Now's the time to fix the Health Bill

The government’s Health Bill is only about halfway through parliament but already feels like an artefact of a previous administration with a different agenda.

That’s because it is. Its origins lie in Keir Starmer’s speech on reforming the British state in March 2025, which centred on stripping out bureaucracy and asserting government control for the public good.

That agenda has now largely been superseded by July’s Cabinet statement, Rewiring the State, with its emphasis on devolution and decentralisation.

The change in government hasn’t made the Health Bill so anachronistic that it needs to be abandoned, and its core aims – removing NHS England to streamline the centre, plus bringing about a single patient record (SPR) – are worth sticking with.

However, as the Lords prepare to debate it in earnest, it’s a good time to acknowledge that the bill is far from perfect in its current form, and there is an opportunity now to improve it.

Making the right changes would have three benefits. It would: ease its passage through parliament and avoid a delay to abolishing NHS England; secure the SPR; and give the NHS a firmer set of foundations for the future.

Patient voice and safety

Like others, we have been concerned about the proposal to abolish Healthwatch and move its local functions into integrated care boards (ICBs) and councils. It risks scrapping a truly independent patient voice, while asking commissioners of services to mark their own homework.

Thankfully, it looks like change may be coming. Rightly, minister Karin Smyth has committed to reviewing these measures, and underlined an ambition to see patient voices at the heart of local decision making. One way through would be to keep Healthwatch to guarantee an independent voice, and strengthen its local functions by giving them more support from the centre.

To ensure stronger patient involvement, start with the legal duties ICBs and trusts already have in this area. Then ask: why are these not enough at the moment? These could be beefed up – for example to proactively involve patients and communities, or to do so systematically. But there may also be non-legislative solutions – such as making patient involvement more central to how organisations’ leadership and overall capability are assessed through regulation.

There is also an opportunity to rethink the plan to make the Health Services Safety Investigation Body (HSSIB) an arm of the Care Quality Commission (CQC). Many have found the logic for doing this unconvincing. And, they are concerned that HSSIB’s safe space would be fatally compromised by making it part of a regulator which can take punitive action. 

More practically, CQC is on a long recovery journey, and does not currently have the confidence of those it regulates. To enable the Lords to focus on the parts of the Bill that need to be passed, the provisions on HSSIB would ideally be dropped. If it must become part of CQC, the investigation function should be fully ringfenced, with separate leadership, staffing, resources, information governance and appropriate legal protections.

Empowering the frontline

The best argument for streamlining the centre is that an empowered frontline is much more likely to deliver improvement and transformational change.

For that reason, the government is right in its ambition to create a leaner centre that only does what needs to be done nationally. It fits with other welcome policies aimed at devolving power, such as strategic commissioning and advanced foundation trusts.

However, ministers could lock in this approach – and send a signal that they really mean it – by giving up some of the new powers the Bill gives them over trusts and ICBs. Powers of direction should be scrapped or at the very least curtailed in terms of when they can be used.

The vexed issue of the future NHS operating model – which urgently needs sorting – presents an opportunity to build good governance into the new setup. There are some functions which are best kept free of political interference or influence – or the perception of it: appointments of trust and ICB chairs, and regulation and related intervention.

We have called for both these functions to be ringfenced. The mooted special health authority to employ NHSE staff could receive these functions to ensure they continue to command trust and avoid conflicts of interest.

Single patient record – eyes on the prize

The most transformational part of the Health Bill is establishing a single patient record (SPR). We are strongly in favour, as it could improve safety, continuity and prevention by ensuring the right information is available at the right time.

However, this will require shifting data controllership from GPs to the Secretary of State, and the risk is that, done badly, this will not command the confidence of GPs, patients, and legislators.

The Bill must be more explicit about: who is data controller for each function, liabilities and indemnities, permitted uses of data and transparency obligations, and application of the NHS National Data Opt-Out.

GPs warn that, without this clarity, data sharing could be slowed rather than accelerated.

Do it right and move forward

The flaws in the Bill are mostly down to the previous government committing to abolish NHS England before working out how best to do it. That is not the fault of the current administration, so we have a chance to set things right before this reaches the statute book.

At the NHS Alliance, we have been engaging constructively with officials and parliamentarians since before the Bill was introduced. Our detailed suggestions for improving the legislation are available elsewhere – but the strategic approach outlined here represents a credible way to land the Bill and give the NHS clarity about its future direction. 

It’s now time to focus on what we need this legislation to do, and make changes to ensure an empowered frontline is the end result.

And then – we can get on with working out how the NHS will plug into the new government’s vision of a rewired state.