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

this Part;

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Part 5 (standing rules: commissioning contract terms); and

in respect of a CCG, a person for whom it is responsible under or by virtue of section F183(2) of the 2006 Act (duties of clinical commissioning groups as to commissioning certain health services) M15, in relation only to the provision of services which it has a duty to arrange for, or in respect of, that person; and

in respect of F3NHS England, a person for or in respect of whom it is required to arrange the provision of services for under or by virtue of regulations under section 3B of the 2006 Act (Secretary of State's power to F19require NHS England to commission services), in respect only of services which F3NHS England is required to arrange for, or in respect of, that person.

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

that person's family.

community services;

secondary care services; and

the services specified in Schedule 4.

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

where, and to the extent that, F3NHS England 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.

A is the spouse or civil partner of B; or

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

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.

evidence of regular financial support of A by B;

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;

evidence of a joint savings plan or joint investments of a substantial nature;

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

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

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

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

evidence of the length of the relationship.

has been severely injured in service; and

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

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

where, and to the extent that, F3NHS England 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;

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

has died or has become mentally incapacitated; and

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

where, and to the extent that, F3NHS England 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.

community services (including mandatory dental services and sedation services);

secondary care services; and

the services specified in Schedule 4.

a court;

a secure children's home F24...;

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;

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

a young offender institution F25....

a “relevant contract” is a contract having effect as between F3NHS England and another person for the provision as part of the health service of transferring services where that contract has effect immediately before the transfer date;

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;

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;

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;

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;

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

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.

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

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

the health service provider is a registered person; or

the health service provider is carrying on a regulated activity.

co-operates with the education and training body in such manner and to such extent as the education and training body may request, in planning the provision of, and in providing, education and training for health care workers; and

provides F32the education and training body with such information as it may request.

for “Registered persons” in paragraph (1), substitute “Health service providers”;

for “registered person”, in each place it appears, substitute “health service provider”;

in paragraph (1), omit “in carrying on a regulated activity”; and

in paragraphs (8) and (9) for “a regulated activity”, substitute “health care services”;

terms and conditions making provision for the matters specified in regulation 16; and

such other terms and conditions as F3NHS England. considers are, or might be, appropriate for inclusion in commissioning contracts entered into by a relevant body.

before exercising its functions under regulation 17(1) and (2) for the first time; and

the Care Quality Commission M18;

F38integrated care boards ;

Healthwatch England M19;

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

the Secretary of State; and

such other persons as F3NHS England considers it is appropriate to consult.

in the case of F3NHS England, by virtue of regulation 7 (secondary care services and community services: serving members of the armed forces and their families) or regulation 10 (services for prisoners and other detainees).

there may be a need for such care; or

an individual who is receiving NHS Continuing Healthcare may no longer be eligible for such care.

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

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

complete and use the NHS Continuing Healthcare Checklist issued by the Secretary of State and dated F521st March 2018 to inform that decision;

inform that person (or someone lawfully acting on that person's behalf) in writing of the decision as to whether to carry out an assessment of that person's eligibility for NHS Continuing Healthcare; and

make a record of that decision.

the relevant body makes a decision as to whether that person has a primary health need in accordance with paragraph (7), using the completed Decision Support Tool to inform that decision.

where that person is, or is to be, accommodated in relevant premises, more than incidental or ancillary to the provision of accommodation which a social services authority is, or would be but for a person's means, under a duty to provide; or

of a nature beyond which a social services authority whose primary responsibility is to provide social services could be expected to provide,

an individual has a primary health need arising from a rapidly deteriorating condition; and

the condition may be entering a terminal phase,

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

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

make a record of that decision.

the procedure followed by the relevant body in reaching that decision; or

the primary health need decision made in accordance with paragraph (5)(b).

consult with the relevant social services authority before making a decision about a person's eligibility for NHS Continuing Healthcare, including any decision that a person receiving NHS Continuing Healthcare is no longer eligible to do so; and

co-operate with the relevant social services authority in arranging for persons to participate in a multi-disciplinary team for the purpose of fulfilling its duty under regulation 21(5).

a decision as to eligibility for NHS Continuing Healthcare; or

where a person is not eligible for NHS Continuing Healthcare, the contribution of a relevant body or social services authority to a joint package of care for that person,

are receiving community care services under F65Part 1 of the Care Act 2014 (care and support) or section 117 of the Mental Health Act 1983 (after-care) on the date on which they are found to be eligible to receive NHS Continuing Healthcare;

have been in receipt of NHS Continuing Healthcare but are determined to be no longer eligible for NHS Continuing Healthcare; or

are otherwise determined to be ineligible for NHS Continuing Healthcare.

appoint such number of persons to act as chairs of the panels referred to in paragraph (4) (“chairs”) as F3NHS England considers reasonable to ensure that applications for a review under paragraph (3) can be considered by such a panel within a reasonable time; and

appoints under paragraph (1)(a); or

includes in a list pursuant to paragraph (1)(b),

a chair;

one F38integrated care board member drawn from the list established under paragraph (1)(b) who has been appointed in respect of a F38integrated care board, other than F38an integrated care board whose procedure or decision is the subject of the review; and

one social services authority member drawn from that list who has been appointed in respect of a social services authority other than one in whose area is situated all or part of the area of F38an integrated care board whose procedure or decision is the subject of the review.

when requested to do so by F3NHS England, provide its nomination pursuant to paragraph (1) as soon as is reasonably practicable; and

ensure that F38integrated care board members are, so far as reasonably practicable, available to participate in review panels.

the chair, a member (other than a member of an NHS foundation trust), a director, a governor or an employee of an NHS body;

the chair or a member of the governing body of F38an integrated care board ; or

an elected member or employee of a social services authority in England and Wales or of an equivalent body in Scotland or Northern Ireland.

the chair, the chief executive, a non-executive director or a non-officer member of an NHS body (other than a member of an NHS foundation trust);

the chair or a member of the governing body of F38an integrated care board; or

an elected member of a social services authority in England and Wales or of an equivalent body in Scotland or Northern Ireland.

that person may, after the second anniversary of the day on which they were dismissed, apply in writing to F3NHS England to remove the disqualification for appointment as a chair, F38integrated care board member or social services authority member; and

F3NHS England may decide that the disqualification is removed.

that person has become disqualified for appointment under regulation 25, F3NHS England must notify that person in writing of such disqualification; or

at the time of that person's appointment they were so disqualified, F3NHS England must declare that the person in question was not duly appointed and notify that person in writing to that effect.

is resident in relevant premises or may need to become resident in such premises; and

may be in need of nursing care,

the relevant body has carried out an assessment pursuant to regulation 21(2); but

paragraph (3) does not apply because a decision has been made that the person is not eligible for NHS Continuing Healthcare,

the relevant body determines that a person has a need for nursing care pursuant to this regulation; and

the person has agreed with that body that that person does want to be provided with such nursing care,

has their need for nursing care assessed and it is determined that that person no longer has any need for nursing care;

is no longer resident in the relevant premises;

becomes eligible for NHS Continuing Healthcare pursuant to this Part; or

dies.

£100 per week, where nursing care is provided in accommodation in Northern Ireland, or

£78 per week, where nursing care is provided in accommodation in Scotland,

has their need for nursing care assessed and it is determined that that person no longer has any need for nursing care;

is no longer resident in that accommodation;

becomes eligible for NHS Continuing Healthcare pursuant to this Part; or

dies.

has their need for nursing care assessed on or after the relevant date and it is determined that that person no longer has any need for nursing care;

is no longer resident in the relevant premises;

becomes eligible for NHS Continuing Healthcare pursuant to this Part; or

dies.

has their need for nursing care assessed on or after the relevant date and it is determined that that person no longer has any need for nursing care;

is no longer resident in the relevant premises;

becomes eligible for NHS Continuing Healthcare pursuant to this Part; or

dies,

has their need for nursing care assessed on or after the relevant date; and

following that assessment it is determined that that person's need for nursing care has diminished to the extent that if the old Guidance were applied, that person would be eligible only for a medium band payment or low band payment,

the person in respect of whom the high band payment was being made (and where appropriate that person's representative); and

the registered person,

regulation 21(2)(b) applies;

an assessment of eligibility for NHS Continuing Healthcare is undertaken pursuant to regulation 21; and

that body determines that the person is no longer eligible for NHS Continuing Healthcare.

regulation 21(2)(b) applies;

an assessment of eligibility for NHS Continuing Healthcare is undertaken pursuant to regulation 21; and

that body determines that the person is no longer eligible for NHS Continuing Healthcare.

started to assess a person’s eligibility for NHS Continuing Healthcare, the relevant body with responsibility for that person must complete the assessment as if it had commenced under regulation 21.

continues for such period as it would have continued if the clinical commissioning group had not been abolished, and

as if that person were appointed as an integrated care board member in respect of each integrated care board whose area falls wholly or partly within the area of the clinical commissioning group in relation to which they were a CCG member.

the National Health Service (Nursing Care in Residential Accommodation) (England) Directions 2007 M31 which came into force on 1st October 2007;

the National Health Service (Nursing Care in Residential Accommodation) (Amendment) (England) Directions 2009 which came into force on 1st October 2009 M32;

the NHS Continuing Healthcare (Responsibilities) Directions 2009 M33 which came into force on 1st October 2009; and

the Delayed Discharges (Continuing Care) Directions 2009 which came into force on 28thSeptember 2009 M34.

the making of a direct payment;

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

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.

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

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.

a decision under paragraph (4A); or

written reasons in accordance with paragraph (7),

ensure that the relevant body complies with relevant NICE recommendations; and

include arrangements for the determination of any request for the funding of a health care intervention for a person, where there is no relevant NICE recommendation and the relevant body's general policy is not to fund that intervention.

publish on its website a written statement of its reasons for any general policy it has on whether a particular healthcare intervention is to be made available for persons for whom it has responsibility; or

where it has not published such a statement, provide a written statement of the reasons for any such policy when any person makes a written request for such a statement.

makes a decision to refuse a request for the funding of a health care intervention for a person; and

its general policy is not to fund that intervention,

before 1st July 2022, a person has made a request for a written statement of the reasons for a clinical commissioning group’s general policy on whether a particular health care intervention is to be made available pursuant to regulation 35(1)(b), and

a written statement of reasons has not been provided before 1st July 2022 by the clinical commissioning group to whom that request was made,

before 1st July 2022, has made a decision to refuse a request for the funding of a health care intervention in respect of a person where the clinical commissioning group’s general policy is not to fund that intervention, but

has not provided that person with a written statement of reasons for that decision pursuant to regulation 35(2),

before 1st July 2022, has made a decision to fund a health care intervention for a person where the clinical commissioning group’s general policy is not to fund that intervention, but

has not notified that person of that decision,

decide whether or not to fund that intervention, and

if the decision is to refuse to fund that intervention, provide a written statement of reasons to that person as soon as reasonably practicable.

who requires an elective referral; and

for whom that body has responsibility,

has not been offered that choice by the person making the initial referral; and

notifies the relevant body who has responsibility for that person that that choice was not offered.

a person makes a choice pursuant to the arrangements required by paragraph (1), and

the relevant body which is responsible for that person does not have in place a commissioning contract for the service required as a result of the referral,

a relevant body when exercising its commissioning functions, or

an NHS trust or NHS foundation trust in the exercise of the commissioning functions of a relevant body that have been delegated by virtue of arrangements made under section 65Z5(1) of the 2006 Act.

services subject to the duty in regulation 52(1) (duty to make arrangements to diagnose or rule out cancer); or

maternity services; F105...

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

publicising details, and promoting awareness, of where that information may be found.

to apply for inclusion in the list of patients of the practice of the person’s choice;

Part 2 of Schedule 3 to the National Health Service (General Medical Services Contracts) Regulations 2015 (other contractual terms - patients: general),

Part 2 of Schedule 2 to the National Health Service (Personal Medical Services Agreements) Regulations 2015 (other required terms - patients: general), or

arrangements for the provision of primary medical services made under section 83(2) of the 2006 Act (primary medical services).

in accordance with regulation 39, or

otherwise than in accordance with regulation 39 where the relevant body has not restricted the number of providers from which patients may choose.

the award of an NHS Standard Contract where the provider does not have an existing NHS Standard Contract with the relevant body, or

references to the offering or awarding of an NHS Standard Contract to a provider are to be read respectively as references to the offering to modify or the modifying of an existing NHS Standard Contract held by a provider;

the reference in regulation 42B(5) to “paragraph (4)” is to be read as a reference to paragraph (2) of this regulation;

in the application of regulation 42C pursuant to regulation 42B(4) as modified by this regulation, the reference in regulation 42C to “regulation 42B(4) to (6)” is to be read as a reference to paragraphs F112(2), (3) and (5) of this regulation.

the provision of new services,

the provision of existing services from a location other than that specified in the existing NHS Standard Contract, or

a change to the criteria specified in that contract which determine the means by which a service will be accessible to patients.

the criteria in regulation 42C are met,

the proposed modification of the existing NHS Standard Contract is not contrary to any restrictions on modification of contracts imposed by regulations made under section 12ZB of the National Health Service Act 2006, and

the provider agrees to the proposed modification,

the criteria in regulation 42C are met, but

the proposed modification of an existing NHS Standard Contract would be contrary to any restrictions on modification of contracts imposed by regulations made under section 12ZB of the National Health Service Act 2006.

the request for assessment of the provider in respect of a proposed modification under this regulation is to be treated as having been a request for assessment of the provider for the award of an NHS Standard Contract under regulation 42B(4) (without the modifications made by this regulation), and

a new NHS Standard Contract must instead be awarded pursuant to regulation 42B(6) in respect of such of the matters for which the provider asked to be assessed under paragraph (2).

a relevant body, or

in relation to the period before 1st July 2022, a clinical commissioning group (as established in accordance with Chapter A2 of Part 2 of the 2006 Act as it applied before 1st July 2022),

in respect of a complaint under regulation 13(1) of the National Health Service (Procurement, Patient Choice and Competition) (No. 2) Regulations 2013,

where the grounds for the complaint occurred before 1st January 2024, and

which has not been concluded before 1st January 2024,

commenced before 1st July 2022, and

continued as against an integrated care board pursuant to regulation 21(4) of the Health and Care Act 2022 (Commencement No. 2 and Transitional and Saving Provision) Regulations 2022.

the relevant body has responsibility for that person;

there has been a start date in respect of that person; and

the person's waiting time period, as specified in regulation 46, has not come to an end.

it is more appropriate for that person to receive treatment from a primary care service;

a clinical decision is made to start a period of monitoring of that person F123...;

a clinical decision is made that no treatment should be provided to that person;

an eligible referrer; or

themselves, with the prior approval of an eligible referrer.

a consultant;

a member of a consultant's team; or

persons providing interface services where a person who has been referred may be referred on from those services to a consultant or consultant-led team.

has not commenced appropriate treatment; or

will not have commenced appropriate treatment,

in the case of the relevant health service provider or F38an integrated care board, the person referred or a person lawfully acting on their behalf; or

in the case of F3NHS England, F38an integrated care board which has been notified by the person referred or a person lawfully acting on their behalf.

the date for the appointment was reasonable;

that person had been made aware of the consequences of not attending appointments; and

that person had not requested in advance that the date for that appointment be re-arranged.

that person had re-arranged the date of the appointment;

the original date for the appointment had been reasonable; and

that person had been made aware of the consequences of not attending appointments.

that patient had been offered a reasonable appointment date falling within that period; or

they decided that they did not want to be offered any appointment dates within that period.

has been offered a reasonable appointment date falling within that period; or

was unable to make themselves available for any appointment dates within that period.

that it is in the best clinical interests of that patient to commence treatment after the end of the period of 18 weeks beginning with the start date;

that the person does not need treatment; or

to refer the patient back to primary care services prior to any treatment commencing.

the relevant body has responsibility for that person; and

an outcome (either a diagnosis or ruling out of cancer) is communicated to the person or, if earlier, a notification containing an outcome is sent to the person,

a clinical decision is made that the person requires further interval scanning or testing before a diagnosis of cancer can be made or cancer can be ruled out, or

a clinical decision is made that the person requires treatment before a diagnosis of cancer can be made or cancer can be ruled out.

the person concerned did not attend the first appointment made by a health service provider in response to the urgent referral, and

that person had not requested in advance of the first appointment that the date for that appointment be rearranged,

begins with the start date, and

ends on the date on which the health service provider receives notification that the person who has been urgently referred is available again for an appointment with that provider.

the referred person, or a person lawfully acting on their behalf, asks the provider or the relevant body which has responsibility for the person referred to arrange an alternative appointment or review;

no clinical decision has been made that the person requires further interval scanning or testing;

no clinical decision has been made that the person requires treatment before a diagnosis of cancer can be made or cancer can be ruled out.

was made aware of the consequences of not attending the first appointment made by the provider in response to the referral, and

did not attend the first appointment.

publish the name and contact details of the service; and

take reasonable steps to communicate the name and contact details of that service to any relevant persons for which it has responsibility.

establishes a service for the purpose of providing advice and assistance to relevant persons referred to the provider;

publishes the name and contact details of that service; and

takes reasonable steps to communicate the name and contact details of that service to any relevant persons referred to the provider for whom the relevant body is responsible.