Briefing: Health Bill, Second Reading, Monday 1 June 2026

Despite pledging not to restructure the NHS, the government has embarked on a major top-down reorganisation of the health service. Evidence shows that NHS reorganisations cause widespread disruption and rarely deliver the benefits expected by ministers. 

While there is some logic in bringing the workings of NHS England and the Department of Health and Social Care (DHSC) closer together, the communication and planning of the government’s decision to abolish NHS England left much to be desired and the decision caused disruption to the service at a time when patients need it most. The question now is how to make the new structure work.

The bill transfers a long list of powers from NHS England to the secretary of state, including workforce planning, digital and data systems, oversight and regulation of local NHS bodies, and more. It also creates several entirely new powers for the secretary of state, most notably the broad power to direct integrated care boards (ICBs) in the exercise of their functions. This power contains only limited exceptions, including individual clinical decisions or interventions on drugs and treatments that would be inconsistent with National Institute for Health and Care Excellence (NICE) guidance.

Accountability for the health service will always rise upwards to politicians in a tax-funded health system and it is right that ministers set strategy and direction for the NHS. But the bill hands ministers too much responsibility for its day-to-day management. For example, appointments of chairs and non-executive directors of local NHS bodies (who appoint their chief executives), which have been managed at arm’s length of politicians since 2001, will now fall to the secretary of state. Transferring functions from an arm's length body with a defined statutory remit to a government department with a far broader role may also reduce clarity and transparency about how these functions are exercised in practice.

The bill risks enabling excessive political interference that could cause harm in the future. For instance, through political bias in appointing local leaders or political pressure linked to publication of NHS performance data. Simply merging NHS management back into the DHSC (without some demarcation) alongside cuts to central headcount also runs the risk of the NHS dominating health policy even more than it does today.

The bill goes too far in centralising power in the hands of ministers. The government needs to do more to articulate the benefits of handing such extensive powers to the secretary of state and set out safeguards for how these powers are used. For instance, to keep some processes, such as appointments, at arm’s length. Ultimately, some split between policy and management should remain at the top of the NHS.

The 10-Year Health Plan marked a return to market-style mechanisms that were a prominent feature of the last Labour government’s approach to managing the health service in the 2000s, with a sharper split between NHS commissioners and providers, greater freedoms for hospitals over finances and measures encouraging competition between them (such as league tables).

The bill legislates for some of these changes. For instance, revising NHS ICB membership (to focus boards more squarely on the job of commissioning), and scrapping requirements for local NHS organisations to collectively manage their finances. Hierarchy, competition and collaboration coexist in the NHS. But the government’s reforms mean the dial is shifting away from collaboration as the organising principle for managing the health service.

The problem is that the big challenges facing health require a coordinated response. For example, the number of people living with multiple long term conditions is rising substantially. ICBs were originally designed to encourage cross-sector collaboration on these and other issues. Changes in the bill might help simplify the system, but risk running against the partnership working needed to improve heath and care. Closer links between the NHS and strategic authorities on health is a positive step, but the decision to remove mandatory local authority representatives from ICBs could weaken the links between the NHS, social care, and public health at a more local level.

Evidence indicates that previous reforms of NHS commissioning have struggled to improve patient care and outcomes. The same is true in other countries with hospitals consistently having more power and resources than commissioning organisations. Substantial cuts to ICB budgets and another round of organisational disruption risk weakening the starting position for commissioners even further.

For strategic commissioning to have any chance of success, policymakers will need to play an active role in supporting it. ICB leaders in our research pointed to a mix of skills and capabilities that they wanted support on, including analytical, economic and actuarial skills, and capabilities seen as core to strengthening commissioning and contracting within their organisations.

The bill risks undermining the collaboration needed to address the challenges facing the health and care system. Changes should be made to rebalance this, for instance by reversing the decision to remove mandatory local authority members from ICBs. The government also needs to do more to set out how ‘strategic commissioning’ is intended to drive improvement in the NHS and ensure the skills and capabilities are in place to support it.

The bill includes powers to establish a single patient record to bring together the existing information on a person’s health and social care use into one place. The aim of joining up data to improve patient care is good. Patients and staff are frustrated with the current system, with clinicians navigating multiple and incomplete information systems, while patients often have to report their story many times to different health and care professionals. 

Whether the plans can avoid the fate of past national NHS IT programmes is unclear. Detail on how the new record will work is thin. Questions include how it will tackle the causes of existing fragmentation and poor data quality in local systems, how data will be accessed and governed and whether GPs will continue to be liable for data they may no longer control. 

Trust from patients, staff and the public will be essential for the plans to succeed. Yet measures elsewhere in the bill to bring digital and data responsibilities into the DHSC may undermine the trust needed to deliver. Our recent polling data suggest the public trusts the NHS more than the government with health data. 

While the ambition to join up health and social care data to improve patient care is welcome, the government needs to provide greater clarity on how its proposed single patient record will work in practice, including how it will bring together fragmented local systems and how data will be accessed and governed. It will also be essential to build trust among patients and staff. Involving the public early to ensure their concerns have been heard and addressed will be critical.

The bill proposes to remove the requirement for NHS foundation trusts to have councils of governors; a policy originally intended to boost accountability to communities, rather than central government. The government also plans to abolish Healthwatch, the independent organisation that operates nationally and locally to gather patient and public views. The experience of Healthwatch has been varied and its impact hampered by budget cuts and a power imbalance with the NHS. But scrapping it entirely and bringing its functions ‘in house’ means patients are losing an institutionally independent voice. 

The NHS has a mixed record of listening to patients, as repeated inquiries into patient safety failings show. And it is not clear that the DHSC or ICBs will have the information, skills, capacity or legitimacy to play this role effectively, particularly following such deep cuts to headcount and ICB budgets. Moving the NHS functions of local Healthwatch organisations into newly enlarged ICB footprints could also result in the loss of a more nuanced local understanding of the public’s priorities and needs, with particular implications for seldom heard or more vulnerable communities.

The government should think again about these changes. Ministers could choose to do more to listen to patient and public views without reorganising anything. An independent body with sufficient infrastructure to gather local data in a meaningful and equitable way and influence national decisions is essential. The government’s current proposals fall short on several counts.

Standing back, the bill is the latest example of ministers focusing on the NHS over the broader health of the nation. As our recent analysis of healthy life expectancy showed, the UK’s health is declining, resulting in significant economic costs as well as taking a substantial human toll. Turning the rising tide of ill health requires a new approach that places rebuilding the UK’s health alongside delivering economic growth at the heart of government policy. 

The new health duty for Strategic Authorities introduced in the English Devolution and Community Empowerment Act creates an important opportunity to embed health improvement in decision-making at regional level. But a similar approach is needed to embed health in policy decisions across central government too. To improve alignment, a broader duty could be added to the Health Bill for the secretary of state to improve health and reduce health inequalities, therefore mirroring the approach for Strategic Authorities. 

More broadly, the government needs to widen its lens from the NHS to health. This means taking a cross-government approach to addressing the wider factors that shape people’s health, such as poverty, inadequate housing and the quality of work, a shift to prevention and a new strategy to address health inequalities. Successive governments, including Labour with its now largely abandoned ‘health mission’, have understood this but failed to take the necessary action.

While the action needed to address the UK’s declining health goes well beyond the scope of this bill, it does provide an opportunity to strengthen the statutory framework. A good start would be to bolster the current requirements for the secretary of state to improve health and reduce health inequalities by mirroring the new duty on strategic authorities in the English Devolution and Community Empowerment Act.