actions taken by individuals to maintain their own health, manage minor or long-term conditions, including conditions that are self-limiting, and prevent ill health, including through the use of over-the-counter medicines, health information and digital tools.” This new clause would require neighbourhood health plans to include arrangements for supporting self-care and self-management. It would require guidance to the responsible local authority and integrated care boards to reflect the guidance and require the Secretary of State to publish a national self-care strategy. New clause 157—Report on delivery of transformative technology commitments— “(1) The Secretary of State must, within 12 months of the day on which this Act is passed, publish and lay before Parliament a report setting out the Government’s approach to delivering the transformative technology commitments in the document entitled “Fit for the Future: the 10 Year Health Plan for England” published in July 2025. (2) The report under subsection (1) must cover the following areas— (a) data quality, interoperability and the use of NHS data for research and innovation, (b) artificial intelligence, (c) genomics and predictive analytics, (d) wearables and real-time monitoring, and (e) robotics and precision technologies. (3) The report must include— (a) the principal milestones and intended outcomes for patients and the health service in each of the areas listed in subsection (2), (b) the main risks to delivery and the steps being taken to mitigate them, and (c) how progress will be measured.” New clause 158—Progress reports on the women’s health strategy— “(1) The Secretary of State must, within 12 months of the day on which this Act is passed and at least once every two years thereafter, publish and lay before Parliament a report on progress in delivering the renewed Women’s Health Strategy for England (published April 2026) or any successor strategy. (2) A report under this section must include— (a) a summary of delivery against the actions listed in the strategy’s action summary tables, including which actions are on track, delayed or revised and the reasons why that is the case; (b) data from the women’s health data dashboard (or any successor data publication) on performance, access, outcomes and experience at national and neighbourhood level; and (c) a summary of ongoing engagement with women, including through the women’s voices partnership and patient-reported experience and outcome measures, and how that engagement has informed delivery. (3) The report may incorporate or cross-refer to existing published material (including the action summary tables and the women’s health data dashboard) where this meets the requirements of subsection (2).” New clause 160—Annual report on specialised services— “(1) Within 12 months of the passage of this Act, and every 12 months thereafter, the Secretary of State must publish a report on the commissioning and performance of specialised services commissioned by integrated care boards. (2) A report under subsection (1) must include information relating to— (a) patient outcomes; (b) access to services; (c) waiting times; (d) workforce capacity; (e) service sustainability; (f) geographical variation in services; (g) compliance with national service specifications; and (h) arrangements for the coordination of specialist, community and neighbourhood care. (3) A report under subsection (1) must be laid before both Houses of Parliament.” This new clause would require the Secretary of State to publish an annual report on specialised services commissioned by integrated care boards. New clause 162—Specialised services: annual report and published data— “(1) The Secretary of State must, prepare a report on the performance of specialised services in England, measured against the relevant national standards for those services. (2) The Secretary of State must lay a report under subsection (1) before each House of Parliament as soon as reasonably practicable after the end of the financial year to which it relates. (3) The Secretary of State must make arrangements for the regular publication of data on the quality and outcomes of specialised services, including, but not limited to, data of the kind currently published as Specialised Services Quality Dashboards. (4) In this section, "specialised services" has the same meaning as in section 3B of the National Health Service Act 2006 (as amended by this Act).” This new clause would place a duty on the Secretary of State to report annually to Parliament on the performance of specialised services against national standards, and to maintain regular publication of data on their quality and outcomes, equivalent to the Specialised Services Quality Dashboards currently produced by NHS England. Amendment 102, in clause 1, page 1, line 2, at end insert— “(2) Before NHS England is abolished, the Secretary of State must publish a document setting out the operating model for the exercise of functions by the Department of Health and Social Care following the abolition of NHS England (the "operating model document"). (3) The Secretary of State must publish a plan for the management of personnel affected by the abolition of NHS England and the transfer of its functions to the Department of Health and Social Care (the "workforce transition plan"). (4) The operating model document must include— (a) a description of how each of the functions exercised by NHS England is to be exercised following its abolition; (b) the governance and accountability arrangements for the exercise of those functions; (c) the organisational structure of the Department of Health and Social Care as it will operate following the abolition; and (d) the proposed timetable for the transition. (5) The workforce transition plan must include— (a) an assessment of the number of personnel whose employment is affected by the abolition of NHS England; (b) the arrangements for the transfer, redeployment or redundancy of affected personnel; and (c) proposals for consultation with recognised trade unions and staff representative bodies in connection with the abolition.” This amendment would require the Secretary of State to publish an operating model for the merged DHSC/NHSE and associated plan to manage personnel before NHS England is abolished. Amendment 19, in clause 4, page 3, line 29, at end insert— “(c) reduce inequalities between the people of England with respect to the access to health services and outcomes achieved for them between coastal and inland areas, and (d) reduce inequalities between the people of England with respect to the access to health services and outcomes achieved for them between rural and urban areas.” This amendment would create a duty for the Secretary of State to reduce inequalities between coastal and inland areas and rural and urban areas. Amendment 80, page 3, line 29, at end insert— “(c) reduce inequalities in the prevention, diagnosis and treatment of diabetes, including variation in access to structured education, glucose monitoring technology and insulin pump therapy.” This amendment would make diabetes-related health inequalities an explicit, named consideration within the Secretary of State's general duty to reduce inequalities, rather than leaving diabetes provision to be addressed only implicitly. Amendment 95, in clause 5, page 4, leave out lines 2 to 4 and insert— “(1) In exercising functions in relation to the health service, the Secretary of State must act with a view to enabling patients to make choices with respect to aspects of health services provided to them, including to make choices as to the provider of those services. (2) For the purposes of subsection (1), the Secretary of State must ensure that patients referred for a service to be provided outside a hospital setting (“out-of-hospital services”) are offered a choice of provider of that service from among the providers available in their integrated care board area and, where relevant, in neighbouring areas, in accordance with regulations made under section 14Z45B. (3) Regulations under section 14Z45B must provide that, where an out-of-hospital service is to be provided to a patient, the integrated care board must— (a) offer the patient a choice of at least two providers capable of providing the service, which may include NHS bodies and independent sector providers approved to provide that service under arrangements with the integrated care board; (b) provide the patient with information about each available provider to support an informed choice, including— (i) indicative waiting times, (ii) the location at which the service would be provided, (iii) the quality ratings or outcomes data applicable to that provider for that service where such data is available, and (iv) whether any costs may be incurred by the patient in travelling to or receiving the service with each provider; (c) not exclude from the list of available providers any provider approved solely on grounds of commercial interest or organisational type; and (d) take all reasonable steps to give effect to the patient's choice within a clinically appropriate timeframe. (4) For the purposes of this section, “out-of-hospital services” means services— (a) provided in community, primary care or ambulatory settings rather than in a hospital inpatient or outpatient department, and (b) which the Secretary of State specifies by regulations as being within the scope of the choice obligation under subsection (2). (5) For the purposes of this subsection (4)(b), out of hospital services which the Secretary of State may specify by regulations may include— (a) diagnostic services, (b) audiology and hearing aid care, (c) podiatry, (d) dietetics and nutrition, (e) physiotherapy, (f) ambulatory cardiac monitoring, and (g) such other services as the Secretary of State considers appropriate. (6) In specifying services under subsection (4)(b), the Secretary of State must have regard to— (a) the potential for the expansion of choice to reduce waiting times for the relevant service, (b) the availability of sufficient independent and NHS providers to make genuine choice meaningful, and (c) the desirability of ensuring access to choice for patients in all parts of England, including in rural and deprived areas. (7) The Secretary of State must publish, and lay before Parliament, within 12 months of the date on which this Act is passed, a statement setting out— (a) the out-of-hospital services for which choice obligations under subsection (2) will initially apply, (b) the timetable for extending the choice obligation to further services, and (c) the support that will be made available to patients, in particular those with limited digital access or literacy, to exercise the choices to which they are entitled under this section. (8) The Secretary of State must review and update the statement required by subsection (6) at intervals of not more than two years.” This amendment strengthens the new patient choice duty inserted by Clause 5 from a general aspiration into a specific, enforceable right to choose between providers for out-of-hospital services. Amendment 37, in clause 6, page 4, line 11, at end insert— “(1A) For the purposes of subsection (1) the Secretary of State must ensure that innovation in the provision of health services is supported and developed equitably across all regions of England, including by reducing inequalities in clinical research funding and clinical research capacity between different regions of England.” This amendment would ensure that in exercising their duty to promote innovation in the provision of health services, the Secretary of State must ensure that innovation in the provision of health services is supported and developed equitably across all regions of England. Amendment 81, page 4, line 11, at end insert— “(1A) The duty in subsection (1) includes, in particular, promoting innovation in the prevention, diagnosis and treatment of diabetes, including through the adoption of glucose monitoring and automated insulin delivery technologies.” This amendment would ensure that the existing duty to promote innovation is understood to cover the specific diabetes technologies (flash/CGM and hybrid closed loop systems) currently being rolled out by NHS England ,so that momentum on adoption is not lost through the transfer of functions. Amendment 97, page 6, line 12, leave out clause 10. Amendment 38, in clause 11, page 6, line 28, leave out lines 28 and 29 and insert— “(1) Where the geographic area covered by an integrated care board sits within a Mayoral Combined Authority, the relevant Mayor may give integrated care boards directions as to the exercise of their functions. (1A) Where the geographic area covered by an integrated care board does not sit within a Mayoral Combined Authority, the Secretary of State may give integrated care boards directions as to the exercise of their functions.” This amendment would give direction-making powers over integrated care boards to Combined Authority Mayors where boards sit within their authority. The Secretary of State would retain direction-making power where there is no relevant Combined Authority Mayor. Amendment 39, page 7, line 4, after “Secretary of State” insert “or relevant Combined Authority Mayor”. This amendment is consequential on Amendment 38. Amendment 40, page 7, line 11, after “Secretary of State” insert “or relevant Combined Authority Mayor”. This amendment is consequential on Amendment 38. Amendment 103, in clause 12, page 9, leave out lines 33 to 39 and insert— “(2) Before prescribing a service or facility under subsection (1)(b), the Secretary of State must publish an assessment of the likely impact of such a prescription on— (a) patient safety; (b) clinical outcomes; (c) equality of access to services; (d) workforce capacity and specialist expertise; (e) service sustainability; and (f) geographical variation in access to, and outcomes from, services. (2A) The Secretary of State must lay the assessment under subsection (2) before both Houses of Parliament. (2B) In deciding whether it would be appropriate to prescribe a service or facility under subsection (1)(b), the Secretary of State must have regard to the assessment published under subsection (2). (2C) Where regulations made under subsection (1)(b) prescribe a service or facility for commissioning other than by the Secretary of State, the Secretary of State must publish and maintain a national service framework for that service or facility. (2D) A framework under subsection (2C) must include provision relating to— (a) service standards; (b) care pathways; (c) workforce requirements; (d) rehabilitation and long-term follow-up; (e) collection and publication of outcome data; (f) coordination between specialist, community and neighbourhood services; and (g) coordination of care for persons receiving treatment through multiple clinical pathways.”. This amendment would require the Secretary of State to publish an impact assessment before they make a decision to prescribe a service or facility under subsection (1)(b) of section 3B of the National Health Service Act 2006 and maintain a national service framework for any specialised service no longer commissioned directly by the Secretary of State. Amendment 101, page 10, line 10, at end insert— “(5) The Secretary of State must, within six months of this section coming into force, publish a specialised commissioning plan setting out— (a) which services or facilities the Secretary of State intends to commission nationally under section 3B(1)(b), and (b) the principles and criteria that will be used to decide whether a service or facility should be commissioned nationally or by integrated care boards. (6) Before making regulations under section 3B(1)(b) that would make a significant change to the range of services or facilities commissioned nationally, the Secretary of State must— (a) publish a transition plan explaining the reasons for the change, the impact on patients, and the arrangements for continuity of care and clinical standards, (b) consult such persons as the Secretary of State considers appropriate (including patients who use the affected services or their representatives, clinicians, and the bodies that would gain or lose commissioning responsibility), and (c) publish a summary of the consultation responses and the Secretary of State’s response to them. (7) The specialised commissioning plan under subsection (5) must be kept under review and revised as appropriate, and any revised plan must be published.” Amendment 53, Clause 14, page 10, leave out lines 40 to 44 and insert— “(a) confers functions on integrated care boards in relation to commissioning primary care services, including the provision of alternative general medical services for patients who— (i) are unable to obtain appropriate care from the general practice responsible for their usual catchment area, or (ii) no longer reasonably feel able or comfortable to receive care from that general practice, (b) requires integrated care boards to make arrangements to support access to such alternative provision where it is necessary to meet the reasonable requirements of those patients, (c) transfers related functions from NHS England to the Secretary of State, and (d) contains other amendments relating to primary care services.” This amendment would require integrated care boards to support and arrange alternative general practice provision for patients who cannot access appropriate care from their usual catchment GP practice, or who reasonably no longer feel able or comfortable receiving care from that practice. Amendment 76, in clause 15, page 11, line 33, at end insert— “(4A) The Secretary of State must take reasonable steps to ensure that arrangements under subsection (2) are accessible and inclusive, having particular regard to the needs of persons with disabilities and persons with long-term, complex or fluctuating health conditions.” This amendment would require the Secretary of State to take reasonable steps to ensure that arrangements for public involvement in commissioning are accessible and inclusive, with particular regard to the needs of persons with disabilities and persons with long-term, complex or fluctuating health conditions. Amendment 79, in clause 16, page 11, line 10, at end insert— “(3) Regulations under this section must, in relation to children and young people referred to child and adolescent mental health services, require integrated care boards to make arrangements for appropriate interim support during any period between referral and the commencement of substantive treatment or assessment. (4) The arrangements under subsection (3) may include— (a) regular appointments or check-ups with a GP or other primary care professional; (b) support from a family support worker; (c) regular wellbeing checks or support provided through a school, including by a school nurse or other appropriate professional; and (d) access to appropriate peer support, youth clubs or other community-based support. (5) The purpose of arrangements under subsection (3) is to ensure that a child or young person does not remain without appropriate support solely because they are awaiting the commencement of substantive assessment or treatment.” This amendment would require interim support for children and young people referred to CAMHS while they are waiting for substantive assessment or treatment. Amendment 32, page 12, line 10, at end insert— “(3) Regulations under this section must make provision requiring integrated care boards to make arrangements which ensure that community equipment and wheelchair services are provided within 18 weeks of the date on which a person is assessed as requiring such equipment or services. (4) For the purposes of subsection (3)— “community equipment and wheelchair services” means equipment, aids, home adaptations or appliances provided to support a person’s independence, safety, care or daily living at home or in the community, including hoists, hospital beds, pressure-relieving mattresses, commodes, shower chairs, walking frames, grab rails, ramps, specialist seating, postural support equipment, associated mobility equipment, and wheelchairs.” This amendment would require the Secretary of State to make regulations which would require integrated care boards to ensure that community equipment and wheelchair services are provided within 18 weeks of the date on which a person is assessed as requiring such equipment or services. Amendment 98, page 12, line 10, at end insert— “(3) Regulations under subsection (1) must require the publication, at least monthly, of statistics on consultant-led referral-to-treatment pathways that include a breakdown of unreported removals, and the reasons for those removals, including distinguishing between— (a) removals attributable to validation exercises (including administrative, technical or clinical validation), and (b) other unreported removals. (4) The statistics required by subsection (3) must be published— (a) at national level, (b) by integrated care board area, and (c) by NHS trust and NHS foundation trust. (5) In this section— “unreported removals” means the residual figure calculated as the waiting list at the start of the period plus new RTT periods minus completed pathways minus waiting list at the end of the period; “validation exercises” includes any systematic review of pathways for the purpose of removing those that should not remain on the waiting list.”” Amendment 99, page 12, line 10, at end insert— “14Z45AA Prohibition on administrative minimum waiting times An integrated care board must not adopt or apply any policy, contract term, activity planning assumption or other arrangement that has the effect of requiring or incentivising a minimum period of waiting before a patient may receive treatment, assessment, or a diagnostic test, where that minimum period is imposed for administrative, financial or capacity management reasons rather than clinical reasons.” Amendment 34, page 12, line 16, at end insert— “(1A) The regulations must impose a duty on integrated care boards to make provision for any person with a terminal illness diagnosis to be offered a conversation with a relevant healthcare professional about their needs for end-of-life care, including their— (a) mental and physical health support needs, and (b) financial support needs. (1B) For the purposes of subsection (1A), if a person with a terminal illness diagnosis is unable to have the conversation, an integrated care board must ensure that the person’s next-of-kin are offered a conversation. (1C) The regulations must make provision for any relevant authorities to have regard to the needs identified in a conversation under subsection (1A).” This amendment would require the Secretary of State to make regulations which make provision for the any person with a terminal illness diagnosis to be offered a conversation with a relevant authority about their needs for end-of-life care. Amendment 28, page 12, line 22, at end insert— “14Z45BA Patient choice: community services substituting for consultant-led elective care (1) The Secretary of State must by regulations make provision to enable patients to make choices in respect of non-consultant-led community services where those services are commissioned as a direct substitute for, or to prevent a referral to, consultant-led elective services. (2) For the purposes of subsection (1), a service is to be regarded as a direct substitute for, or intended to prevent a referral to, consultant-led elective services if it— (a) provides assessment, treatment or management for a condition that would otherwise be referred to a secondary care specialist; or (b) is commissioned by an integrated care board for the purpose of reducing or managing demand on secondary or elective care. (3) Services to which this section applies include, but are not limited to— (a) community audiology services; (b) community glaucoma management and monitoring services; and (c) minor eye conditions services. (4) Regulations made by virtue of this section must ensure that— (a) patients are offered a choice of any clinically appropriate provider commissioned under a qualifying NHS contract for the relevant service; (b) no limitation on the number of providers from which a patient may choose is imposed solely on grounds of cost or demand management; and (c) patients are provided with information enabling them to make an informed choice, including information about waiting times and quality. (5) An integrated care board must not commission a community service of a kind falling within subsection (2) in a manner which has the effect of restricting patient choice below the standard that would apply to an equivalent consultant-led elective service.” Amendment 36, in clause 20, page 15, line 25, at end insert— “(2A) Performance assessments must include details of how each integrated care board is meeting its duty to provide palliative care services or facilities to meet the reasonable requirements of the people for whom it has responsibility. (2B) For the purposes of subsection (2A) the following guidance are considered reasonable requirements— (a) NICE guideline [NG31] “Care of dying adults in the last days of life 2015”, (b) NICE guideline [NG142] “End of life care for adults: service delivery 2019”, (c) NICE quality standard [QS13] “End of life care for adults 2021”, (d) NHS England “Palliative and End of Life Care” Statutory Guidance for Integrated Care Boards (September 2022).” This amendment would require annual performance assessments to incorporate an assessment of whether each integrated care board is providing a reasonable standard of palliative and end of life care. Amendment 104, in clause 20, page 15, line 28, at end insert— “(4) In conducting a performance assessment under this section, the Secretary of State must assess the discharge by an integrated care board of any functions relating to specialised services. (5) An assessment under subsection (4) must consider— (a) patient outcomes; (b) access to services; (c) compliance with national service specifications; (d) workforce capacity; (e) service sustainability; and (f) geographical variation in access to, and outcomes from, services. (6) The report published under subsection (3) must include a summary of the assessments undertaken under subsections (4) and (5).” This amendment would require the Secretary of State to undertake and publish a national assessment of the performance of integrated care boards in relation to specialised services. Amendment 45, page 15, line 29, leave out clause 21. Amendment 91, in clause 21, page 15, leave out line 32 and insert— “(a) for sub-paragraph (4), substitute—” Government amendment 60. Amendment 29, page 15, line 38, at end insert— “(2A) The constitution must provide for the ordinary members appointed as mentioned in sub-paragraph (1)(b) to include at least one member nominated jointly by the local authorities whose areas coincide with, or include the whole or any part of, the integrated care board's area.” This amendment would require integrated care boards to have a member jointly nominated by local authorities from within the board's area. Government amendment 61. Amendment 30, page 16, line 3, leave out from “mayor” to “must” and insert “or local authority nominating an ordinary member as mentioned in sub-paragraphs (2) and (2A)” This amendment is consequential on Amendment 29 and would require a local authority involved in nominating a member of an integrated care board to have regard to guidance published by the Secretary of State. Amendment 83, page 16, line 6, at end insert— “(5) The constitution of an integrated care board must provide for the appointment of one or more members of the board with explicit responsibility for— (a) people with learning disabilities; (b) autistic people; (c) people with Down syndrome; and (d) children and young people with special educational needs and disabilities. (6) The integrated care board must publish details of the member or members appointed under sub-paragraph (5).” This amendment would require each Integrated Care Board to appoint one or more board members with responsibility for people with learning disabilities, autistic people, people with Down syndrome, and children and young people with special educational needs and disabilities (SEND), placing existing NHS England board-level leadership guidance on a statutory footing following the abolition of NHS England. Amendment 92, page 16, line 6, omit subsection (b). Amendment 96, page 16, line 7, leave out subsection (b) and insert— “(b) for sub-paragraph (5) substitute— “(5) The constitution must provide for the ordinary members of the integrated care board to include— (a) at least one qualified, professionally registered, consultant in public health who provides wholly independent, transparent, leadership and advice to the board on preventing and reducing disease and improving the health of the population it serves, (b) at least two clinicians with current experience of providing primary care services, at least one of whom is a general practitioner, and (c) at least one medical practitioner with current experience of providing secondary care services. (5A) A person appointed under sub-paragraph (5) must not be appointed to represent the interests of a provider organisation whose services are commissioned by the integrated care board.”” This amendment would require every Integrated Care Board to include an independent qualified and registered consultant in public health, at least two clinicians from primary care, and a clinical representative from secondary care. Amendment 93, page 16, leave out line 8 and insert— “after sub-paragraph (7) insert—” Government amendment 62. Amendment 31, page 16, line 9, at end insert— ““local authority” has the meaning given by section 2B;” This amendment is consequential on Amendments 29 and 30 and defines the term “local authority”. Amendment 94, page 17, line 12, leave out clause 23. Amendment 77, in clause 24, page 17, line 35, at end insert. “A neighbourhood health plan must include consideration of how health services will meet the needs of persons with long-term, complex or fluctuating health conditions” This amendment would require neighbourhood health plans to include consideration of how health services will meet the needs of persons with long-term, complex or fluctuating health conditions. Government amendment 63. Amendment 84, in clause 29, page 21, leave out line 7. This amendment would retain the requirement for NHS Foundation Trusts to have a Council of Governors. Government amendment 64. Amendment 55, in clause 42, page 30, line 29, at end insert— “(5) After subsection (6) insert— “(7) Where the Secretary of State is satisfied that a pharmacy provider has materially failed to comply with contractual, patient-safety or workforce obligations, the Secretary of State may by direction require the relevant integrated care board— (a) to suspend or terminate arrangements with that provider, where appropriate, (b) to make arrangements with another provider for the provision of pharmaceutical services, (c) to secure continuity of the supply of medicines and other pharmaceutical services, and (d) to take such other emergency measures as may be specified in the direction. (8) A direction under subsection (7) may be given where the Secretary of State considers that there is a significant risk to patient safety, continuity of medicines supply or the provision of pharmaceutical services. (9) The Secretary of State must ensure that arrangements made under subsection (7) are implemented as soon as reasonably practicable. (10) A direction under subsection (7) must specify the period for which it has effect and must be published.”” This amendment would enable intervention where a pharmacy provider seriously fails to meet contractual, safety or workforce obligations, ensuring continuity of services and medicines supply. Amendment 58, page 30, line 29, at end insert— “(7) Where a situation or event has resulted, or is likely to result, in the closure, failure or disruption of a provider of pharmaceutical services, the Secretary of State and the relevant integrated care board must provide such assistance and support as is necessary to enable a new provider to establish or continue the provision of pharmaceutical services. (8) Assistance or support under subsection (7) may include facilitating and establishing a relationship between a new provider and the manufacturers or suppliers of medicines and other pharmaceutical products. (9) The assistance and support under subsection (7) must be available, in particular, where a new provider is— (a) taking over premises previously operated by a provider of pharmaceutical services that has failed or closed, (b) taking over premises where there has been evidence of serious misconduct, including malpractice or failure to pay staff, or (c) an independent provider or a provider which is not part of a large company operating multiple pharmacy premises. (10) The purpose of assistance and support under this section is to enable the new provider to secure supplies of medicines and other pharmaceutical products as quickly as reasonably practicable and to minimise any interruption in the provision of pharmaceutical services.” This amendment would require the Government and integrated care boards to support new and independent pharmacy owners taking over failing, closed or disrupted pharmacies, including by helping them establish relationships with pharmaceutical manufacturers and suppliers so that they can secure medicines and other supplies quickly and maintain continuity of service. Amendment 59, in clause 47, page 32, line 15, after subsection (4) insert— “(4A) In determining the amount to be allotted to an integrated care board under subsection (1), the Secretary of State must have regard to the additional costs of providing health services in rural and coastal communities. (4B) The matters to which the Secretary of State must have regard under subsection (4A) include— (a) rurality, (b) population age, (c) transport and travel costs, (d) seasonal changes in demand, (e) recruitment and retention difficulties, (f) the loss of economies of scale arising from sparsely populated communities, and (g) unmet need for primary medical, dental and pharmaceutical services. (4C) The Secretary of State must ensure that the methodology used in determining allotments does not rely predominantly on measures of deprivation where those measures fail adequately to reflect the costs or unmet need as set out in subsection (4B). (4D) The Secretary of State must publish the methodology used in determining allotments under this section and must review that methodology at intervals of not more than five years.” This amendment would require ICB funding allocations to reflect the additional costs and unmet health needs of rural and coastal communities. Amendment 10, page 32, line 30, at end insert— “(2A) The Secretary of State must give integrated care boards directions to increase spending on mental health services at least in line with the change in level of their total programme funding.” This amendment would place the original mental health investment standard on a statutory footing, requiring integrated care boards to increase spending on mental health services at least in line with the growth in their total programme (healthcare) funding. Amendment 17, page 32, line 30, at end insert— “(2A) The Secretary of State must give integrated care boards directions to increase spending on Primary Care services. (2B) The increase in spending set out in subsection (2B) must be in line with the change in level of their total programme funding.” This amendment would introduce the primary care Investment standard, requiring integrated care boards to increase spending on primary care services at least in line with the growth in their total programme (healthcare) funding. Amendment 11, page 32, line 34, after “subsection (1)” insert “and (2A)”. This amendment is consequential on Amendment 10 and would enable the Secretary of State to implement financial penalties if an integrated care board fails to comply with a direction to increase spending on mental health services in line with the growth in their total programme (healthcare) funding. Amendment 18, in clause 47, page 32, line 34, after “subsection (1)” insert “and (2A) and (2B)”. This amendment is consequential on Amendment 17 and would enable the Secretary of State to implement financial penalties if an integrated care board fails to comply with a direction to increase spending on primary care services in line with the growth in their total programme (healthcare) funding. Amendment 26, in clause 51, page 35, line 38, after “available” insert “for the purpose of delivering or improving patient health or social care”. Amendment 42, page 36, line 1, leave out “health” and insert “direct patient”. This amendment clarifies that the Secretary of State’s regulation-making powers in respect of the single patient record are limited to the provision of direct patient care and social care. Amendment 105, page 36, line 8, at end insert— “(ba) enabling a patient, following diagnosis of a health condition, to consent to the sharing of such information as is necessary for the purpose of enabling the organisation to offer or provide condition-specific support to the patient with an approved voluntary, community or charitable organisation providing condition-specific support services; (bb) facilitating referral, where consent has been provided, to such an organisation under subsection (ba);” This amendment would ensure that regulations establishing the Single Patient Record may include provision enabling patients, following diagnosis, to consent to referral and information sharing with approved voluntary, community and charitable organisations providing condition-specific support services. Amendment 43, page 36, line 11, leave out “including” and insert “solely for the purposes of” This amendment would ensure that regulations requiring or authorising the making available of patient information through the single patient record system can only make provision in respect of the circumstances set out in the Bill. Amendment 15, page 36, line 13, after “behalf” insert “, including nominated carers” This amendment makes it explicit that nominated carers can access the single patient record on behalf of those they care for. Amendment 27, page 36, line 21, leave out lines 21 to 23. Amendment 35, page 36, line 21, at end insert— “The regulations must make provision for patient information to be readily available to providers of palliative and end-of-life care including voluntary sector providers.” This amendment would ensure the single patient record is available to all palliative and end of life care providers. Amendment 23, page 36, line 23, at end insert— “(3A) The regulations must make provision for medical markers for firearms licence holders to be visible to all relevant health workers under the establishment of a single patient record. (3B) The regulations must include a requirement for the Secretary of State to prepare and publish a report on the potential merits of introducing a statutory requirement for mandatory medical markers for firearms licence holders to be used by those relevant in providing patient care.” This amendment would require medical markers for firearms licence holders to be visible to all relevant health workers under the establishment of a single patient record. Amendment 24, page 36, line 23, at end insert— “(3A) The regulations must make provision for prior membership in the armed forces to be visible to all relevant healthcare workers under the establishment of a single patient record. (3B) The regulations must include a requirement for the Secretary of State to prepare and publish a report on the potential merits of making prior membership in the armed forces visible on the single patient record. (3C) A report under subsection (3B) must consider— (a) the ability of veterans to access the necessary NHS support, and (b) the ability of medical staff to provide former members of the armed forces with appropriate care.” This amendment would require prior membership in the armed forces to be visible to all relevant healthcare workers under the establishment of a single patient record and require the Secretary of State to publish a report on making prior membership in the armed forces visible on the single patient record. Amendment 88, page 36, line 26, at end insert— “(4A) Regulations may not be made under this section unless the Secretary of State has first published and laid before both Houses of Parliament a Single Patient Record Outline Plan. (4B) The Outline Plan under subsection (4A) must set out, as a minimum— (a) the intended high-level design and scope of the single patient record, including the core data categories expected to be included and the principal care settings to be connected in the first phase; (b) the proposed technical and architectural approach, including how existing source systems will be linked rather than replaced; (c) the proposed timetable and phased rollout plan, including priority pathways; (d) the intended access model for patients, clinicians and other relevant care professionals, including arrangements for proxy access and digital inclusion; (e) the key safeguards for privacy, security, audit and prevention of inappropriate access; and (f) the proposed approach to public engagement and awareness before the system becomes operational. (4C) The Outline Plan must be published at least three months before any regulations under this section are laid.” Amendment 22, page 36, line 32, at end insert— “(6A) Before making regulations under this section, the Secretary of State must prepare and publish a risk assessment on the potential for digital exclusion under the establishment of a single patient record. (6B) In preparing a risk assessment under subsection (6A) the Secretary of State must consult all stakeholders the Secretary of State considers relevant, including patient representation groups. (6C) In preparing a risk assessment under subsection (6A) the Secretary of State must have particular regard for— (a) those without access to a suitable electronic device, (b) those without access to suitable broadband connectivity, (c) those with physical and/or mental disabilities, (d) those belonging to groups considered socially excluded, and (e) those considered lacking digital skills. (6D) The Secretary of State must lay a copy of the risk assessment under subsection (6A) before both Houses of Parliament.” This amendment would require the Secretary of State to prepare and publish a risk assessment on the potential for digital exclusion under the establishment of single patient record. Amendment 87, page 36, line 32, after subsection (6) insert— “(6A) Regulations under this section must make provision to ensure that the system— (a) complies with the Accessible Information Standard, DAPB1605, or any standard which replaces it; (b) uses and is interoperable with the Reasonable Adjustment Digital Flag, DAPB4019, or any system or standard which replaces it; (c) enables patients’ communication, information and reasonable adjustment needs to be identified, recorded, flagged, shared, met and reviewed without avoidable repetition by the patient; and (d) enables patients to receive and access information relating to their care in formats appropriate to their communication and accessibility needs. (6B) In preparing regulations under this section, the Secretary of State must secure the participation of disabled people, including blind and partially sighted people, and organisations representing them, in the design, development, testing and review of the system.” This amendment seeks to ensure that the Single Patient Record supports the communication, information and reasonable adjustment needs of blind and partially sighted people and other disabled patients by embedding existing NHS accessibility standards within the system. It also requires disabled people and their representative organisations to be involved in the design, development, testing and ongoing review of the Single Patient Record to ensure accessibility is embedded from the outset. Amendment 52, in schedule 1, page 57, line 15, at end insert— “83B Primary care estate investment programme (1) The Secretary of State must establish and maintain a programme for providing capital funding for the improvement and modernisation of premises used for the provision of primary medical services. (2) The programme must prioritise practices where premises— (a) are no longer fit for purpose, (b) require substantial repair, adaptation or modernisation, or (c) otherwise materially restrict the provision of safe, accessible or effective primary medical services. (3) The Secretary of State must ensure that the process for applying for and accessing capital funding under this section is proportionate and does not impose unnecessary administrative burdens. (4) The arrangements must be designed to ensure that a viable provider of primary medical services is not prevented from carrying out essential improvements because of insufficient access to capital funding. (5) In this section “premises” includes premises owned, leased or otherwise occupied for the provision of primary medical services.” This amendment would establish a capital funding programme to improve and modernise primary care and General Practice premises. Amendment 50, page 57, line 26, at end insert— “5A after section 87 insert— “87A Sustainable funding for general practice (1) The Secretary of State must ensure that arrangements for payments under general medical services contracts provide for sustained investment in general practice. (2) In exercising functions under this section, the Secretary of State must have regard to the role of general practice in— (a) preventing illness, (b) managing long-term conditions, (c) providing care in the community, and (d) reducing avoidable hospital admissions. (3) Arrangements for funding general practice must have regard to the volume, complexity and value of care delivered through general practice. (4) The Secretary of State must publish, for each financial year, a statement setting out how the arrangements for payments under general medical services contracts are intended to support the matters in subsections (1) to (3).”” This amendment would require sustained investment in general practice reflecting the volume, complexity and value of care provided. Amendment 51, page 57, line 26, at end insert— “5A After section 87 insert— “87A Rural and coastal general practice funding (1) Arrangements for payments under general medical services contracts must take account of the additional costs of delivering primary medical services in rural and coastal communities. (2) The factors to which arrangements under subsection (1) must have regard include— (a) rurality, (b) the age profile of the population, (c) transport and travel costs, (d) seasonal changes in demand, (e) difficulties in recruiting and retaining staff, and (f) the loss of economies of scale arising from sparsely populated communities. (3) The Secretary of State must ensure that the funding arrangements under this section are reviewed periodically and amended where necessary to reflect changes in the costs of providing services in rural and coastal areas.”” This amendment would require GP funding to reflect the additional costs of providing services in rural and coastal areas. Amendment 47, page 60, line 6, at end insert— “99C Dental training hubs (1) The Secretary of State must make arrangements for the establishment and support of dental training hubs in areas where there is an unmet need for NHS dental services. (2) The arrangements under subsection (1) must include provision for dental training hubs in Dorset, including provision in west Dorset. (3) In exercising the duty under subsection (1), the Secretary of State must work with— (a) universities and other providers of approved dental education and training, (b) local authorities, and (c) integrated care boards and other NHS bodies. (4) The purpose of dental training hubs is to— (a) increase the capacity for dental education and training, (b) increase the availability of NHS dental services in areas of unmet need, (c) strengthen the recruitment and retention of the dental workforce, and (d) support the development of the long-term dental workforce. (5) Arrangements under this section must provide for students in the final year of an approved course of dental education to provide NHS dental treatment under appropriate supervision. (6) Treatment provided by a student under subsection (5) must— (a) be NHS treatment carried out on an NHS patient, (b) be provided under the supervision of a suitably qualified dental professional, and (c) be free at the point of use to the patient where the supervising provider is receiving, or is entitled to receive, the relevant NHS tariff or other NHS payment in respect of that treatment. (7) A dental training hub must provide, or participate in, structured pathways into dental apprenticeships and other appropriate employment-based dental training. (8) Arrangements under this section must include measures to support retention of dental professionals trained through the hubs to meet future workforce commitments. (9) In this section “dental training hub” means a facility or network of facilities at which dental education, supervised clinical training and NHS dental service provision are integrated.” This amendment would establish dental training hubs in areas of unmet need, including Dorset and west Dorset, to expand training, improve NHS dental access and strengthen the workforce. Amendment 48, page 60, line 6, at end insert— “99C Allocation of NHS dental funding according to unmet need (1) The Secretary of State must make arrangements to ensure that NHS dental funding is allocated according to local unmet need. (2) Where funding allocated for primary dental services in a financial year is not used for the purpose for which it was allocated, the Secretary of State must ensure that, so far as reasonably practicable, that funding is redirected to measures designed to increase access to NHS dental services. (3) Measures under subsection (2) may include— (a) additional NHS dental capacity, (b) additional NHS dental appointments, (c) measures to reduce waiting times, (d) outreach dentistry, (e) domiciliary dental services, and (f) dental services provided in or in connection with schools. (4) The arrangements must include mechanisms to ensure that funding allocated for the purpose of increasing access results, so far as is reasonably practicable, in additional NHS dental capacity, appointments or reduced waiting times. (5) In making arrangements under this section, the Secretary of State must have particular regard to people who face barriers to travelling to dental services, including older people, people with disabilities, vulnerable people and schoolchildren.” This amendment would require dental funding to reflect local unmet need and redirect unused funding towards improving access. Amendment 49, page 60, line 22, after paragraph 18 insert— “18A After section 103 insert— “103A Rural and local-need factors in NHS dental funding (1) Directions made under section 103 must provide for NHS dental funding arrangements to take account of local need. (2) In making provision under subsection (1), the Secretary of State must have proper regard, in particular, to— (a) the rurality of the area, (b) the age profile of the population, (c) the population who have disabilities, (d) local transport and travel costs, (e) seasonal changes in demand for services, (f) difficulties in recruiting and retaining dental professionals, and (g) the loss of economies of scale arising from sparsely populated communities. (3) Provision made under section 103 must proportionately weight other measures alongside deprivation when determining the level of NHS dental funding required in an area. (4) The Secretary of State must every three years review and by regulations amend the factors mentioned in subsection (2).”” This amendment would require dental funding to properly take account of rurality, local need, travel costs, workforce challenges and other factors alongside deprivation. Amendment 56, page 64, line 34, at end insert— “45A After section 133 insert— “133A Emergency intervention in pharmaceutical services (1) Where an integrated care board considers that a person providing pharmaceutical services is failing, or is likely to fail, materially to comply with— (a) a contractual obligation, (b) a patient-safety requirement, or (c) a workforce obligation, the board must consider whether emergency intervention is required to protect patients or continuity of pharmaceutical services. (2) Where the board considers that emergency intervention is required, it may— (a) require the provider to take specified remedial action, (b) suspend specified arrangements, (c) terminate arrangements with the provider, (d) make arrangements with another provider for the provision of pharmaceutical services, or (e) take any combination of the steps in paragraphs (a) to (d). (3) The powers in subsection (2) must be exercised with regard to the need to maintain continuity of medicines supply and protect patients from avoidable disruption. (4) An integrated care board must not continue arrangements with a provider where it is satisfied that the provider is demonstrably unfit to provide pharmaceutical services safely and effectively. (5) Before exercising a power under subsection (2), the board must, except in an emergency, give the provider a reasonable opportunity to make representations. (6) Nothing in this section prevents an integrated care board from taking immediate action where delay would materially risk patient safety or continuity of medicines supply.”” This amendment would give integrated care boards powers to intervene where a pharmacy provider is failing to provide their required services to protect patients and medicines supply. Amendment 57, page 72, line 40, at end insert— “(3D) Regulations made under subsection (1) must ensure that the remuneration arrangements for pharmaceutical services take account of the costs of providing those services in rural and sparsely populated areas. (3E) In making provision under subsection (3D), the determining authority must have regard to— (a) rurality, (b) the age profile of the population, (c) transport and distribution costs, (d) seasonal changes in demand, (e) difficulties in recruiting and retaining staff, and (f) the loss of economies of scale arising from sparsely populated communities. (3F) The remuneration arrangements must be designed to support the financial sustainability of pharmacies providing essential NHS services in rural and sparsely populated areas. (3G) The Secretary of State must review the operation of the remuneration arrangements periodically and make such changes as are necessary to ensure that the matters in subsections (3D) to (3F) continue to be reflected.” This amendment would require pharmacy funding to reflect the additional costs of providing services in rural and sparsely populated areas. Government amendments 70 and 71. Amendment 85, in schedule 3, page 86, line 14, leave out paragraphs 5 to 8. This amendment would retain the requirement for NHS Foundation Trusts to have a Council of Governors. Amendment 86, page 86, line 30, leave out paragraph 14. This amendment would retain the requirement for NHS Foundation Trusts to have a Council of Governors. Amendment 16, page 88, line 19, at end insert— “(1A) The function under sub-paragraph (1) must be exercised by a person employed in the civil service of the State, and a Minister of the Crown or a special adviser must not be involved in any decision relating to such an appointment, suspension or removal.” This amendment would ensure that civil servants are responsible for the decision making and appointment processes for trust and ICB leaders, rather than Ministers or Special Advisers. Amendment 54, in schedule 8, page 106, line 33, at end insert— “5A After section 254 insert— “254A Interoperability of health and social care information systems (1) The Secretary of State must make regulations requiring providers of NHS health services to use interoperable digital information systems. (2) Regulations under subsection (1) must apply, so far as appropriate, to— (a) providers of primary medical services, (b) providers of primary dental services, (c) providers of pharmaceutical services, (d) NHS trusts, (e) NHS foundation trusts, and (f) providers of community health services. (3) The regulations must provide for the secure exchange of relevant patient information between providers using interoperable systems. (4) The regulations must include provision for electronic prescribing across NHS care settings where prescribing is clinically appropriate. (5) The Secretary of State must ensure that the arrangements under this section are designed to— (a) reduce duplication, (b) reduce unnecessary administrative work, (c) improve continuity of care, (d) reduce avoidable delays in diagnosis, treatment and referral, and (e) enable clinicians to access relevant information securely when providing care. (6) Regulations under this section must include appropriate requirements relating to information governance, cyber security, patient confidentiality and the lawful processing of personal data. (7) Before making regulations under this section, the Secretary of State must consult such persons as the Secretary of State considers appropriate, including representatives of general practice, hospitals, community services and patients.”” This amendment would require interoperable NHS digital systems to improve information sharing, reduce duplication and support continuity of care. Amendment 13, page 106, leave out lines 34 and 35 and insert— “For section 255 (power to request NHS England to establish information systems), substitute— “255 Powers to request the Secretary of State to establish information systems (1) Any person (including a devolved authority) may request the Secretary of State to establish and operate a system for the collection or analysis of information of a description specified in the request. (2) A request may be made under subsection (1) by a person only if the person considers that the information which could be obtained by complying with the request is information which it is necessary or expedient for the person to have in relation to the person's exercise of functions, or carrying out of activities, in connection with the provision of health care or adult social care. (3) The Secretary of State must comply with a mandatory request unless the Secretary of State considers that the request relates to information of a description prescribed in regulations. (4) For the purposes of this Chapter a request under subsection (1) is a mandatory request if— (a) it is made by a principal body, and (b) the body considers that the information which could be obtained by complying with the request is information which it is necessary or expedient for the body to have in relation to its discharge of a duty in connection with the provision of health services or of adult social care in England. (5) Subsection (6) applies where the Secretary of State has discretion under this section as to whether to comply with— (a) a mandatory request, or (b) other request under subsection (1). (6) In deciding whether to comply with the request, the Secretary of State— (a) must, in particular, consider whether doing so would interfere to an unreasonable extent with the exercise by the Secretary of State of any of its functions, and (b) may take into account the extent to which the principal body or other person making the request has had regard to— (i) the code of practice prepared and published by the Secretary of State under section 263, and (ii) advice or guidance given by the Secretary of State under section 265. (7) In this section “principal body” means— (a) the Care Quality Commission, (b) the National Institute for Health and Care Excellence, and (c) such other persons as may be prescribed in regulations. (8) In this Chapter “health care” includes all forms of health care whether relating to physical or mental health and also includes procedures that are similar to forms of medical or surgical care but are not provided in connection with a medical condition.”” This amendment would enable the Care Quality Commission and NICE to continue to make mandatory requests to the Secretary of State to establish an information system, following the transfer of NHS England’s functions. Amendment 14, page 110, line 37, leave out paragraph 14. This amendment is consequential on Amendment 13. Amendment 41, page 112, leave out lines 1 and 2 and insert— “23 For section 274A (Secretary of State’s guidance about NHS England data functions) substitute— “274A Secretary of State’s guidance in respect of their data functions (1) The Secretary of State must publish guidance about the exercise of— (a) their relevant data functions, and (b) their other functions in connection with their relevant data functions. (2) Before publishing guidance under this section the Secretary of State must consult any other persons that the Secretary of State considers appropriate in relation to the guidance. (3) The Secretary of State must have regard to the guidance published under this section.”” This amendment would transfer the existing statutory requirement for published guidance about data functions from NHS England to the Secretary of State. Amendment 46, in schedule 12, page 151, leave out paragraph 98.