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HC 1224

House of Commons

Regulatory Reform Committee

Draft Legislative Reform (Clinical Commissioning Groups) Order 2014

Fifth Report of Session 2013–14

HC 1224 Published on 10 April 2014

by authority of the House of Commons London: The Stationery Office Limited

House of Commons


Draft Legislative Reform (Clinical Commissioning Groups) Order 2014

Fifth Report of Session 2013–14

Report, together with formal minutes and written evidence

Ordered by the House of Commons to be printed 9 April 2014

£6.50


The Regulatory Reform Committee (previously the Deregulation and Regulatory Reform Committee) is appointed to consider and report to the House on draft Legislative Reform Orders under the Legislative and Regulatory Reform Act 2006. Its full remit is set out in S.O. No. 141, which was approved on 4 July 2007.

Current membership

James Duddridge MP (Conservative, Rochford and Southend East) (Chair) Heidi Alexander MP (Labour, Lewisham East) Mr David Anderson MP (Labour, Blaydon) Andrew Bridgen MP (Conservative, North West Leicestershire) Jack Dromey MP (Labour, Birmingham, Erdington) Richard Fuller MP (Conservative, Bedford) Lilian Greenwood MP (Labour, Nottingham South) Rebecca Harris MP (Conservative, Castle Point) Gordon Henderson MP (Conservative, Sittingbourne and Sheppey) John Hemming MP (Liberal Democrats, Birmingham, Yardley) Andrew Jones MP (Conservative, Harrogate and Knaresborough) Ian Lavery MP (Labour, Wansbeck) Andrew Percy MP (Conservative, Brigg and Goole) Valerie Vaz MP (Labour, Walsall South) The following members were also members of the committee during the parliament: Mr Robert Syms MP (Conservative, Poole) Ben Gummer MP (Conservative, Ipswich) Brandon Lewis MP (Conservative, Great Yarmouth)

Criteria against which the Committee considers each draft legislative reform order

Paragraph (3) of Standing Order No.141 requires us to consider any draft legislative reform order against the following criteria: … whether the draft legislative reform order — (a) appears to make an inappropriate use of delegated legislation; (b) serves the purpose of removing or reducing a burden, or the overall burdens, resulting directly or indirectly for any person from any legislation (in respect of a draft Order under section 1 of the Act); (c) serves the purpose of securing that regulatory functions are exercised so as to comply with the regulatory principles, as set out in section 2(3) of the Act (in respect of a draft Order under section 2 of the Act); (d) secures a policy objective which could not be satisfactorily secured by non-legislative means; (e) has an effect which is proportionate to the policy objective; (f) strikes a fair balance between the public interest and the interests of any person adversely affected by it; (g) does not remove any necessary protection; (h) does not prevent any person from continuing to exercise any right or freedom which that person might reasonably expect to continue to exercise; (i) is not of constitutional significance; (j) makes the law more accessible or more easily understood (in the case of provisions restating enactments); (k) has been the subject of, and takes appropriate account of, adequate consultation;

(l) gives rise to an issue under such criteria for consideration of statutory instruments laid down in paragraph (1) of Standing Order No 151 (Statutory Instruments (Joint Committee)) as are relevant; (m) appears to be incompatible with any obligation resulting from membership of the European Union.

Publications

The Reports and evidence of the Committee are published by The Stationery Office by Order of the House. All publications of the Committee (including press notices) are on the internet at www.parliament.uk/regrefcom. A list of Reports of the Committee in the present Parliament is at the back of this volume.

Committee staff

The current staff of the Committee are James Davies (Clerk), Amelia Aspden (Second Clerk), Ian Hook (Senior Committee Assistant), and Pam Morris (Committee Assistant).

Contacts

All correspondence should be addressed to the Clerk of the Regulatory Reform Committee, House of Commons, 14 Tothill Street, London SW1H 9NB. The telephone number for general enquiries is 020 7219 5469; the Committee’s email address is [email protected]

Draft Legislative Reform (Clinical Commissioning Groups) Order 2014 1

Contents

Report Page

1 Introduction 3

2 Description of the draft Order 3

3 Assessment of the draft Order 4 A: Appropriate use of delegated legislation 5 B: Removal of a burden 5 C: Better regulation 5 D: Legislative need 5 E: Proportionality 6 F: Public and private interests 6 G: Necessary protection 6 H: Existing rights and freedoms 7 I: Constitutional significance 7 J: Accessibilty of the law 7 K: Consultation 7 L: Issues relating to statutory instruments 8 M: Compatibilty with membership of the European Union 8

4 Conclusion 8

Annex 9

Formal Minutes 14

List of Reports from the Committee during the current Parliament 15


1 Introduction 1. The draft Legislative Reform (Clinical Commissioning Groups) Order 2014 (the ‘draft Order’) and Explanatory Document were laid before Parliament on 13 March 2014 by the Department of Health (the ‘Department’).

2. The draft Order would enable Clinical Commissioning Groups (CCGs) to form joint committees with other CCGs where they wish to do so. The draft Order would also allow CCGs to form joint committees with NHS England to jointly exercise CCG functions. Both proposals in the draft Order are voluntary. Primary Care Trusts, the predecessor bodies to CCGs, were able to create binding joint decision making bodies between themselves.1

3. The Department states that “Although the amendments are more than merely technical, they remain fairly straightforward and the consultation did not raise any major concerns about the proposals”.2 However, concerns were expressed that these arrangements may lead to a move away from local control of commissioning of services. The Minister has recommended that the draft Order be subject to the affirmative resolution procedure. We have examined the draft Order in accordance with Standing Order No. 141(3) and recommend under 141(4) that the draft Order be approved.

2 Description of the draft Order 4. The National Health Service Act 2006, as amended by the Health and Social Care Act 2012 (“the 2006 Act, as amended”), established the NHS Commissioning Board (known by its operating name NHS England) and Clinical Commissioning Groups (CCGs). NHS England is responsible for commissioning primary care in England, for certain specialised services, and for supporting CCGs in the discharge of their commissioning duties. There are 211 CCGs, which together cover the geographical area of England. The members of a CCG are the providers of primary medical services (GP practices) within its area. Each CCG is responsible for the commissioning of health services for people within its area, under sections 3 and 3A of the 2006 Act, as amended. The services commissioned by a CCG are broadly termed ‘secondary care’,3 although that term does not appear in legislation.

5. The draft Order includes two proposals which the Department states would facilitate joint commissioning by CCGs. Both the proposals in the draft Order are voluntary.4

6. Proposal A in the draft Order would enable two or more CCGs to form a joint committee. Section 14Z3 of the 2006 Act as amended allows two or more CCGs to exercise their commissioning functions jointly, but there is no express provision within the 2006 Act as amended to enable them to form joint committees when doing so. The Department states that as an interim measure, some CCGs have formed “committees in common” in

1 See Annex, Letter from the Department of Health to the Committee, 8 April 2014 (Q2)

2 Explanatory Document, paragraph 3.10



4 Draft Legislative Reform (Clinical Commissioning Groups) Order 2014

order to exercise their functions jointly, but that this arrangement “is cumbersome and a hindrance to effective joint commissioning by CCGs”.5 The Department explains:

A committee in common involves each CCG making arrangements in its constitution for an employee or member of the group to exercise the group’s functions (see Schedule 1, paragraph 3, of the NHS Act). Those individuals then meet in a committee in common to collaborate on the joint exercise of their functions, but they will be acting individually (i.e. as individual representatives of their respective CCGs) and not collectively. This means that any decisions, to be properly effective as jointly binding decisions, have to be taken unanimously, in most cases. The Department is aware of an arrangement which would allow for majority voting by a committee in common which involved a separate legal agreement.

When Primary Care Trusts (the predecessors to CCGs for these purposes) formed joint committees they would typically each nominate a representative to attend that committee. It was open for the Terms of Reference of the committee to provide for majority decision making. Together, this meant that each PCT could express its views on a matter, but that a majority decision was binding on all. The amendments proposed by the LRO would enable this to happen for CCGs (see further, the response to question 5) where agreed.6

7. Proposal B in the draft Order would enable CCGs and NHS England jointly to exercise a CCG commissioning function and to form a joint committee when doing so. The Department states that at present section 13Z of the 2006 Act as amended enables NHS England to exercise its own functions jointly with a CCG and form a joint committee when doing so, but that there is no similar provision for CCGs and NHS England to jointly exercise a CCG function.

8. The draft Order extends to England and Wales. However the Department states that its actual application is limited to England only because NHS England and CCGs exercise functions in relation to the health service in England only. The Department states that officials of the Welsh Assembly were kept informed of the Order; were invited to respond to the consultation; and have advised that a Statutory Instrument Consent Memorandum is not required.7

3 Assessment of the draft Order 9. Our role is to assess whether the proposals meet the statutory conditions required of an order under the Legislative and Regulatory Reform Act 2006 (the “LRRA 2006”), and to examine the proposals against a number of tests. Standing Order No.141 sets out the criteria under which the Committee makes that assessment. In this section we assess the draft Order against those criteria.





A: Appears to make an inappropriate use of delegated legislation

10. The draft Order does not make an inappropriate use of delegated legislation and therefore does not raise any issues in respect of this test.

B: Serves the purpose of removing or reducing a burden, or the overall burdens, resulting directly or indirectly for any person from any legislation (in respect of a draft order under section 1 of the Act)

11. A burden is defined in section 1(3) of the LRRA 2006 as any of the following: a financial cost; an administrative inconvenience; an obstacle to efficiency, productivity or profitability; or a sanction, criminal or otherwise, which affects the carrying on of any lawful activity.

12. For Proposal A, the Government’s view is that the current approach of establishing committees in common represents an administrative inconvenience and an obstacle to efficiency, productivity and value for money, and that enabling two or more CCGs to exercise their functions jointly by way of a joint committee would remove this burden.8

13. For Proposal B, the Government’s view is that it would enable CCGs and NHS England to respond more effectively to future changes in the way that health services are configured, and would remove an administrative inconvenience that is a barrier to efficiency, productivity and value for money.9

14. We agree that the draft Order would reduce a burden.

C: Serves the purpose of securing that regulatory functions are exercised so as to comply with the regulatory principles, as set out in section 2(3) of the Act (in respect of a draft order under section 2 of the Act)

15. The draft Order does not raise any issues in respect of this test.

D: Secures a policy objective which could not be satisfactorily secured by non-legislative means

16. The Department confirms that CCGs are created by statute and may only exercise the powers they are given. No power has been given to CCGs to form joint committees when exercising functions jointly with other CCGs.10 With respect to Proposal A, the Department states that some CCGs have established committees in common in order to exercise joint commissioning functions. Two CCGs which responded to the consultation stated that this was an adequate arrangement and that legislative changes were unnecessary. However, the Department explained that the arrangements for committees in common required the creation of delegation structures and separate ratification of decisions, and so were cumbersome and a hindrance to effective joint commissioning by



10 Annex, Letter from the Department of Health to the Committee, 8 April 2014 (Q6)


CCGs.11 Consultation responses from CCGs which had used committees in common provided examples of these difficulties.

17. With respect to Proposal B, there is currently no legal provision for CCGs and NHS England to jointly exercise a CCG function, or to create a joint committee when doing so.12

18. We agree that the proposed reforms are only possible through legislation.

E: Has an effect which is proportionate to the policy objective

19. In light of the further information supplied by the Department at the request of the Committee, which is annexed to this Report, we agree that the effect is proportionate to the policy objective.

F: Strikes a fair balance between the public interest and the interests of any person adversely affected by it

20. In light of the information at paragraphs 4.19 and 4.20 of the Explanatory Document, we agree that this requirement has been met.

G: Does not remove any necessary protection

21. For Proposal A, one CCG in its consultation response raised concerns about possible loss of protection as a result of the proposed changes, on the basis that:

• Joint committees would be able to take majority decisions on behalf of their constituent CCGs and NHS England, and so individual CCGs might find themselves accountable for implementing policies that their members did not consider to be in the best interests of the local population. Another CCG, which supported the changes, also raised this concern; and

• The decisions of joint committees would be made in private and so reduce the transparency of decision making.13

22. The Department explained that the amendments proposed would enable a CCG to put in place appropriate governance arrangements for any joint committee it created. The Department states that pursuant to paragraph 1 of Schedule 1A to the 2006 Act as amended, a CCG must have a constitution which specifies, amongst other matters, the arrangements it has made for the discharge of its functions.14 These might include arrangements that would allow majority decision making, but only if the CCGs involved agreed this was appropriate.15 With regard to the issue of transparency, the Department explained that CCGs were subject to a number of provisions relating to transparency of its proceedings, and that it would expect CCGs to make suitable arrangements to ensure these





15 See Annex, Letter from the Department of Health to the Committee, 8 April 2014 (Qq2,4,5)


duties were complied with when exercising their functions jointly with other CCGs through a joint committee.16

23. In light of the further information provided by the Department at the request of the Committee, we are satisfied that the draft Order would not remove any necessary protection.

H: Does not prevent any person from continuing to exercise any right or freedom which that person might reasonably expect to continue to exercise

24. The Explanatory Document includes information relevant to this test at paragraphs 4.23-4. On the basis of that information, we are satisfied that the draft Order does not raise any issues in respect of this test.

I: Is not of constitutional significance

25. The Explanatory Document includes information relevant to this test at paragraphs 4.25-4.26. The Department confirms that the proposals are not of constitutional significance.

J: Makes the law more accessible or more easily understood (in the case of provisions restating enactments)


K: Has been the subject of, and takes appropriate account of, adequate consultation

27. The Government conducted a consultation between 14 November 2013 and 7 January 2014, seeking views on the proposals to enable (a) two or more CCGs to form a joint committee whilst jointly exercising functions and (b) CCGs and NHS England to jointly exercise CCG functions and to form a joint committee when doing so.

28. The Department states that it was advised by the Better Regulation Unit at the Department for Business and Innovation and Skills that since the draft Order was seeking to remove an administrative burden, it would be appropriate to conduct a targeted consultation rather than a full public consultation.17 On that basis, the consultation documents were sent by email to all 211 CCGs in England and to NHS England, the Local Government Association, NHS Clinical Commissioners (the representative membership body for CCGs) and the Welsh Assembly Government. 33 responses were received.

29. A joint response from the Association of Directors of Adult Social Services and the Local Government Association fully supported the move towards greater service cohesion and integration to meet local needs but recommended that any joint arrangements be fully




aligned with local Health and Wellbeing Board geographical boundaries and strategies. We asked the Department how it planned to respond to this point and it explained that:

We would […] expect CCGs when deciding to form joint committees to ensure they participate fully in each Health and Wellbeing Board where they fall wholly or partly within that local authority area: and ensure their commissioning is informed by the Joint health and Wellbeing Strategies of those local authorities.18

30. NHS Clinical Commissioners (the membership body of CCGs) supported the proposed changes in the draft Order, but asked the Department to provide reassurance that any joint working arrangements would be subject to the agreement of the CCGs concerned; that CCGs would not be forced to reconfigure as a result of the new measures; and that CCGs would not be pushed into shared arrangements with NHS England if it were not in their local interests to do so. The Department stated that any arrangements for CCGs to exercise functions jointly would be voluntary.19 It explained that NHS England had a duty under section 13F of the 2006 Act to promote the autonomy of persons exercising functions in relation to the health service and that “the wording of the proposed amendment to section 14Z9 is designed to ensure that a CCG function can only be jointly exercised with NHS England where both parties are in agreement, thus preserving a CCG’s autonomy”.20

31. We are satisfied that the consultation requirement has been met.

L: Gives rise to an issue under such criteria for consideration of statutory instruments laid down in paragraph (1) of Standing Order No. 151 (Statutory Instruments (Joint Committee)) as are relevant


M: Appears to be incompatible with any obligation resulting from membership of the European Union.


34. We conclude that the draft Order meets the required preconditions and tests.

4 Conclusion 35. We conclude that a satisfactory case has been made in favour of the proposals and recommend that the draft Order be approved using the affirmative resolution procedure.

18 Annex, Letter from the Department of Health to the Committee, 8 April 2014 (Q3)




Annex

Letter from the Department of Health to the Committee, dated 8 April 2014

Department of Health responses to questions from the Regulatory Reform Committee on the Draft Legislative Reform (Clinical Commissioning Groups) Order 2014

1. The Department states that its intention is to preserve the autonomy of CCGs. The proposed amendment to s14Z9 NHS Act 2006 provides that the Board or one or more CCGs “may make arrangements” for CCG functions to be exercised jointly by the Board and the CCGs (s). Is the drafting of the proposed amendment sufficiently precise to ensure that a CCG will make a genuinely voluntary decision to allow joint exercise of its functions?

The wording of the amendment to section 14Z9 follows that of section 14Z3 (arrangements by clinical commissioning groups in respect of the exercise of functions). Under section 14Z3 two or more CCGs may make arrangements as to the exercise of their functions. This wording allows for agreement between the parties as to the arrangements they are to enter into. It contrasts with the wording of section 13Z under which the Board may make arrangements for its functions to be exercised by or jointly with various bodies, including a CCG. The wording of section 13Z contemplates a unilateral arrangement, which is what the Department seeks to avoid.

The Board is under the duty in section 13F to promote autonomy in the exercise of its functions. The Department recognises that the amendment to section 14Z9 is in relation to the exercise of CCG functions, rather than Board functions, but the Board should still have regard to the principle of autonomy when considering whether to enter into arrangements with a CCG.

2. What are the characteristics of a committee in common and why are its arrangements considered to be cumbersome?

A committee in common involves each CCG making arrangements in its constitution for an employee or member of the group to exercise the group’s functions (see Schedule 1, paragraph 3, of the NHS Act). Those individuals then meet in a committee in common to collaborate on the joint exercise of their functions, but they will be acting individually (i.e. as individual representatives of their respective CCGs) and not collectively. This means that any decisions, to be properly effective as jointly binding decisions, have to be taken unanimously, in most cases. The Department is aware of an arrangement which would allow for majority voting by a committee in common which involved a separate legal agreement.

When Primary Care Trusts (the predecessors to CCGs for these purposes) formed joint committees they would typically each nominate a representative to attend that committee. It was open for the Terms of Reference of the committee to provide for majority decision making. Together, this meant that each PCT could express its views on a matter, but that a majority decision was binding on all. The amendments proposed by the LRO would enable this to happen for CCGs (see further, the response to question 5) where agreed.


3. The consultation response from the Association of Directors of Adult Social Services/Local Government Association stated that it was critical that any CCG joint working arrangements be aligned to the geographical boundaries and strategies of Health and Wellbeing Boards. What is the Department’s response to this comment?

Joint Health and Wellbeing Strategies (JHWS) are strategies for meeting the needs identified in Joint Strategic Needs Assessments (JSNAs). As with JSNAs, their development is overseen by Health and Wellbeing Boards (HWBs) and each is unique to each local area. Each local authority must establish a HWB for its area and each relevant CCG must have a representative on the HWB. (A relevant CCG is one whose area coincides with or falls wholly or partly within the local authority area). CCG plans for commissioning services are expected to be informed by relevant JSNAs and JHWSs and by the involvement of the HWB in the preparation of the plan. These are continuous processes and are an integral part of CCG commissioning cycles.

We would therefore expect CCGs when deciding to form joint committees to ensure they participate fully in each Health and Wellbeing Board where they fall wholly or partly within that local authority area; and ensure their commissioning is informed by the Joint Health and Wellbeing Strategies of each of those local authorities.

4. Two consultation responses from CCGs raised concerns that the decision making process of joint committees would be less transparent than for CCGs, because joint committee meetings would not have to be held in public. Is it correct that there would be no legal requirement for joint committee meetings to be public, and if so, how do you plan to ensure that joint decisions are fully transparent?

Meetings of the governing body of a CCG must be open to the public except where the CCG considers it would not be in the public interest (paragraph 8(3) of Schedule 1A to the NHS Act). However there is no express requirement for other meetings of the CCG or its committees to be open to the public, except for when the CCG presents its annual report. Rather, each CCG must include in its constitution the arrangements it has made for securing transparency about the group’s decisions and the way in which they are made.

In terms of transparency, CCGs are under a duty under section 14Z2 as to public involvement and engagement in the planning of, and decisions as to, their commissioning arrangements. This may be by consultation, provision of information, or in other ways. There are also requirements in the National Health Service (Procurement, Patient Choice and Competition) (No.2) Regulations 201221 for CCGs to act in a transparent and proportionate way when procuring health services and to publish on a website maintained by the Board a record of each contract awarded for the provision of health care services. Further provisions in those regulations and in section 14O of the NHS Act 2006 relate to the management of conflicts of interest, including (in section 14O) a requirement to maintain and publish registers of interests. These duties apply in the exercise of a CCG’s functions. We would expect CCGs to make suitable arrangements to ensure these duties

21 SI 2013/500


were complied with when exercising their functions jointly with other CCGs through a joint committee.

5. One consultation response from a CCG raised concerns that a joint committee could be passed by majority vote, even if all members of an individual CCG voted against that decision, and the CCG would then have to implement locally a decision which it did not support. What is the Department’s response to this concern?

The proposals in the draft Order are voluntary. As explained in the response to question 2, the amendments proposed by the LRO will enable CCGs to create joint committees and, if they choose, put in place governance arrangements that allow for majority decision making. In deciding whether to form a joint committee CCGs will need to be satisfied that this procedure for reaching decisions is one that they are able to agree to.

6. Please provide an exact description of the existing barriers to CCGs forming joint committees. The ED states that the NHS Act 2006 contains “no express provision” to enable CCGs to form joint committees to exercise their functions jointly (ED para 2.3). Why does an absence of express provision mean that CCGs cannot form joint committees?

CCGs are created by statute and may only exercise the powers they are given. No power has been given to them to form joint committees when exercising functions jointly with other CCGs. Where the NHS Act provides for bodies to exercise functions jointly it generally makes express provision for those bodies to form a joint committee to do so. Examples are: section 13Z (joint exercise of functions by the Board and another body), section 14Z4 (joint exercise of functions by CCGs and Local Health Boards) or section 29 (joint exercise of functions by Special Health Authorities). There was also the former provision in section 19 of the NHS Act for Primary Care Trusts to form a joint committee when jointly exercising functions.

7. The ED (para 2.3) states that the NHS Act 2006 expressly provided that Primary Care Trusts (CCG predecessors) could form joint committees. Why was an equivalent provision not included for CCGs at the time they were established?

Section 19 of the NHS Act (exercise of Primary Care Trust functions) included a regulation making power. Regulations could provide for any functions exercisable by a PCT jointly with a Strategic Health Authority or other PCT to be exercised by a joint committee or joint sub-committee. An equivalent provision was not included for CCGs at the time they were established.

In light of the practical challenges that some CCGs are facing, the Department believes that it is now necessary to make an equivalent provision, in order to minimise the administrative burden placed on CCGs when working jointly.

8. Please give 3 practical examples of how CCGs would benefit from being able to form joint committees to exercise their functions jointly.


Examples of where CCGs would benefit from being able to form joint committees to exercise their functions jointly include the large scale transformation of NHS services across multiple providers and populations, such as those being pursued by CCGs in Greater Manchester and North West London. This may involve networking services across hospital sites with professionals providing services at different locations depending on patient needs and the local provider landscape, taking joint decisions on the locations for more specialised acute services to reduce duplication and inefficiency of services. It would also enable CCGs to provide a unified strategic approach with healthcare providers and wider local stakeholders such as local authorities and Health and Wellbeing Boards, which might improve the effectiveness of their relationships with providers.

Another example would be where CCGs wish to pursue shared priorities and strategies with a single large provider that serves their populations, such as the commissioning of ambulance services or the commissioning of community and acute mental health services across a wider geographical area, which would be more effectively delivered, co-ordinated and managed over a wider geographical area rather than having separate commissioning arrangements with each CCG.

One further example might be that individual CCGs wish to agree consistent approaches to clinical or administrative approaches where the development and management of shared protocols might enable more efficiency, challenge and transparency, such as those for Individual Funding Requests (IFRs),22 Joint audit or remuneration committee arrangements.

9. Please provide 3 practical examples of how CCGs and NHS England would benefit from being able to jointly exercise a CCG commissioning function and to form a joint committee when doing so.

CCGs and NHS England would benefit from this proposal by enabling them as co-commissioners to develop and agree aligned strategic planning and delivery processes that take into account the effects of services across a whole pathway, facilitating design and continuity of services across primary, secondary and community care.

A further example might include a review of service delivery across specialised services (commissioned by NHS England) and any impact re-design may have on non-specialised acute services (commissioned by CCGs) in order for services to be designed and delivered to achieve the best possible outcome for the population served. The inability to form a joint committee makes it more difficult to make timely decisions, which can delay the ability to improve patient safety.

Another example might be to improve the integration of the respective health services that CCGs and NHS England commission, and the integration of health with social care services more widely. Both the Board and CCGs are under statutory duties to promote integration (see sections 13N and 14Z1 of the 2006 Act respectively). As part of this, the

22 Clinicians, on behalf of their patients, are entitled to make a request (an Individual Funding Request (IFR)) to NHS

England for treatment that is not normally commissioned by NHS England. The full guidance is available on NHS England’s website:http://www.england.nhs.uk/wp-content/uploads/2013/04/cp-03.pdf12


better integration of primary care with community and secondary care is viewed as providing benefits, by, for example, helping to reduce hospital admissions, particularly emergency admissions, by the provision of more effective primary and community care services, or ‘out of hospital’ care. This will be greatly facilitated by the joint exercise of functions by the Board and CCGs. Board functions (primary care) can already be jointly exercised. The LRO would allow CCG functions (secondary care) to also be jointly exercised enabling greater collaboration between commissioners where integration between and across providers is required.


Formal Minutes

Wednesday 9 April 2014

Members present:

James Duddridge, in the Chair

Andrew Bridgen Richard Fuller Rebecca Harris

John Hemming Andrew Jones Valerie Vaz

Draft Report (Draft Legislative Reform (Clinical Commissioning Groups) Order 2014), proposed by the Chair, brought up and read.

Ordered, That the draft Report be read a second time, paragraph by paragraph.

Paragraphs 1 to 35 read and agreed to.

Annex agreed to.

Question put, That the Report be the Fifth Report of the Committee to the House.

The Committee divided.

Ayes, 5 Noes, 1

Andrew Bridgen Richard Fuller Rebecca Harris John Hemming Andrew Jones Valerie Vaz

Resolved, That the Report be the Fifth Report of the Committee to the House. Ordered, That the Chair make the Report to the House.

[Adjourned till a date and time to be fixed by the Chair


List of Reports from the Committee during the current Parliament

Session 2013–14

First Report Draft Legislative Reform (Regulation of Providers of Social Work Services)(England and Wales) Order 2013

HC 270

Second Report Draft Legislative Reform (Payments by Parish Councils, Community Councils and Charter Trustees) (England and Wales) Order 2013

HC 929

Third Report Draft Legislative Reform (Overseas Registration of Births and Deaths) Order 2014

HC 1010

Fourth Report The Harrogate Stray Act 1985 (Tour de France) Order 2014

HC 1197

Fifth Report Draft Legislative Reform (Clinical Commissioning Groups) order 2014

HC1224

Session 2012–13

First Report Draft Legislative Reform (Annual Review of Local Authorities) Order 2012

HC 158

Second Report Draft Legislative Reform (Constitution of Veterinary Surgeons Preliminary Investigation and Disciplinary Committees) Order 2013

HC 824

Session 2010–12

First Report Draft Legislative Reform (Civil Partnership) Order 2010

HC 595

Second Report Draft Legislative Reform (Epping Forest) Order 2011 HC 963

Third Report Draft Legislative Reform (Industrial and Provident Societies and Credit Unions) Order 2011: Second Stage

HC 1564

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