Citation, commencement and interpretation

1. —(1) These Regulations may be cited as the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2013.

(2) These regulations come into force for the purposes of this regulation and regulation 6 on 16th December 2013, and for all other purposes on 1st April 2014.

(3) In these Regulations, “the 2012 Regulations” means the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012( 3 ).

Amendments in relation to NHS Continuing Healthcare and NHS funded nursing care

2. —(1) In regulation 21 of the 2012 Regulations (duty of relevant bodies: assessment and provision of NHS Continuing Healthcare)—

(a) for paragraph (3), substitute—

“ (3) If an assessment of a person’s need for NHS Continuing Healthcare is required under paragraph (2)(a), the relevant body must ensure that it is carried out before—

(a) any assessment pursuant to regulation 28(1) (persons who enter relevant premises or who develop a need for nursing care) is carried out in relation to that person; and

(b) any notice is given to a social services authority pursuant to section 2(2) of the Community Care (Delayed Discharges etc ) Act 2003 (notice of patient’s likely need for community care services) ( 4 ) in relation to that person. ” ;

(b) after paragraph (7) insert—

“ (7A) Paragraph (7B) applies where an NHS trust makes a recommendation to a relevant body that it should decide that a person is eligible for NHS Continuing Healthcare pursuant to direction 2(6) of the Delayed Discharges Directions.

(7B) Where this paragraph applies, the relevant body may decide that the person is eligible for NHS Continuing Healthcare in reliance on the recommendation of the NHS trust, and if it does so, paragraphs (2) to (6) do not apply. ” ;

(c) in paragraph (8), for “a Fast Track Pathway Tool”, substitute “the Fast Track Pathway Tool”;

(d) for paragraph (9) substitute—

“ (9) A relevant body must decide that a person is eligible for NHS Continuing Healthcare upon receipt of—

(a) the Fast Track Pathway Tool completed in accordance with paragraph (8); or

(b) the recommendation of an NHS trust under direction 2(9) of the Delayed Discharges Directions that a person is eligible for NHS Continuing Healthcare, based on the Fast Track Pathway Tool completed in accordance with direction 2(8) of those Directions. ” ;

(e) for paragraph (10) substitute—

“ (10) Where a relevant body makes a decision about a person’s eligibility for NHS Continuing Healthcare, it must—

(a) notify the person (or someone lawfully acting on that person’s behalf), in writing, of the decision made about their eligibility for NHS Continuing Healthcare, the reasons for that decision and, where applicable, the matters referred to in paragraph (11); and

(b) make a record of that decision. ” ; and

(f) in paragraph (13)—

(i) in the definition of “appropriate clinician”, for “a Fast Track Pathway Tool”, substitute “the Fast Track Pathway Tool”;

(ii) after the definition of “appropriate clinician” insert—

“ “Delayed Discharges Directions” means the Delayed Discharges (Continuing Care) Directions 2013 ( 5 ) ” ; and

(iii) in the definition of “healthcare profession”, for “(whether or not that person is regulated by, or by virtue of, any enactment)”, substitute “(whether or not a person engaged in that profession is regulated by, or by virtue of, any enactment)”.

(2) In Schedule 5 (persons disqualified from being a chair, CCG member or social services authority member of a review panel), omit paragraph (2).

Amendments in relation to personal health budgets and NHS Continuing Healthcare

3. After Part 6 of the 2012 Regulations, insert—

“ PART 6A

Standing rules: personal health budgets

Interpretation

32A. —(1) In this Part—

“Continuing Care for Children” means that part of a package of care which is arranged and funded by a relevant body for a person aged 17 or under to meet needs which have arisen as a result of disability, accident or illness;

“eligible person” means a person for whom a relevant body considers it necessary to arrange the provision of a relevant health service;

“NHS Continuing Healthcare” means a package of care arranged and funded solely by the health service in England for a person aged 18 or over to meet physical or mental health needs which have arisen as a result of disability, accident or illness;

“personal health budget” means an amount of money—

“relevant health service” means—

(2) References in this Part to an eligible person’s representative are to such persons whom, in the opinion of the relevant body, it is appropriate to consult about, and involve in, decisions about the provision of a relevant health service to the eligible person by means of a personal health budget.

Duties of relevant bodies in relation to personal health budgets

32B. —(1) A relevant body must ensure that it is able to arrange for the provision of a relevant health service to an eligible person by means of a personal health budget which is managed in accordance with paragraph (2).

(2) A personal health budget must be managed in at least one of the following ways—

(a) the making of a direct payment ( 6 ) ;

(b) the application of the personal health budget by the relevant body in accordance with the outcome of discussions with the eligible person or that person’s representative as to how best to secure the provision of the relevant health service to the person; or

(c) the transfer of the personal health budget by a relevant body to a person who applies the money in accordance with the outcome of discussions with the eligible person or that person’s representative as to how best, with the agreement of the relevant body, to secure the provision of the relevant health service to the eligible person.

(3) A relevant body must—

(a) publicise and promote the availability of personal health budgets to eligible persons and their representatives; and

(b) provide information, advice and other support to eligible persons and their representatives to assist them in deciding whether to request a personal health budget in respect of a relevant health service.

(4) A relevant body must—

(a) give due consideration to a request made by or on behalf of an eligible person for a personal health budget;

(b) decide whether it is appropriate in the circumstances of the eligible person’s case to arrange for the provision of the relevant health service to that person by means of a personal health budget; and

(c) if it decides that it would be appropriate, decide which of the ways mentioned in paragraph (2) would be the most appropriate way in which to manage the personal health budget.

(5) A relevant body must make arrangements for eligible persons for whom a personal health budget has been arranged, and their representatives, to obtain information, advice and other support in connection with the management of the personal health budget.

(6) The duty in paragraph (5) does not apply in relation to any part of a personal health budget to which regulation 9 of the National Health Service (Direct Payments) Regulations 2013 ( 7 ) (information, advice and other support) applies.

(7) If a relevant body decides to refuse a request for a personal health budget made by or on behalf of an eligible person, it must provide that person and their representatives with the reasons for that decision in writing.

(8) On receipt of written reasons in accordance with paragraph (7), an eligible person or a person acting on the eligible person’s behalf may require a relevant body to undertake a review of the decision and may provide evidence or information for the relevant body to consider as part of that review.

(9) A relevant body must inform the eligible person or their representatives in writing of the decision following a review, and state the reasons for the decision.

(10) A relevant body may not be required to undertake more than one review following a decision under paragraph (7) in any six month period. ”

Amendments in relation to choice of health service provider

4. —(1) In regulation 39 of the 2012 Regulations (duty to ensure persons are offered a choice of health serviceprovider)—

(a) for paragraph (2) substitute—

“ (2) Subject to regulations 40 and 41, the choices specified for the purposes of this paragraph are the choice—

(a) in respect of a first outpatient appointment with a consultant or a member of a consultant’s team, of—

(i) any clinically appropriate health service provider with whom any relevant body has a commissioning contract for the service required as a result of the referral, and

(ii) any clinically appropriate team led by a named consultant who is employed or engaged by that health service provider; and

(b) in relation to an elective referral for mental health services in respect of which the patient’s first outpatient appointment is not with a consultant or a member of a consultant’s team, of—

(i) any clinically appropriate health service provider with whom any relevant body has a commissioning contract for the service required as a result of the referral, and

(ii) any clinically appropriate team led by a named health care professional who is employed or engaged by that health service provider. ” ;

(b) omit paragraphs (3) and (4); and

(c) in paragraph (5), for “paragraphs (1) and (3)”, substitute “paragraph (1)”.

(2) In regulation 40 of the 2012 Regulations (services to which the duties as to choice do not apply)—

(a) in paragraph (1)—

(i) at the end of sub-paragraph (a), insert “or”;

(ii) omit the “or” at the end of sub-paragraph (b); and

(iii) omit sub-paragraph (c); and

(b) in paragraph (2), for “Regulation 39(1) and (3) do”, substitute “Regulation 39(1) does”.

(3) In regulation 41 of the 2012 Regulations (persons to whom the duties as to choice do not apply), for “Regulations 39(1) and (3) do”, substitute “Regulation 39(1) does”.

(4) In regulation 42(2)(a)(iii) of the 2012 Regulations (duty to publicise and promote information about choice), for “regulation 39(3)” substitute “regulation 39(1)”.

Amendment in relation to waiting times

5. In regulation 50 of the 2012 Regulations (duty to have regard to guidance), for ““The Referral to Treatment Consultant-led Waiting Times Rules Suite” dated January 2012”, substitute ““The Referral to Treatment Consultant-led Waiting Times Rules Suite” dated April 2014”( 8 ).

Amendments in relation to persons for whom a CCG has responsibility

6. In Schedule 1 to the 2012 Regulations (additional persons for whom a CCG has responsibility) in paragraphs 3(b)(i) and 5(b)(i), after “CCG” insert “or of a Local Health Board”.