NHS overhaul heads back to Parliament as major Health Bill moves towards next stages

One of the most significant restructures of the NHS in recent years is preparing to return to Parliament, with MPs due to consider the remaining stages of the Health Bill in September.

The Health Bill 2026-27, which forms the legislative basis for the government’s NHS modernisation programme, was introduced to Parliament on 14 May and has since progressed through its earlier Commons stages. Parliamentary business currently schedules two days for its remaining stages, on 7 and 8 September.

At the centre of the legislation is the government’s plan to abolish NHS England and transfer its functions elsewhere within the health system. Responsibilities currently held by NHS England would move principally to the Department of Health and Social Care, the Secretary of State for Health and Social Care and integrated care boards.

The government says the changes are intended to reduce bureaucracy, remove duplication, strengthen accountability and allow more resources to reach frontline healthcare. Ministers have argued that the existing structure has created fragmented lines of responsibility between NHS England and the Department of Health and Social Care.

The legislation would consequently give the Health Secretary greater direct responsibility for the NHS. Powers currently exercised by NHS England would transfer to the Secretary of State, including significant responsibilities relating to NHS organisations, finance, digital services and the performance of integrated care boards.

The Bill would also give the Secretary of State broader powers to direct an integrated care board in carrying out its functions. Ministers have said the changes will establish clearer democratic accountability, with the Health Secretary ultimately accountable to Parliament and the public for the performance of the health service.

However, abolishing NHS England represents only one part of a much wider package of reforms. The legislation would also enable the creation of a single patient record bringing together health information in one place. NHS providers, including GPs, could be legally required to disclose information so that it could be combined within the record, which would be accessible to patients and clinicians involved in their care.

The government argues that improved sharing of information could help create a more joined-up health service and reduce situations where patients repeatedly provide the same information to different parts of the NHS. The proposals have nevertheless generated debate around privacy, governance and the safeguards surrounding access to patient information.

Major changes are also proposed to the patient safety system. The Bill would implement recommendations from Dr Penelope Dash’s review of patient safety across health and care, including bringing the Health Services Safety Investigations Body within the Care Quality Commission.

Healthwatch would also be abolished under the legislation, with local Healthwatch responsibilities transferred to integrated care boards and local authorities. The proposed change has attracted concern about how the independent voice of patients and the public will be maintained within the restructured NHS.

Integrated care boards themselves would undergo further reform. The Bill would change their membership and governance arrangements, remove the requirement to establish integrated care partnerships and alter statutory requirements relating to local health and wellbeing planning.

NHS foundation trusts would also be affected. The legislation would remove the requirement for foundation trusts to maintain councils of governors and members, while responsibility for appointing foundation trust chairs would move from governors to the Secretary of State.

The Health Secretary would additionally receive a new power to remove an organisation’s foundation trust status, effectively returning it to NHS trust status.

Financial accountability across the NHS would change too. Rather than relying solely on system-wide financial targets, the Secretary of State would be able to establish financial objectives for individual integrated care boards and specified partner trusts. Powers currently held by NHS England to set capital and revenue limits and issue expenditure directions would also transfer to the Secretary of State.

Responsibility for commissioning primary care services would formally move from NHS England to integrated care boards, reflecting arrangements which have already largely operated through delegated responsibilities since 2022 and 2023.

The Bill would also introduce new powers relating to waiting times and patient choice. Regulations could place duties on integrated care boards to protect and promote patients’ rights to choose services, while the Secretary of State would be able to investigate and enforce compliance where those obligations were not being met.

The scale of the reforms means the legislation is likely to remain under close scrutiny as it continues through Parliament. While supporters argue that removing organisational duplication could simplify the NHS and make accountability clearer, concerns have been raised about the potential loss of expertise during restructuring, disruption to services and the concentration of greater powers within the Department of Health and Social Care.

Questions have also been raised about whether greater central control can comfortably sit alongside the government’s stated ambition to give local NHS organisations more freedom to design services around the needs of their populations.

The government has positioned the reforms as part of its wider 10 Year Health Plan for England, with the legislation providing many of the structural changes required to deliver its proposed new NHS operating model.

With the remaining Commons stages provisionally scheduled across two days in September, MPs will now have another opportunity to scrutinise and amend legislation that could fundamentally change who controls the NHS, how local organisations are governed and where responsibility ultimately lies when services fail.

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