The Health Bill can put health at the heart of government

The new Health Bill, due to be debated when parliament returns from recess, is among a raft of new laws to set government’s direction and deliver its plan for change. The bill implements the latest NHS reorganisation, abolishing NHS England and transferring its functions to the health secretary. Will this advance the government’s aim of a shift towards prevention? And how does this measure up against the Health Foundation’s recent call for a new drive to rebuild the UK’s health? 

The bill’s stated aim is to reduce bureaucracy and duplication and increase ministerial control and democratic accountability for patient care. The concern from health experts is that this is neither matched by control nor accountability for delivering the broader shift to prevention and on government’s promise of ‘a fairer Britain, where everyone lives well for longer’. 

Over the coming months, the risk is that the Department of Health and Social Care (DHSC) is focused on the bill and reorganisation, rather than supporting other parts of the system to work together to embed health improvement and tackle inequalities across economic and public policy. As our recent analysis shows, the nation’s health is slipping backwards and inequalities widening. But there’s still chance to revive this agenda this parliamentary session. 

Improving health and reducing inequalities will require going beyond the NHS and DHSC. We need to take a whole-government approach that considers health as a shared asset for the country and purposefully aligns all government decision making with the goal of improving the building blocks of health.

A framework to put health at the heart of government

Legislation is not a silver bullet, but it is an important part of our armoury in this mission. Working with a panel of experts, the Health Foundation has proposed a statutory framework that would enshrine the changes needed to deliver on Labour’s manifesto commitments and the broader mission for health. While it focuses mainly on the NHS, the Health Bill could provide a starting point for creating this framework. 

At present, the Health Bill brings together old duties on the health secretary and NHS England to reduce inequalities in access to health care and outcomes (Section 4). These duties are too narrow and do not reflect the wider determinants of health that the government has pledged to tackle. Health Equals – the campaigning coalition founded and supported by the Health Foundation – is promoting amendments to strengthen these duties so that the government has the same requirements as strategic authorities to improve health and reduce health inequalities, including those that are due to the building blocks of health such as air quality and housing. 

This would set the scene for a comprehensive statutory framework, akin to that for environmental protection, where all government departments contribute to a shared plan and are accountable for clear, long-term targets. Health Equals is working with our coalition members and MPs across parties to bring forward a new Health Improvement and Inequalities Bill that would put health at the heart of government and get the health mission back on track. 

The proposed legislation would enact five key mechanisms: 

1. A new duty, placed on the health secretary on behalf of the whole government, to improve health and reduce health inequalities – encompassing the building blocks of health, not just NHS services. The government has just passed the English Devolution and Communities Act 2026 that creates equivalent new duties on strategic authorities, but no one in central government shares the same accountability. Without stronger cross-government alignment, clearer expectations and appropriate capacity and incentives, the new devolution duties risk becoming a tick-box exercise. Our proposed new duty would ensure a consistent mission from the top of government through to regions and neighbourhoods. 
2. A requirement to develop and deliver a comprehensive cross-government health improvement and health inequalities strategy, giving the health secretary the responsibility to coordinate action across departments – just as the law already requires a cross-government environmental improvement plan, coordinated by the Secretary of State for the Environment, Food and Rural Affairs. 
3. Establish targets for improving health and reducing health inequalities that would both drive immediate action and ensure long-term consistency of focus – in line with other cross-government targets, such as those set under the Environment Act 2021. 
4. Establish regular independent reporting and oversight to monitor progress against these targets and hold government to account. 
5. Produce statutory guidance on health impact assessments for major policies, as recently introduced in Wales. 

Turning around the nation’s declining health and widening inequalities is a generational challenge that will take long-term national and local action. But without a framework that puts health at the heart of government, this challenge will not be met.