This bill amends the National Health Service Act 2006 to permit co‑funding of NHS‑commissioned care in England and to extend occasions when co‑payments may be charged. It inserts new provisions into the Act that define co‑funding, create mandatory charge triggers for certain in‑patient and missed‑appointment events, and allow voluntary co‑payments for weekend/bank‑holiday elective care and for expedited non‑elective care to return a patient to work.
For professionals: the measure creates legal authority for new patient charges and third‑party funding agreements, forces local NHS bodies to design billing and recovery processes, and raises practical and legal questions about eligibility, clinical decision‑making, equity and devolution. Trusts, commissioners, employers, insurers and debt‑recovery functions will all see immediate operational implications if implemented.
At a Glance
What It Does
The bill inserts sections 12G–12I into the NHS Act 2006. It authorises co‑funding (care partly paid by a patient or on their behalf), makes two events explicitly chargeable (in‑patient care beyond a clinically assessed residency threshold and unattended appointments without a reasonable excuse), and permits the NHS to require co‑payment for elective weekend/bank‑holiday care and to speed non‑elective care where a patient or third party co‑pays.
Who It Affects
Directly affects NHS trusts and commissioners in England who must implement co‑funding agreements and billing; patients who may face out‑of‑pocket charges; employers and third‑party payers who may pay for expedited care; and private insurers or brokers offering co‑funding products.
Why It Matters
The bill creates a statutory basis for user payments previously limited by policy, potentially shifting costs onto patients and third parties, changing how capacity is managed, and creating new administrative, legal and equality risks for the NHS and for regulators to resolve.
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What This Bill Actually Does
The bill changes primary statute to say co‑funding is permissible: where NHS‑commissioned care is paid in part by a patient or someone on their behalf, that arrangement is now expressly allowed. Practically, that gives NHS organisations statutory cover to enter agreements where the NHS provides care but a private party contributes (or wholly pays) part of the cost.
The change also amends the Secretary of State’s duty language so that charges that form part of co‑funding agreements fall within permitted activity.
The bill then creates a small menu of chargeable events. It requires that, for in‑patient hospital care in England, if a patient is found not to meet the clinical criteria to reside, the costs after a 48‑hour point become chargeable to the patient.
It also makes missed appointments chargeable where a patient has had notice and has no reasonable excuse. Separately the NHS may require co‑payments for elective procedures scheduled at weekends or bank holidays, and may offer faster non‑elective care to return a person to work where the patient, their employer, or another third party agrees to co‑pay.Although the bill’s operative clauses refer to England (the substantive powers and chargeable events apply in England), the short title and commencement clause cover England and Wales and bring the Act into force two months after passage.
The statutory text is compact and leaves most implementation details—definitions of “criteria to reside,” what counts as “due notice” and a “reasonable excuse,” billing procedures, exemptions, collection mechanisms and clinical safeguards—to policy and secondary instruments or local practice. That is where the real administrative work will fall if this becomes law.In short: the bill gives statutory authority for limited charging and third‑party funding in NHS‑commissioned care and specifies a few concrete charge triggers, but leaves critical definitional, procedural and safeguards questions to ministers, commissioners and trusts to resolve.
The Five Things You Need to Know
The bill inserts new sections 12G–12I into the National Health Service Act 2006 to govern co‑funding and co‑payment in England.
Section 12H makes inpatient care chargeable to the patient once it is determined they do not meet the clinical ‘criteria to reside’ and 48 hours have elapsed.
Section 12H also makes the cost of a missed NHS appointment chargeable if the patient received due notice and has no "reasonable excuse.", Section 12I permits the NHS to require co‑payment for elective care provided at weekends or bank holidays.
Section 12I authorises the NHS to provide quicker non‑elective care to enable return to work where the patient, their employer, or another person agrees to co‑pay.
Section-by-Section Breakdown
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Allows charges that form part of co‑funding/co‑payment agreements
This amends the Secretary of State’s duty language so that the prohibition on charging no longer blocks charges that are part of a co‑funding agreement. The drafting explicitly makes such charges a permitted category under the Act rather than leaving them to policy. That change is narrow in words but broad in effect: it converts a policy choice into permissive statutory language and will be a touchstone for interpreting later clauses and secondary regulations.
Statutory permission to accept partial or third‑party payments
Section 12G defines co‑funding as an NHS‑commissioned service being partly funded by the patient or by someone on the patient’s behalf. It does not set limits, means‑tests, or prescribe how agreements should be recorded, priced, or supervised. The primary consequence is legal clarity: commissioners and trusts have express authority to structure mixed‑funded pathways, but they will need policy guidance or contractual templates to manage conflicts of interest, clinical independence, and pricing transparency.
Two explicit chargeable events: extended inpatient stays and missed appointments
Section 12H(1) creates a precise trigger — a 48‑hour point after a determination that a patient does not meet the ‘criteria to reside’ — when costs become chargeable to the patient. That requires a clinical decision point and a follow‑up administrative charge: both must be defined and documented. Section 12H(2) makes unattended appointments chargeable when patients had notice and lack a reasonable excuse; this introduces a subjective standard that will need procedural rules, appeals, and debt‑recovery pathways. Neither clause sets the charge amounts, exemptions, or recovery mechanisms—those details are left for implementing guidance or local policy.
Permits charging for weekend elective care and expedited return‑to‑work treatment
Section 12I lets the NHS require co‑payment for elective care at weekends and bank holidays and allows services to be expedited where someone (patient, employer or third party) agrees to co‑pay so the patient can return to work faster. This creates a formal route for employers and insurers to purchase speed of access on the NHS, but the clause does not constrain who may pay, how priority is managed against clinical need, or how such payments interact with existing referral and waiting‑list rules.
Geographic and temporal scope; commencement timing
The Act’s text states it extends to England and Wales, but the operative powers and charge events are explicitly framed as applying in England. The bill sets commencement at two months after passage. That mismatch with devolutionary practice invites administrative and legal coordination issues between Westminster and the Welsh Government, especially because health is devolved and Wales may not implement analogous charging arrangements.
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Explore Healthcare in Codify Search →Who Benefits and Who Bears the Cost
Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- Patients who can pay (and employers or insurers acting on their behalf): they gain a statutory route to purchase faster access or weekend elective slots and to arrange co‑funded pathways that reduce waiting time.
- Employers and occupational insurers: they can use co‑payment as a tool to accelerate return‑to‑work treatment for employees, potentially cutting absence costs.
- NHS trusts and commissioners with capacity bottlenecks: the ability to accept co‑funding provides a route to recoup some costs and to manage elective capacity more flexibly.
- Private brokers, insurers and third‑party funders: the statutory permission creates a market opportunity to offer co‑funding products and employer‑sponsored pathways.
Who Bears the Cost
- Patients, particularly lower‑income and vulnerable people: they face explicit new charge events (inpatient costs after 48 hours and missed‑appointment fees) and may experience increased out‑of‑pocket spending if they seek quicker care.
- NHS trusts and commissioning teams: they must build billing, documentation, exemption and appeals processes, increasing administrative workload and requiring IT and staff investment.
- Local commissioners and regulators: they will need to design eligibility rules, fee schedules, clinical safeguards, dispute and waiver processes, and oversight mechanisms—functions that have budgetary and staffing implications.
- Devolved administrations and intergovernmental relations: because the Act extends to England and Wales while applying substantively in England, the Welsh Government (and stakeholders in devolved systems) may face policy and coordination costs.
Key Issues
The Core Tension
The bill confronts a central dilemma: it seeks to relieve pressure on NHS capacity and give individuals or employers a route to buy speed or avoid wasted appointments, yet does so by introducing user charges that cut against the NHS principle of care free at the point of use—raising equity, administrative and clinical‑integrity tradeoffs that statutory permission alone cannot resolve.
The bill is short on definitions and implementation detail, which is where most practical and legal disputes will arise. Key terms—"criteria to reside," "due notice," and "reasonable excuse"—are left undefined.
Those terms govern when the NHS may impose charges and therefore determine how frequently charges are applied and how defensible recovery actions will be. Absent clear statutory or secondary‑legislative definitions, trusts will have to develop local criteria that courts or ombudsmen could later scrutinise for consistency, clinical soundness, and fairness.
The proposals also trade off administrative cost and clinical independence against revenue and capacity management. Recovering charges requires billing systems, staff time, and potentially debt‑collection; those costs may erode any revenue and risk diverting clinical staff time into gatekeeping.
Co‑funding arrangements raise conflict‑of‑interest risks where third‑party payers steer patients toward particular pathways or create incentives to prioritise paying patients. The bill contains no safeguards on priority setting, means‑testing, or exemptions for groups protected under equality law, so regulators and ministers will need to decide how to protect vulnerable patients.
Finally, the devolution/territorial framing creates legal and political friction: the Act purports to extend to England and Wales while explicitly limiting substantive application to England. That mismatch will require coordination with the Welsh Government and careful drafting of secondary instruments and guidance to avoid confusion about enforceability and coverage.
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