The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012

PART 3 E+W Services to be commissioned by the Board

Interpretation of Part 3 E+W

5.  In this Part—

“Armed Forces Compensation Scheme” means the Armed Forces and Reserve Forces Compensation Scheme 2011 set out in the Armed Forces and Reserve Forces (Compensation Scheme) Order 2011 M1 ;

“community dental services” means dental services provided as part of the health service other than—

(a)

emergency services,

(b)

dental services provided pursuant to arrangements made by the Board under Part 5 of the 2006 Act, or

(c)

the dental services specified in Schedule 2;

“community services” means services provided as part of the health service other than—

(a)

emergency services,

(b)

primary care services,

(c)

secondary care services, or

(d)

the services specified in Schedule 4;

“Defence Medical Services” means medical services provided by—

(a)

the Ministry of Defence including the Surgeon General's organisation,

(b)

other elements of the Joint Forces Command, and

(c)

the three single Service medical organisations M2 ;

“emergency services” means ambulance services and accident and emergency services provided as part of the health service, whether provided at a hospital accident or emergency department, a minor injuries unit, a walk-in centre or elsewhere;

“secondary care services” means services provided as part of the health service in a hospital setting, or by those working in or based in a hospital setting, other than emergency services, primary care services or the services specified in Schedule 4;

“veteran” means any person who has served for at least one day in one of the armed forces or Merchant Navy seafarers and fishermen who have served in a vessel at a time when it was operated to facilitate military operations by the armed forces.

Marginal Citations

M1 S.I. 2011/517.

M2 The three single Service organisations referred to are Royal Navy Medical Services, Army Medical Services and RAF Medical Services.

Dental services E+W

6.  The Board must arrange, to such extent as it considers necessary to meet all reasonable requirements, for the provision as part of the health service of—

(a) community dental services; and

(b) the dental services specified in Schedule 2.

Services for serving members of the armed forces and their families E+W

7.—(1) This regulation applies to—

(a) a person who is a serving member of the armed forces; and

(b) that person's family.

(2) The Board must arrange, to such extent as it considers necessary to meet all reasonable requirements, for the provision as part of the health service to persons to whom this regulation applies of—

(a) community services;

(b) secondary care services; and

(c) the services specified in Schedule 4.

(3) The arrangements to be made by the Board under paragraph (2)(b) in respect of a person referred to in paragraph (1)(a) must include the provision of any infertility treatment to that person and to that person's partner.

(4) The infertility treatment referred to in paragraph (3) must—

(a) where a person referred to in paragraph (1)(a) has been injured in service and is in receipt of compensation for infertility under the Armed Forces Compensation Scheme, include funding the cost of sperm storage facilities from the date on which the injury was sustained (where clinically necessary and where provision for such storage has previously been made); and

(b) where, and to the extent that, the Board is satisfied that this is clinically appropriate in the circumstances of any case, include the provision of up to three cycles of in vitro fertilisation treatments or other means of assisted conception.

(5) In paragraph (1)(b), “family”, in relation to a person to whom this regulation applies, means that person's immediate family registered for primary care services with Defence Medical Services.

(6) The Board must regard a person (“A”) as the partner of a person referred to in paragraph (1)(a) (“B”) if—

(a) A is the spouse or civil partner of B; or

(b) A and B are cohabiting as partners in a substantial and exclusive relationship in circumstances where either—

(i) A is financially dependent on B, or

(ii) A and B are financially interdependent.

(7) In deciding whether A is in a substantial relationship with B, the Board must—

(a) have regard to any evidence which A considers demonstrates that the relationship is substantial; and

(b) in particular, have regard to the examples of evidence specified in paragraph (8) which could, either alone or together, indicate that the relationship is substantial.

(8) The evidence referred to in paragraph (7)(b) is—

(a) evidence of regular financial support of A by B;

(b) evidence of a will or life insurance policy, valid at the time at which the infertility treatment is sought in which—

(i) B nominates A as principal beneficiary or co-beneficiary, or

(ii) A nominates B as the principal beneficiary;

(c) evidence indicating that A and B have purchased or are purchasing accommodation together as joint owners or evidence of joint ownership of other valuable property, such as a car or land;

(d) evidence of a joint savings plan or joint investments of a substantial nature;

(e) evidence that A and B operate a joint account for which they are co-signatories;

(f) evidence of joint financial arrangements such as joint repayment of a loan or payment of each other's debts;

(g) evidence that either A or B has given the other the power of attorney;

(h) evidence that the names of both A and B appear on a lease or, if they live in rental accommodation, rental agreement; and

(i) evidence of the length of the relationship.

(9) For the purposes of paragraph (6)(b), a relationship is not an exclusive relationship if one or both of the parties is a party to another relationship which is, or could be considered to be, a substantial and exclusive relationship having regard to the provisions of this regulation.

Infertility treatment: seriously injured serving members and veterans E+W

8.—(1) This regulation applies to a person who is a serving member of the armed forces or a veteran of the armed forces where that person—

(a) has been severely injured in service; and

(b) as a result of the injury sustained—

(i) suffers from infertility, and

(ii) is in receipt of compensation for infertility under the Armed Forces Compensation Scheme; and

(c) after specialist sperm retrieval, wishes to receive infertility treatment and is eligible for, and has been accepted for, such treatment.

(2) The Board must arrange, to such extent as it considers necessary to meet all reasonable requirements, for the provision as part of the health service of infertility treatment to a person to whom this regulation applies and to that person's partner.

(3) The infertility treatment referred to in paragraph (2) must—

(a) in any case, include funding the cost of sperm storage facilities;

(b) where, and to the extent that, the Board is satisfied that it is clinically appropriate in the circumstances of any particular case, include up to three cycles of in vitro fertilisation treatments or other means of assisted conception;

(c) be provided at the same facility at which the specialist sperm retrieval took place and the extracted sperm of that person is stored.

(4) For the purposes of this regulation and regulation 9, “partner” is to be construed in accordance with regulation 7(6) to (9).

Infertility treatment: further provision E+W

9.—(1) Where a person referred to in regulation 7(1)(a) or 8(1)—

(a) has died or has become mentally incapacitated; and

(b) has, before the time of that person's death or mental incapacity—

(i) made provision for sperm storage, and

(ii) given written consent to the stored sperm being used by a named partner,

the Board must arrange, to such extent as it considers necessary to meet all reasonable requirements, for the provision as part of the health service of infertility treatment to that person's named partner.

(2) The infertility treatment referred to in paragraph (1) must—

(a) in any case, include funding the cost of sperm storage facilities from the date on which the person died or, as the case may be, became mentally incapacitated; and

(b) where, and to the extent that, the Board is satisfied that it is clinically appropriate in the circumstances of any particular case, include up to three cycles of in vitro fertilisation treatments and other means of assisted conception.

(3) Where infertility treatment is provided by the Board under paragraph (1) to the named partner of a person referred to in regulation 8(1), that treatment must be provided at the same facility at which specialist sperm retrieval took place in relation to that person and at which that person's extracted sperm has been stored.

Services for prisoners and other detainees E+W

10.—(1) Where a person is detained in a prison or in other accommodation described in paragraph (2), the Board must arrange, to such extent as it considers necessary to meet all reasonable requirements, for the provision to that person as part of the health service of—

(a) community services;

(b) secondary care services; and

(c) the services specified in Schedule 4.

(2) The other accommodation referred to in paragraph (1) is—

(a) a court;

(b) a secure children's home (except those specified in Part 1 of Schedule 3);

(c) a secure training centre specified in the first column of Table 1 in Schedule 3 from the date specified in the corresponding entry in the second column of that Table;

(d) an immigration removal centre specified in the first column of Table 2 in Schedule 3 from the date specified in the corresponding entry in the second column of that Table; and

(e) a young offender institution (except Ashfield Young Offender Institution).

(3) In this regulation, “court” means any court in which criminal proceedings against a person are heard.

Specified services for rare and very rare conditions E+W

11.  The Board must arrange, to such extent as it considers necessary to meet all reasonable requirements, for the provision as part of the health service of the services specified in Schedule 4.

Assessment, diagnostic, elective and minor elective care services provided by Independent Sector Treatment Centres E+W

12.—(1) This regulation applies to services provided by an Independent Sector Treatment Centre pursuant to the arrangements specified in paragraph (2).

(2) The arrangements referred to in paragraph (1) are—

(a) the agreement made on 20thJuly 2005 and ending on 27th July 2013 between the Secretary of State for Health, Nations Healthcare (Nottingham) Limited, Nottinghamshire County Teaching Primary Care Trust, Nottingham City Primary Care Trust, Derby City Primary Care Trust, Derbyshire County Primary Care Trust, Lincolnshire Teaching Primary Care Trust, Leicestershire County and Rutland Primary Care Trust, Bassetlaw Primary Care Trust and Nottinghamshire University Hospitals NHS Trust for the provision of elective services and diagnostic services by Nations Healthcare (Nottingham) Limited;

(b) the agreement made on 15th December 2006 and ending on 31st March 2014 between the Secretary of State for Health, InHealth Group Limited and InHealth London Limited for the provision of diagnostic services by InHealth London Limited;

(c) the agreement made on 30th May 2008 and ending on 2nd February 2016 between the Secretary of State for Health, Care UK Clinical Services Limited and Care UK Limited for the provision of assessment and minor elective care services and diagnostic services by Care UK Clinical Services Limited;

(d) the agreement made on 30th May 2008 and ending on 27th October 2015 between the Secretary of State for Health, PHG (Hampshire) Limited and Care UK plc for the provision of elective services and diagnostic services by PHG (Hampshire) Limited;

(e) the agreement made on 31st July 2008 and ending on 31st October 2015 between the Secretary of State for Health, UKSH South West Limited and UK Specialist Hospitals Limited for the provision of elective services and diagnostic services by UKSH South West Limited; and

(f) the agreement made on 26th September 2011 and ending on 16th October 2016 between the Secretary of State for Health, Clinicenta (Hertfordshire) Limited and Carillion plc for the provision of elective services and assessment and minor elective care services by Clinicenta (Hertfordshire) Limited.

(3) The Board must arrange, to such extent as it considers necessary to meet all reasonable requirements, for the provision as part of the health service of the services to which each of the agreements specified in paragraph (2)(a) to (f) relates for the period beginning on 1st April 2013 and, in the case of each respective agreement, ending on the date on which that agreement comes to an end.

(4) In this regulation—

“assessment and minor elective care services” means services related to the assessment, screening and planned care or treatment of minor medical conditions;

“diagnostic services” includes imaging services (such as MRI, CT, Ultrasound, Xray, Dexa Scan), physiological measurement, audiology, endoscopies, including direct access diagnostic services from primary care and other ancillary services needed to support the delivery of these services; and

“elective services” means clinical care services including Final Finished Consultant Episodes relating to, for example, trauma and orthopaedic surgery, general surgery, ear nose and throat, oral surgery, urology, gynaecology, plastic surgery, ophthalmology, hepatobiliary and pancreatic surgery, colorectal surgery, vascular surgery, gastroenterology, respiratory medicine, endocrinology, rheumatology, pain management and dermatology.

Fixated threat assessment services E+W

13.—(1) The Board must arrange, to such extent as it considers necessary to meet all reasonable requirements, for the provision as part of the health service of specialised clinical risk assessment and management services for people with mental health problems who may present a risk to prominent people or locations.

(2) The arrangements to be made by the Board under paragraph (1) must include—

(a) the provision of funding for mental health staff to provide the services referred to in paragraph (1); and

(b) such provision for partnership working with other persons or health services as is considered necessary to facilitate the effective delivery of those services.