Part 1: Health Service in England: Integration, Collaboration and Other Changes NHS England Section 8: NHS England: Wider effect of Decisions
Duty to have regard to effect of decisions – this provision, which is inserted into the NHS Act 2006 as the new section 13NA, sets out a new duty for NHS England. A similar new duty also applies to integrated care boards (new section 14Z43), NHS Trusts in England (new section 26A) and NHS Foundation Trusts (new section 63A).
	This duty has been described operationally as the "triple aim" duty.
	Section 13NA(1) provides that NHS England will be under a duty, in making a decision about the carrying out of their functions, to have regard to all likely effects of their decisions on three areas: the health and well-being of the people of England (paragraph (a)), the quality of services provided or arranged by relevant bodies (paragraph (b)) and the efficiency and sustainability of resources used by the relevant bodies (paragraph (c)).
	The reference in the subsection to "all" likely effects means that NHS England will have to consider, under paragraphs (b) and (c), the effects of the decision both on its own quality of services and resource use and those of other relevant bodies.
	Section 13NA(2) excludes decisions relating to services provided to a particular individual (e.g. individual clinical decisions or highly specialist commissioning decisions concerning an individual patient) from this duty. Under paragraphs (b) and (c), it also specifies that when complying with the Triple Aim duty, NHS England must consider inequalities in health and well-being and the benefits of services when considering the effects of their decisions on the areas in sections 13NA(1)(a) and (b).
	Section 13NA(3) provides that NHS England must have regard to guidance on the discharge of this duty that it publishes (under section 13NB).
	Section 13NB gives NHS England a power to publish guidance on the discharge of the Triple Aim duty by NHS England, integrated care boards, NHS Trusts and NHS Foundation Trusts and requires NHS England to consult those who they view as appropriate when producing or revising the guidance.