National Health Service (Wales) Act 2006

• Citation: 2006 c. 42
• Sections: 396

Section 1 Welsh Ministers' duty to promote health service

(1) The Welsh Ministers must continue the promotion in Wales of a comprehensive health service designed to secure improvement—

(a) in the physical and mental health of the people of Wales, and

(b) in the prevention, diagnosis and treatment of illness.

(2) The Welsh Ministers must for that purpose provide or secure the provision of services in accordance with this Act.

(3) The services so provided must be free of charge except in so far as the making and recovery of charges is expressly provided for by or under any enactment, whenever passed.

Section 1A Welsh Ministers' duty to secure quality in health services

(1) The Welsh Ministers must exercise their functions in relation to the health service with a view to securing improvement in the quality of health services.

(2) For the purposes of this section—

“ health services ” means any services provided or secured in accordance with this Act;

“ quality ” includes, but is not limited to, quality in terms of—

the effectiveness of health services,

the safety of health services, and

the experience of individuals to whom health services are provided.

(3) The Welsh Ministers must publish an annual report on the steps they have taken to comply with the duty in subsection (1).

(4) The report must include an assessment of the extent of any improvement in outcomes achieved by virtue of those steps.

(5) The Welsh Ministers must lay a copy of the report before the National Assembly for Wales.

Section 2 Welsh Ministers' general power

(1) The Welsh Ministers may—

(a) provide such services as they consider appropriate for the purpose of discharging any duty imposed on them by this Act, and

(b) do anything else which is calculated to facilitate, or is conducive or incidental to, the discharge of such a duty.

(2) Subsection (1) does not affect—

(a) the powers of the Welsh Ministers apart from this section,

(b) Part 6 and Chapter 1 of Part 7 (ophthalmic and pharmaceutical services).

Section 3 Welsh Ministers' duty as to provision of certain services

(1) The Welsh Ministers must provide throughout Wales, to such extent as they consider necessary to meet all reasonable requirements—

(a) hospital accommodation,

(b) other accommodation for the purpose of any service provided under this Act,

(c) medical, dental, ophthalmic, nursing and ambulance services,

(d) such other services or facilities for the care of pregnant women, women who are breastfeeding and young children as they consider are appropriate as part of the health service,

(e) such other services or facilities for the prevention of illness, the care of persons suffering from illness and the after-care of persons who have suffered from illness as they consider are appropriate as part of the health service,

(f) such other services or facilities as are required for the diagnosis and treatment of illness.

(2) For the purposes of the duty in subsection (1), services provided under—

(a) section 41(2) (primary medical services) or 56(2) (primary dental services), or

(b) a general medical services contract or a general dental services contract,

must be regarded as provided by the Welsh Ministers.

(3) This section does not affect Part 6 and Chapter 1 of Part 7 (ophthalmic and pharmaceutical services).

Section 4 High security psychiatric services

(1) The Welsh Ministers' duty under section 1 includes a duty to provide hospital accommodation and services for persons who—

(a) are liable to be detained under the Mental Health Act 1983 (c. 20), and

(b) in the opinion of the Welsh Ministers require treatment under conditions of high security on account of their dangerous, violent or criminal propensities.

(2) The hospital accommodation and services mentioned in subsection (1) are referred to in this section and paragraph 15 of Schedule 3 as “high security psychiatric services”.

(3) High security psychiatric services may be provided only at hospital premises at which services are provided only for the persons mentioned in subsection (1).

(4) “ Hospital premises ” means—

(a) a hospital, or

(b) any part of a hospital which is treated as a separate unit.

Section 5 Other services

Schedule 1 makes further provision about the Welsh Ministers and services under this Act.

Section 6 Performance of functions outside Wales

(1) The Welsh Ministers may provide or secure the provision of anything mentioned in section 3(1) outside Wales.

(2) The Welsh Ministers' functions may be performed outside England and Wales, in so far as they relate to—

(a) holidays for patients,

(b) the transfer of patients to or from Scotland, Northern Ireland, the Isle of Man or the Channel Islands, or

(c) the return of patients who have received treatment in England and Wales, to countries or territories outside the British Islands (including for this purpose the Republic of Ireland).

Section 6A Reimbursement of cost of services provided in another EEA state

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Section 6B Prior authorisation for the purposes of section 6A

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Section 6BA Reimbursement of cost of services provided in another EEA state where expenditure incurred on or after 25 October 2013

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Section 6BB Prior authorisation for the purposes of section 6BA

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Section 7 NHS contracts

(1) In this Act, an NHS contract is an arrangement under which one health service body (“the commissioner”) arranges for the provision to it by another health service body (“ the provider ”) of goods or services which it reasonably requires for the purposes of its functions.

(2) Section 97(6) (NHS contracts and the provision of local pharmaceutical services under pilot schemes) makes further provision about acting as commissioner for the purposes of subsection (1).

(3) Paragraph 15 of Schedule 3 (NHS trusts and NHS contracts) makes further provision about an NHS trust acting as provider for the purposes of subsection (1).

(4) “ Health service body ” means any of the following—

(a) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(ba) NHS England ,

(bb) an integrated care board,

(c) an NHS trust,

(d) a Special Health Authority,

(e) a Local Health Board,

(f) a Health Board constituted under section 2 of the National Health Service (Scotland) Act 1978 (c. 29),

(fa) a Special Health Board constituted under that section,

(g) the Regional Agency for Public Health and Social Well-being,

(h) the Common Services Agency for the Scottish Health Service,

(i) the Wales Centre for Health,

(j) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(k) the Care Quality Commission,

(ka) the National Institute for Health and Care Excellence,

(kb) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(l) the Scottish Dental Practice Board,

(m) the Secretary of State,

(n) the Welsh Ministers,

(na) the Scottish Ministers,

(nb) Healthcare Improvement Scotland,

(o) the Regional Business Services Organisation,

(p) a special health and social services agency established under the Health and Personal Social Services (Special Agencies) (Northern Ireland) Order 1990 ( S.I. 1990/247 (N.I.3)),

(q) a Health and Social Care trust established under the Health and Personal Social Services (Northern Ireland) Order 1991 (S.I. 1991/194 (N.I.1)),

(r) the Department of Health, Social Services and Public Safety.

(5) Whether or not an arrangement which constitutes an NHS contract would apart from this subsection be a contract in law, it must not to be regarded for any purpose as giving rise to contractual rights or liabilities.

(6) But if any dispute arises with respect to such an arrangement, either party may refer the matter to the Welsh Ministers for determination under this section.

(7) If, in the course of negotiations intending to lead to an arrangement which will be an NHS contract, it appears to a health service body—

(a) that the terms proposed by another health service body are unfair by reason that the other is seeking to take advantage of its position as the only, or the only practicable, provider of the goods or services concerned or by reason of any other unequal bargaining position as between the prospective parties to the proposed arrangement, or

(b) that for any other reason arising out of the relative bargaining position of the prospective parties any of the terms of the proposed arrangement cannot be agreed,

that health service body may refer the terms of the proposed arrangement to the Welsh Ministers for determination under this section.

(8) Where a reference is made to the Welsh Ministers under subsection (6) or (7), they may determine the matter themselves or appoint a person to consider and determine it in accordance with regulations.

(9) “ The appropriate person ” means the Welsh Ministers or the person appointed under subsection (8).

(10) By the determination of a reference under subsection (7), the appropriate person may specify terms to be included in the proposed arrangement and may direct that it be proceeded with.

(11) A determination of a reference under subsection (6) may contain such directions (including directions as to payment) as the appropriate person considers appropriate to resolve the matter in dispute.

(12) The appropriate person may by the determination in relation to an NHS contract vary the terms of the arrangement or bring it to an end (but this does not affect the generality of the power of determination under subsection (6)).

(13) Where an arrangement is so varied or brought to an end—

(a) subject to paragraph (b), the variation or termination must be treated as being effected by agreement between the parties, and

(b) the directions included in the determination by virtue of subsection (11) may contain such provisions as the appropriate person considers appropriate in order to give effect to the variation or to bring the arrangement to an end.

Section 8 Provision for bodies in Northern Ireland

(1) Subsection (2) applies where the Regional Agency for Public Health and Social Well-being or a body mentioned in paragraph (o), (p), (q) or (r) of section 7(4) is a party or prospective party to an arrangement or proposed arrangement which—

(a) falls within the definition of NHS contract in section 7(1), and

(b) also falls within the definition of HSS contract in Article 8 of the Health and Personal Social Services (Northern Ireland) Order 1991 (S.I. 1991/194 (N.I.1)).

(2) Subsections (5) to (13) of section 7 apply in relation to the arrangement or proposed arrangement with the substitution for references to the Welsh Ministers of references to the Welsh Ministers and the Department of Health, Social Services and Public Safety acting jointly.

Section 8A Provision for bodies in Scotland

(1) Subsection (2) applies where the Scottish Ministers are, or a body mentioned in paragraph (f), (fa), (h), (l) or (nb) of section 7(4) is, a party or prospective party to an arrangement or proposed arrangement which—

(a) falls within the definition of NHS contract in section 7(1), and

(b) also falls within the definition of NHS contract in section 17A of the National Health Service (Scotland) Act 1978.

(2) Subsections (5) to (13) of section 7 apply in relation to the arrangement or proposed arrangement with the substitution for references to the Welsh Ministers—

(a) in so far as the arrangement or proposed arrangement relates to reserved matters within the meaning of the Scotland Act 1998, of references to the Welsh Ministers and the Secretary of State acting jointly, and

(b) for all other purposes, of references to the Welsh Ministers and the Scottish Ministers acting jointly.

(3) Subsection (4) applies (and subsection (2) does not apply) where a cross-border Special Health Authority is a party or prospective party to an arrangement or proposed arrangement which—

(a) falls within the definition of NHS contract in section 7(1), and

(b) also falls within the definition of NHS contract in section 17A of the National Health Service (Scotland) Act 1978 and the definition of NHS contract in section 9(1) of the National Health Service Act 2006.

(4) Subsections (5) to (13) of section 7 apply in relation to the arrangement or proposed arrangement (except in so far as it relates to reserved matters within the meaning of the Scotland Act 1998) with the substitution for references to the Welsh Ministers—

(a) where the cross-border Special Health Authority is exercising functions in relation to Wales only, of references to the Welsh Ministers and the Scottish Ministers acting jointly, and

(b) where the Authority is exercising functions in relation to England and Wales, of references to the Welsh Ministers and the Secretary of State acting concurrently with each other and jointly with the Scottish Ministers.

(5) In subsections (3) and (4), “ cross-border Special Health Authority ” means a Special Health Authority which is established under the National Health Service Act 2006 and the National Health Service (Wales) Act 2006 by virtue of—

(a) paragraph 1(2) of Schedule 2 to the National Health Service (Consequential Provisions) Act 2006, or

(b) the power under section 28 of the National Health Service Act 2006 and the power under section 22 of the National Health Service (Wales) Act 2006 being exercised together.

Section 9 Arrangements to be treated as NHS contracts

(1) This section applies to any arrangement under which a Local Health Board or such other health service body as may be prescribed arranges for the provision to it—

(a) by a contractor under a general ophthalmic services contract,

(b) by a person on an ophthalmic list,

(c) by a person on a pharmaceutical list, or

(d) by a person who has entered into a pharmaceutical care services contract under section 17Q of the National Health Service (Scotland) Act 1978 (c. 29),

of the goods or services mentioned in subsection (2).

(2) The goods or services are those that the body reasonably requires for the purposes of its functions, other than functions under—

(a) Part 6 (general ophthalmic services),

(b) Chapter 1 or 2 of Part 7 (pharmaceutical services and local pharmaceutical services under pilot schemes), or

(c) section 115 of, or Chapter 1 or 2 of Part 7 of, the National Health Service Act 2006 (c. 41) (primary ophthalmic services and pharmaceutical services and local pharmaceutical services under pilot schemes).

(3) Any such arrangement is to be treated as an NHS contract for the purposes of section 7 (other than subsections (7) and (10)).

(4) In this section—

“general ophthalmic services contract” and “contractor” under such a contract have the meanings given by section 117 of the National Health Service Act 2006,

“ health service body ” means a body which is a health service body for the purposes of section 7,

“ ophthalmic list ” includes a list published in accordance with regulations made under—

section 26(2)(a) of the National Health Service (Scotland) Act 1978 (c. 29), or

Article 62(2)(a) of the Health and Personal Social Services (Northern Ireland) Order 1972 (S.I. 1972/1265 (N.I.14)), and

“ pharmaceutical list ” includes a list published in accordance with regulations made under—

section 129(2)(a) of the National Health Service Act 2006, or

Article 63(2A)(a) of the Health and Personal Social Services (Northern Ireland) Order 1972.

(5) The reference to a list published in accordance with regulations made under paragraph (a) of section 26(2) of the National Health Service (Scotland) Act 1978 is a reference to the first part of the list (referred to in sub-paragraph (i) of that paragraph) which is published in accordance with regulations under that paragraph.

Section 10 Welsh Ministers' arrangements with other bodies

(1) The Welsh Ministers may arrange with any person or body to provide, or assist in providing, any service under this Act.

(2) Arrangements may be made under subsection (1) with voluntary organisations.

(3) The Welsh Ministers may make available any facilities provided by them for any service under this Act—

(a) to any person or body carrying out any arrangements under subsection (1), or

(b) to any voluntary organisation eligible for assistance under section 64 or section 65 of the Health Services and Public Health Act 1968 (c. 46).

(4) Where facilities are made available under subsection (3) the Welsh Ministers may make available the services of any person employed in connection with the facilities by—

(a) the Welsh Ministers,

(b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(c) a Special Health Authority, or

(d) a Local Health Board.

(5) Powers under this section may be exercised on such terms as may be agreed, including terms as to the making of payments by or to the Welsh Ministers.

(6) Goods or materials may be made available either temporarily or permanently.

(7) Any power to supply goods or materials under this section includes—

(a) a power to purchase and store them, and

(b) a power to arrange with third parties for the supply of goods or materials by those third parties.

Section 10A Procurement of services etc. as part of the NHS in Wales

(1) The Welsh Ministers may, by regulations, make provision in relation to the processes to be followed and objectives to be pursued by relevant authorities in the procurement of—

(a) services provided as part of the health service in Wales (“health services”), and

(b) goods or other services that are connected to those health services.

(2) Regulations under subsection (1) must include provision specifying steps to be taken when following a competitive tendering process.

(3) Regulations under subsection (1) must, in relation to the procurement of the services or goods to which they apply, make provision for the purposes of—

(a) ensuring transparency;

(b) ensuring fairness;

(c) ensuring that compliance can be verified;

(d) managing conflicts of interest.

(4) Before making regulations under subsection (1), the Welsh Ministers must carry out such consultation as they consider appropriate and publish a summary of the responses they receive.

(5) Explanatory material accompanying regulations made under subsection (1) must set out how the regulations make provision for the purposes of subsection (3).

(6) The Welsh Ministers must publish such guidance as they consider appropriate about compliance with the regulations.

(7) A relevant authority must have regard to guidance published under this section.

(8) The Welsh Ministers must—

(a) review the operation of the regulations, and

(b) publish the conclusions of the review before the end of the period of 5 years beginning with the day on which the regulations come into force.

(9) In this section “ relevant authority ” means—

(a) a county council or county borough council in Wales;

(b) a local health board established under section 11;

(c) a National Health Service trust established under section 18;

(d) a special health authority established under section 22.

Section 10B Direct payments for health care

(1) The Welsh Ministers may, for the purpose of securing the provision to a patient of anything to which subsection (3) applies, make payments to the patient or to a person nominated by the patient.

(2) Subsection (1) is subject to any provision made by regulations under section 10C.

(3) This subsection applies to—

(a) anything that the Welsh Ministers may or must provide under section 2(1) or 3(1);

(b) anything for which the Welsh Ministers must arrange under paragraph 8 of Schedule 1;

(c) any vehicles that the Welsh Ministers may provide under paragraph 9 of Schedule 1;

(d) anything the Welsh Ministers may provide under paragraph 10 of Schedule 1 (including anything for which a grant may be made under paragraph 10(3) of Schedule 1).

(4) Payments may not be made under subsection (1) unless the patient consents to the making of the payments, subject to any provision made by regulations under section 10C in respect of a patient who lacks capacity or is a child.

(5) Where the Welsh Ministers make payments under subsection (1), they must, having regard to the purposes for which the payments are made, make arrangements for the provision to the patient, payee or their representative of such information, advice or other support, as the Welsh Ministers consider appropriate.

(6) Regulations may provide that a Local Health Board may, for the purpose of securing the provision to a patient of after-care services that a Local Health Board must provide under section 117 of the Mental Health Act 1983 (c. 20) , make payments to the patient or to a person nominated by the patient.

(7) Regulations under subsection (6) must—

(a) provide that payments under the regulations cannot be made unless the patient consents to the making of the payments, subject to any provision made by regulations under section 10C in respect of a patient who lacks capacity or is a child;

(b) make provision in respect of information, advice or other support to be provided by a Local Health Board to patients, payees or their representatives in connection with the payments.

(8) In section 10C and section 10D, “ direct payments ” means payments made under subsection (1) or under regulations made under subsection (6).

(9) In this section and section 10C—

(a) “ child ” means a person who has not attained the age of 16;

(b) references to a person lacking capacity are references to a person lacking capacity within the meaning of the Mental Capacity Act 2005 (c. 9) .

Section 10C Regulations about direct payments

(1) Regulations may make provision about direct payments.

(2) The regulations may, in particular, make provision about—

(a) the circumstances in which, and descriptions of persons and services in respect of which, direct payments may, must or must not be made;

(b) the circumstances in which direct payments may, must or must not be made to a person nominated by the patient;

(c) the making of direct payments (and, in particular, as to persons to whom payments may or must be made) if the patient lacks capacity to consent to the making of the payments or is a child;

(d) matters to which the Welsh Ministers or a Local Health Board may or must have regard when making a decision about direct payments;

(e) conditions that the Welsh Ministers or a Local Health Board may, must or must not attach in relation to direct payments;

(f) the steps that the Welsh Ministers or a Local Health Board may or must take before, or after, making a decision about direct payments;

(g) the conditions that the patient or (if different) the payee may or must be required to comply with before, after, or at the time when a direct payment is made;

(h) the amount of any direct payment or how it is to be calculated;

(i) the circumstances in which the Welsh Ministers or a Local Health Board may or must stop making direct payments;

(j) the circumstances in which the Welsh Ministers or a Local Health Board may or must require all or part of a direct payment to be repaid by the patient or (if different) the payee, or otherwise;

(k) the monitoring of the making of direct payments, of their use by the patient or (if different) the payee, or of services which they are used to secure;

(l) the review of decisions as to whether a direct payment should be made;

(m) the arrangements to be made by the Welsh Ministers or Local Health Board for providing patients, payees or their representatives with information, advice or other support in connection with direct payments;

(n) the extent to which such support is to be treated as a service in respect of which direct payments may be made.

(3) If the regulations make provision about persons who lack capacity to consent to the making of direct payments, the regulations may also make provision about the cases or circumstances where a person who has lacked that capacity but no longer does so (whether because of fluctuating capacity or regaining or gaining capacity) .

(4) The regulations may provide for a sum that must be repaid to the Welsh Ministers or Local Health Board (as the case may be) by virtue of a condition or other requirement imposed by or under the regulations to be recoverable as a debt due to the Welsh Ministers or Local Health Board (as the case may be).

(5) The regulations may make provision—

(a) for a service in respect of which a direct payment has been made under section 10B(1) to be regarded as provided or arranged for by the Welsh Ministers under an enactment mentioned in section 10B(3), only to such extent and subject to such conditions as the regulations may specify;

(b) displacing functions or obligations of a Local Health Board with respect to the provision of after-care services under section 117 of the Mental Health Act 1983 (c. 20) , only to such extent and subject to such conditions as the regulations may prescribe.

(6) In this section, “ service ” includes anything in respect of which direct payments may be made.

Section 10D Arrangements with other bodies relating to direct payments

(1) The Welsh Ministers or a Local Health Board may arrange with any person or body to provide assistance in connection with direct payments.

(2) Arrangements may be made under subsection (1) with voluntary organisations.

(3) Powers under this section may be exercised on such terms as may be agreed, including terms as to the making of payments by or to the Welsh Ministers or the Local Health Board.

Section 11 Local Health Boards

(1) The Welsh Ministers may establish bodies to be known as Local Health Boards.

(2) Each Local Health Board is established by order made by the Welsh Ministers (referred to in this Act as an LHB order), and an order may establish more than one Local Health Board.

(3) A Local Health Board is established for the area of Wales specified in its LHB order.

(4) If any consultation requirements apply, they must be complied with before an LHB order is varied or revoked.

(5) “ Consultation requirements ” means requirements about consultation contained in regulations.

(6) Schedule 2 makes further provision about Local Health Boards.

Section 12 Functions of Local Health Boards

(1) The Welsh Ministers may direct a Local Health Board to exercise in relation to its area—

(a) functions which were transferred to the National Assembly for Wales by the Health Authorities (Transfer of Functions, Staff, Property, Rights and Liabilities and Abolition) (Wales) Order 2003 (S.I. 2003/813 (W.98)),

(b) such other of their functions relating to the health service as are specified in the direction.

(2) The functions which may be specified in directions under subsection (1) include functions under enactments relating to mental health and care homes.

(3) The Welsh Ministers may give directions to a Local Health Board about its exercise of any functions.

Section 12A Local Health Boards' duty to secure quality in health services

(1) Each Local Health Board must exercise its functions with a view to securing improvement in the quality of health services.

(2) For the purposes of this section—

“ health services ” means any services provided or secured in accordance with this Act;

“ quality ” includes, but is not limited to, quality in terms of—

the effectiveness of health services,

the safety of health services, and

the experience of individuals to whom health services are provided.

(3) Each Local Health Board must publish an annual report on the steps it has taken to comply with the duty in subsection (1).

(4) The report must include an assessment of the extent of any improvement in outcomes achieved by virtue of those steps.

(5) The Welsh Ministers must issue guidance to Local Health Boards in relation to the requirements imposed by subsections (1) and (3).

(6) The guidance must, in particular, include guidance about—

(a) the evidence to be used in support of an assessment required by this section, and

(b) the conduct of such an assessment.

(7) Each Local Health Board must have regard to guidance issued under subsection (5).

Section 13 Exercise of Local Health Board functions

(1) This section applies to functions exercisable by a Local Health Board under or by virtue of this Act (including this section) or any prescribed provision of any other Act.

(2) The Welsh Ministers may give directions providing for any functions to which this section applies to be exercised—

(a) by another Local Health Board,

(b) by a Special Health Authority, or

(c) jointly with any one or more of the bodies mentioned in subsection (3).

(3) The bodies are—

(aa) NHS England ,

(ab) integrated care boards,

(a) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(b) NHS trusts, and

(c) other Local Health Boards.

(4) Directions given by the Welsh Ministers may provide—

(a) for any functions to which this section applies to be exercised, on behalf of the Local Health Board by whom they are exercisable, by a committee, sub-committee or officer of the Local Health Board,

(b) for any functions which, under this section, are exercisable by a Special Health Authority to be exercised, on behalf of that Special Health Authority, by a committee, sub-committee or officer of the Special Health Authority,

(c) for any functions which, under this section, are exercisable by a Local Health Board jointly with one or more other Local Health Boards (but not with any NHS trusts) to be exercised, on behalf of the Local Health Boards in question, by a joint committee or joint sub-committee.

(5) Subsection (6) applies where, by virtue of subsection (2)(b), a Special Health Authority exercises functions of a Local Health Board in relation to a general dental services contract.

(6) The Welsh Ministers may by order make provision for the transfer to the Special Health Authority of the rights and liabilities of the Local Health Board under the contract (and for their transfer back to the Local Health Board where the Special Health Authority ceases to exercise the functions).

Section 14 Section 50 arrangements and section 64 arrangements

(1) Each Local Health Board must, in accordance with regulations, perform such functions in relation to section 50 arrangements (primary medical services) and section 64 arrangements (primary dental services) as may be prescribed.

(2) The regulations may, in particular—

(a) prescribe functions in relation to training,

(b) provide for appeals to the Welsh Ministers or a prescribed body in relation to prescribed functions.

Section 15 Administration and management of services

Each Local Health Board must, in accordance with regulations—

(a) administer the arrangements made in pursuance of this Act for the provision for its area of primary medical services, primary dental services, general ophthalmic services and pharmaceutical services, and

(b) perform such management and other functions relating to those services as may be prescribed.

Section 16 Advice for Local Health Boards

Each Local Health Board must make arrangements with a view to securing that it receives advice appropriate for enabling it effectively to exercise the functions exercisable by it from persons with professional expertise relating to the physical or mental health of individuals.

Section 17 Plans for improving health etc

(1) Each Local Health Board must, at such times as the Welsh Ministers may direct, prepare a plan which sets out a strategy for improving—

(a) the health of the people for whom it is responsible, and

(b) the provision of health care to such people.

(2) Each Local Health Board must keep under review any plan prepared by it under this section.

(3) Each of the bodies specified in subsection (4) must participate in the preparation or review by a Local Health Board of any plan under this section.

(4) Those bodies are—

(a) any local authority whose area falls wholly or partly within the area of the Local Health Board, and

(b) any NHS trust which provides services at or from a hospital or other establishment or facility which falls within the area of the Local Health Board.

(5) In preparing or reviewing any plan under this section, a Local Health Board—

(a) must consult, or seek the participation of, such persons as the Welsh Ministers may direct, and

(b) may consult, or seek the participation of, such other persons as it considers appropriate.

(6) The Welsh Ministers may give directions as to—

(a) the periods to be covered by plans under this section,

(b) the action to be taken by Local Health Boards, NHS trusts and local authorities in connection with the preparation or review of plans under this section,

(c) the matters to be taken into account in connection with the preparation or review of plans under this section,

(d) the matters to be dealt with by plans under this section,

(e) the form and content of plans under this section,

(f) the publication of plans prepared or reviewed under this section,

(g) the sharing of information between NHS England , integrated care boards, ... ... NHS trusts, Local Health Boards and local authorities in connection with the preparation or review of plans under this section or the preparation of joint local health and wellbeing strategies under section 116A of the Local Government and Public Involvement in Health Act 2007 ,

(h) the provision by NHS England , integrated care boards, ... ... and Local Health Boards of reports or other information to the Welsh Ministers in connection with plans under this section or joint local health and wellbeing strategies under section 116A of the Local Government and Public Involvement in Health Act 2007 .

(7) In exercising its functions—

(a) a Local Health Board must have regard to any plan prepared or reviewed by it, and

(b) an NHS trust and a local authority must have regard to any plan in relation to which it has participated.

(8) For the purposes of this section, the persons for whom a Local Health Board is responsible are—

(a) the people in the area of the Local Health Board, and

(b) such of the people outside the area as may be specified in directions given by the Welsh Ministers.

(9) “ Health care ” means—

(a) services provided to individuals for or in connection with the prevention, diagnosis or treatment of illness, and

(b) the promotion and protection of public health.

Section 18 NHS trusts

(1) The Welsh Ministers may by order establish bodies, called National Health Service trusts (“NHS trusts”), to provide goods and services for the purposes of the health service.

(2) An order under subsection (1) is referred to in this Act as “ an NHS trust order ”.

(3) No NHS trust order may be made until after the completion of such consultation as may be prescribed.

(4) Schedule 3 makes further provision about NHS trusts.

Section 19 Welsh Ministers' directions to NHS trusts

(1) The Welsh Ministers may give directions to an NHS trust about its exercise of any functions.

(2) The Welsh Ministers may not give directions under this section in respect of matters concerning xenotransplantation, surrogacy agreements, embryology or human genetics.

(3) Nothing in provision made by or under this or any other Act affects the generality of subsection (1).

Section 20 General duty of NHS trusts

An NHS trust must exercise its functions effectively, efficiently and economically.

Section 20A Duty of NHS trusts to secure quality in health services

(1) Each NHS trust must exercise its functions with a view to securing improvement in the quality of health services.

(2) For the purposes of this section—

“ health services ” means any services provided or secured in accordance with this Act;

“ quality ” includes, but is not limited to, quality in terms of—

the effectiveness of health services,

the safety of health services, and

the experience of individuals to whom health services are provided.

(3) Each NHS trust must publish an annual report on the steps it has taken to comply with the duty in subsection (1).

(4) The report must include an assessment of the extent of any improvement in outcomes achieved by virtue of those steps.

(5) The Welsh Ministers must issue guidance to NHS trusts in relation to the requirements imposed by subsections (1) and (3).

(6) The guidance must, in particular, include guidance about—

(a) the evidence to be used in support of an assessment required by this section, and

(b) the conduct of such an assessment.

(7) Each NHS trust must have regard to guidance issued under subsection (5).

Section 21 Financial provisions relating to NHS trusts

Schedule 4 makes provision about the financing of NHS trusts.

Section 22 Special Health Authorities

(1) The Welsh Ministers may by order establish special bodies for the purpose of exercising any functions which may be conferred on them by or under this Act.

(2) The Welsh Ministers may make such further provision relating to a body established under subsection (1) as they consider appropriate.

(3) A body established under this section is called a Special Health Authority.

(4) An order may, in particular, contain provisions as to—

(a) the membership of the body established by the order,

(b) the transfer to the body of officers, property and liabilities, and

(c) the name of the body.

(5) The liabilities which may be transferred by virtue of this section, section 203(10) and section 204(1) to an NHS body on the abolition of a Special Health Authority include criminal liabilities.

(6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(7) The Welsh Ministers must, before they make an order under this section, consult with respect to the order such bodies as they may recognise as representing officers who in the opinion of the Welsh Ministers are likely to be transferred or affected by transfers in pursuance of the order.

(8) Schedule 5 makes further provision about Special Health Authorities.

Section 23 Welsh Ministers' directions to Special Health Authorities

(1) The Welsh Ministers may give directions to a Special Health Authority about its exercise of any functions.

(2) The Welsh Ministers may not give directions under this section in respect of matters concerning xenotransplantation, surrogacy agreements, embryology or human genetics.

(3) Nothing in provision made by or under this or any other Act affects the generality of subsection (1).

Section 24 Exercise of health service functions by Special Health Authorities

(1) The Welsh Ministers may direct a Special Health Authority to exercise any of the functions of the Welsh Ministers relating to the health service which are specified in the directions.

(2) Subsection (1) does not apply to the functions of the Welsh Ministers in relation to pilot schemes.

(3) The functions which may be specified in directions include functions under enactments relating to mental health and care homes.

Section 24A Duty of Special Health Authorities to secure quality in health services

(1) Each Special Health Authority must exercise its functions with a view to securing improvement in the quality of health services.

(2) For the purposes of this section—

“ health services ” means any services provided or secured in accordance with this Act;

“ quality ” includes, but is not limited to, quality in terms of—

the effectiveness of health services,

the safety of health services, and

the experience of individuals to whom health services are provided.

(3) Each Special Health Authority must publish an annual report on the steps it has taken to comply with the duty in subsection (1).

(4) The report must include an assessment of the extent of any improvement in outcomes achieved by virtue of those steps.

(5) The Welsh Ministers must issue guidance to Special Health Authorities in relation to the requirements imposed by subsections (1) and (3).

(6) The guidance must, in particular, include guidance about—

(a) the evidence to be used in support of an assessment required by this section, and

(b) the conduct of such an assessment.

(7) Each Special Health Authority must have regard to guidance issued under subsection (5).

(8) This section does not apply in relation to a cross-border Special Health Authority (within the meaning of section 8A(5)).

Section 25 Exercise of Special Health Authority functions

(1) Regulations may provide for any functions which are exercisable by a Special Health Authority under section 24 to be exercised—

(a) by another Special Health Authority, or

(b) jointly with one or more other Special Health Authorities.

(2) Regulations may provide—

(a) for any functions which are exercisable by a Special Health Authority under section 24 or this section to be exercised on behalf of that Special Health Authority by a committee, sub-committee or officer of the Special Health Authority,

(b) for any functions exercisable jointly under subsection (1)(b) to be exercised, on behalf of the Special Health Authorities in question, by a joint committee or joint sub-committee.

Section 25A Duty to have regard to providing sufficient nurses

(1) Subsection (2) applies where a Local Health Board is considering the extent of provision of nursing services for its area necessary to meet all reasonable requirements.

(2) The Local Health Board must have regard to the importance of—

(a) providing sufficient nurses to allow the nurses time to care for patients sensitively, and

(b) where securing the provision of nursing services, ensuring that there are sufficient nurses to allow the nurses time to care for patients sensitively.

(3) Where an NHS Trust in Wales provides nursing services it must provide those services to such extent as it considers necessary to meet all reasonable requirements; and subsection (4) applies where an NHS Trust in Wales is considering the extent of provision of nursing services.

(4) The NHS Trust must have regard to the importance of—

(a) providing sufficient nurses to allow the nurses time to care for patients sensitively, and

(b) where securing the provision of nursing services, ensuring that there are sufficient nurses to allow the nurses time to care for patients sensitively.

(5) For the purposes of having regard to the importance of providing sufficient nurses to allow the nurses time to care for patients sensitively, a Local Health Board or NHS Trust in Wales must (among other things) undertake workforce planning (including planning the recruitment, retention, education and training of nurses).

(6) In this section, and in sections 25B to 25E, references to—

(a) a nurse providing care for patients include the provision of care by a person other than a nurse acting under the supervision of, or discharging duties delegated to the person by, a nurse;

(b) a “nurse” mean a registered nurse;

(c) an “ NHS Trust in Wales” mean an NHS trust all or most of whose hospitals, establishments and facilities are situated in Wales.

Section 25B Duty to calculate and take steps to maintain nurse staffing levels

(1) Where a Local Health Board or NHS Trust in Wales provides nursing services in a situation to which this section applies, it must—

(a) designate a person or a description of person to calculate the number of nurses appropriate to provide care to patients that meets all reasonable requirements in that situation (the “nurse staffing level”),

(b) take all reasonable steps to maintain the nurse staffing level, and

(c) make arrangements for the purpose of informing patients of the nurse staffing level.

(2) A person designated by virtue of subsection (1)(a) (“a designated person”) must calculate the nurse staffing level in accordance with section 25C.

(3) This section applies to the following situations—

(a) adult acute medical inpatient wards,

(b) adult acute surgical inpatient wards, and

(c) such other situations as the Welsh Ministers may by regulations specify.

Section 25C Nurse staffing levels: method of calculation

(1) When calculating a nurse staffing level, a designated person must—

(a) exercise professional judgement, and

(b) take into account each of the following—

(i) the average ratio of nurses to patients appropriate to provide care to patients that meets all reasonable requirements, estimated for a specified period using evidence-based workforce planning tools;

(ii) the extent to which patients' well-being is known to be particularly sensitive to the provision of care by a nurse.

(2) A designated person may calculate different nurse staffing levels—

(a) in relation to different periods of time;

(b) depending on the conditions in which care is provided by a nurse.

Section 25D Nurse staffing levels: guidance

(1) The Welsh Ministers must issue guidance about the duties under sections 25B and 25C and Local Health Boards and any NHS Trust to which those sections apply must have regard to the guidance.

(2) The guidance may set out, in particular, that when calculating a nurse staffing level a designated person should exercise professional judgement by taking the following into account—

(a) the qualifications, competencies, skills and experience of the nurses providing care to patients;

(b) the conditions in which care by a nurse is provided;

(c) the potential impact on care by a nurse of—

(i) the physical condition and layout of the ward or other situation in which the care is provided;

(ii) the turnover of patients receiving the care;

(d) services or care provided to patients by other health professionals or other staff (for example, health care support workers), and their qualifications, competencies, skills and experience;

(e) the extent to which the nurses providing care are required to undertake supervisory or administrative functions.

(3) The guidance may also make provision about workforce planning that Local Health Boards and NHS Trusts may undertake in order to enable them to comply with their duties under sections 25B and 25C.

(4) Before issuing guidance the Welsh Ministers must consult—

(a) Local Health Boards and any NHS Trust that is under a duty to have regard to the guidance,

(b) such organisations as appear to them to represent the interests of any—

(i) providers of care homes, or

(ii) providers of independent hospitals in Wales,

likely to be affected by the guidance,

(c) such organisations as appear to them to represent the interests of any other persons likely to be affected by the guidance, and

(d) such other persons likely to be affected by the guidance as they consider appropriate.

(5) For the purposes of subsection (4)—

“ care home ” means premises at which a care home service within the meaning given by paragraph 1 of Schedule 1 to the Regulation and Inspection of Social Care (Wales) Act 2016 (anaw 2) is provided, and

“ independent hospital ” has the meaning given in section 2 of the Care Standards Act 2000 (c.14).

Section 25E Nurse staffing levels: reports

(1) Each Local Health Board and any NHS Trust to which the duty in section 25B applies must submit a nurse staffing levels report (whether or not as part of a wider report) in accordance with this section.

(2) A nurse staffing levels report must set out, in respect of the period to which the report relates (the “reporting period”)—

(a) the extent to which nurse staffing levels have been maintained;

(b) the impact the Board or Trust considers that not maintaining nurse staffing levels has had on care provided to patients by nurses, for example by reference to complaints about care provided to patients by nurses made in accordance with the Complaints Regulations or by reference to an increase in incidents of harm caused by—

(i) errors in administering medication to patients;

(ii) patients falling;

(iii) patients developing hospital-acquired pressure ulcers;

(c) any actions taken in response to not maintaining nurse staffing levels.

(3) Each nurse staffing levels report must be submitted to the Welsh Ministers no later than 30 days after the last day of the reporting period.

(4) The Welsh Ministers must, after the expiry of each reporting period—

(a) prepare and publish a document summarising the content of the nurse staffing levels reports submitted in respect of that reporting period, and

(b) lay each report submitted to them in that period before the National Assembly for Wales.

(5) For the purposes of this section the reporting period is—

(a) in the case of the initial reporting period, the period of three years beginning with the commencement of this section, and

(b) in the case of all subsequent reporting periods, the period of three years beginning with the day after the last day of the preceding reporting period.

(6) In subsection (2)(b) “ Complaints Regulations ” means regulations made under—

(a) section 113 of the Health and Social Care (Community Health and Standards) Act 2003 (c.43);

(b) the NHS Redress (Wales) Measure 2008 (nawm 1) .

Section 26 Intervention orders

(1) This section applies to NHS bodies other than NHS England , integrated care boards and NHS foundation trusts.

(2) If the Welsh Ministers—

(a) consider that a body to which this section applies is not performing one or more of its functions adequately or at all, or that there are significant failings in the way the body is being run, and

(b) are satisfied that it is appropriate for them to intervene under this section,

they may make an order under this section in respect of the body (an “intervention order”).

(3) An intervention order may make any provision authorised by section 27 (including any combination of such provisions).

Section 27 Effect of intervention orders

(1) In this section—

(a) “ member ” means a member of a ... ... Special Health Authority or Local Health Board, or a member of the board of directors of an NHS trust,

(b) “ employee member ” means a member of a ... ... Special Health Authority or Local Health Board who is an officer of the body, or an executive director of an NHS trust.

(2) An intervention order may provide for the removal from office of—

(a) all the members, or

(b) those specified in the order,

and for their replacement with individuals specified in or determined in accordance with the order (who need not be the same in number as the removed individuals).

(3) An intervention order may provide for the suspension (either wholly, or in respect only of powers and duties specified in or determined in accordance with the order) of—

(a) all the members, or

(b) those specified in the order,

and for the powers of the suspended members to be exercised, and their duties performed, during their suspension by individuals specified in or determined in accordance with the order (who need not be the same in number as the suspended individuals).

(4) The powers and duties referred to in subsection (3) are, in the case of an employee member, only those which he has in his capacity as a member.

(5) An intervention order may contain directions to the body to which it relates to secure that a function of the body specified in the directions—

(a) is performed, to the extent specified in the directions, on behalf of the body and at its expense, by such person as is specified in the directions, and

(b) is so performed in such a way as to achieve such objectives as are so specified,

and the directions may require that any contract or other arrangement made by the body with that person contains such terms and conditions as may be so specified.

(6) If the person referred to in subsection (5)(a) is a body to which section 26 applies, the functions of that body include the performance of the functions specified in the directions under subsection (5).

(7) Subsection (8) applies in relation to any provision in this Act, or in any order or regulations made, or directions given, under this Act, relating to—

(a) the membership of the body to which an intervention order relates (or in the case of an NHS trust to the membership of its board of directors), or

(b) the procedure of the body.

(8) The intervention order may provide in relation to any provision specified in the order—

(a) that it does not apply in relation to the body while the order remains in force, or

(b) that it applies in relation to the body, while the order remains in force, with modifications specified in the order.

(9) An intervention order may contain such supplementary directions to the body to which it relates as the Welsh Ministers consider appropriate for the purpose of giving full effect to the order.

Section 28 Default powers

(1) This section applies to NHS bodies other than NHS England , integrated care boards and NHS foundation trusts.

(2) If the Welsh Ministers consider that a body to which this section applies—

(a) has failed to carry out any functions conferred or imposed on it by or under this Act, or

(b) has in carrying out those functions failed to comply with any regulations or directions relating to those functions,

they may after such inquiry as they consider appropriate make an order declaring it to be in default.

(3) The members of the body in default must immediately vacate their office, and the order—

(a) must provide for the appointment, in accordance with the provisions of this Act, of new members of the body, and

(b) may contain such provisions as seem to the Welsh Ministers expedient for authorising any person to act in the place of the body pending the appointment of new members.

(4) An order under this section may contain such supplementary and incidental provisions as appear to the Welsh Ministers to be necessary or expedient, including—

(a) provision for the transfer to the Welsh Ministers of property and liabilities of the body in default, and

(b) where any such order is varied or revoked by a subsequent order, provision in the subsequent order for the transfer to the body in default of any property or liabilities acquired or incurred by the Welsh Ministers in discharging any of the functions transferred to them.

Section 29 Transfer of residual liabilities

(1) If a Local Health Board, an NHS trust or a Special Health Authority ceases to exist, the Welsh Ministers must exercise their functions so as to secure that all of the body's liabilities (other than any criminal liabilities) are dealt with.

(2) A liability is dealt with by being transferred to an NHS body, the Welsh Ministers or the Secretary of State.

Section 30 Schemes for meeting losses and liabilities etc of certain health service bodies

(1) The Welsh Ministers may by regulations establish a scheme (a “mutual indemnity scheme”) whereby any of the bodies or other persons specified in subsection (2) may make provision to meet—

(a) expenses arising from any loss of or damage to their property, and

(b) liabilities to third parties for loss, damage or injury arising out of the carrying out of the functions of the bodies or other persons concerned.

(2) The bodies and other persons referred to in subsection (1) are—

(a) Local Health Boards,

(b) NHS trusts, ...

(c) Special Health Authorities, ...

(d) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(e) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(f) a person who is providing, or who has provided, primary medical services in accordance with a contract or other arrangement under Part 4, and

(g) a body or other person (other than a body or other person specified under paragraphs (a) to (f)) who is providing or arranging the provision of, or who has provided or arranged the provision of, health services whose provision is the subject of a contract or other arrangements with a Local Health Board, NHS trust or Special Health Authority,

but a mutual indemnity scheme may limit the class or description of bodies which , or other persons who, are eligible to participate in it.

(3) A mutual indemnity scheme may, in particular—

(a) provide for the scheme to be administered by the Welsh Ministers or by an NHS trust or Special Health Authority specified in the scheme,

(b) require any body which , or other person who, participates in the scheme to make payments in accordance with the scheme, and

(c) provide for the making of payments for the purposes of the scheme by the Welsh Ministers.

(4) If the Welsh Ministers so direct, a Local Health Board, NHS trust or Special Health Authority which is eligible to participate in a scheme must do so.

(5) Where a mutual indemnity scheme provides for the scheme to be administered by the Welsh Ministers, a Special Health Authority or NHS trust must carry out such functions in connection with the administration of the scheme as the Welsh Ministers may direct.

(6) Subsections (4) and (5) do not affect any other power of direction of the Welsh Ministers.

(7) A person or body administering a mutual indemnity scheme does not require permission under any provision of the Financial Services and Markets Act 2000 (c. 8) as respects activities carried out under the scheme.

(8) The Welsh Ministers may by regulations establish a scheme (a “direct indemnity scheme”) under which they may indemnify any of the bodies or other persons specified in subsection (2) against—

(a) expenses arising from any loss of or damage to their property, and

(b) liabilities to third parties for loss, damage or injury arising out of the carrying out of the functions of the bodies or other persons concerned.

(9) A direct indemnity scheme may, in particular–

(a) specify the persons or other bodies eligible to be indemnified (including limiting the class or description of bodies or other persons who are eligible);

(b) specify the expenses and liabilities in respect of which a body or other person may be indemnified and the extent to which they may be indemnified;

(c) require any body or other person indemnified under the scheme to make payments in accordance with the scheme.

(10) Nothing in this section limits or affects the powers of the Welsh Ministers under this Act, or any other enactment, to provide an indemnity—

(a) to any person other than the bodies or other persons specified in subsection (2), or

(b) to a body or other person specified in subsection (2) in respect of any expenses or liabilities other than those mentioned in subsections (1) and (8).

(11) In this section—

(a) in subsections (1)(b) and (8)(b) “ functions ”, in relation to a body or other person specified in subsection (2)(g), means the body or person's functions of providing, or arranging the provision of, health services whose provision is the subject of a contract or other arrangements with a Local Health Board, NHS trust or Special Health Authority;

(b) in subsection (2) and in paragraph (a) of this subsection “ health services ” means services provided as part of the health service.

Section 31 Directions and regulations under this Part

(1) This section applies to directions and regulations under any of—

(a) section 12,

(b) section 13,

(c) section 19,

(d) section 23,

(e) section 24,

(f) section 25.

(2) Except in prescribed cases, the directions and regulations must not preclude a person or body by whom the function is exercisable apart from the directions or regulations from exercising the function.

Section 32 Supply of goods and services by local authorities

(1) In the Local Authorities (Goods and Services) Act 1970 (c. 39) the expression “ public body ” includes—

(a) any Local Health Board, and

(b) so far as relates to their functions under this Act, the Welsh Ministers.

(2) Subsection (1) has effect as if made by an order under section 1(5) of the Local Authorities (Goods and Services) Act 1970 and may be varied or revoked by such an order.

(3) Each local authority must make services available to each NHS body acting in its area, so far as is reasonably necessary and practicable to enable the NHS body to discharge its functions under this Act.

(4) “services” means—

(a) in relation to a local authority in England, the services of persons employed by the authority for the purposes of its functions under the Local Authority Social Services Act 1970 (c. 42) ;

(b) in relation to a local authority in Wales, the services of persons employed by the authority for the purposes of functions which are social services functions for the purposes of the Social Services and Well-being (Wales) Act 2014 (anaw 4).