The “Board” (as it is referred to in the Bill) will be subject, concurrently with the Secretary of State (SoS), to a duty to promote a comprehensive health service in England. It will commission some services itself and will have a key role in relation to commissioning consortia.
As a commissioner, the Board will be subject to proposed competition provisions including duties to comply with good procurement practice and promote competition.
Before each financial year the SoS will give the Board a mandate specifying its objectives, requirements and financial allocation. The Board will publish a business plan setting out how it will exercise its functions in that year and the next two financial years.
After each financial year the Board must publish a report on how it exercised its functions during the preceding year. The Board will effectively have a duty to break even each financial year and directions will be issued containing further details on use of funding.
In addition to setting the Board’s mandate, the SoS has powers of intervention if the Board is failing to discharge its functions. This has led some to question how free the Board will be from central control.
Schedule 1 to the Bill provides information about the constitution of the Board including details on its membership, powers to appoint staff, form committees, regulate its affairs and prepare annual accounts.
Some of the Board’s duties and functions will be contained within secondary legislation. Those specified in the Bill (other than those in relation to commissioning consortia) include:
- securing continuous improvement in service quality;
- promoting autonomy;
- reducing inequalities and promoting patient involvement;
- promoting innovation (including power to award prizes);
- encouraging integrated working (including, in particular, encouraging section 75 agreements between commissioning consortia and local authorities);
- a consultation duty similar to that which will apply to commissioning consortia;
- putting in place systems for collecting and analysing service safety information (and provision of associated advice and guidance); and
- issuing guidance on processing information about patients and services.
The Board has various duties in relation to commissioning consortia and will also prepare model commissioning contracts for them to use. Interestingly, although the Board has the duty to commission primary medical services, it can direct consortia to exercise any of the Board’s functions in relation to those services.
It will authorise consortia and ensure national coverage. It can do the latter through its power to allocate practices to consortia and vary a consortium’s geographical area. It will also deal with applications for mergers and dissolutions of consortia (and variations to consortium constitutions).
The Board will also specify, for each financial year, the budget within which each consortium must operate. It will have the ability to make additional payments to consortia where they have “performed well”. It can also establish a contingency fund from which payments can be made to the Board or consortia to enable them to discharge their functions. The Board will publish guidance on how it will exercise this power.
The Board will have intervention powers in the event that a commissioning consortium is failing (or there is a significant risk of failure) to discharge any of its functions. The intervention powers include giving directions to consortia, replacing the Accountable Officer and dissolving the consortium.