Parliamentary briefing: proposed health bill for 2026

The upcoming health bill, due to be announced in the King’s Speech, is a key tool in delivering the government’s vision as set out in the Ten-year plan for health. While the health bill supports elements of this work, much of it can be progressed without requiring legislative change.

The health bill is expected to set out reforms intended to modernise the NHS, improve patient safety and experience, and devolve power from the centre to local health leaders. It is likely to respond to Lord Darzi’s Review of the NHS, which identified over centralisation, poor accountability and fragmented information systems as drivers of poor care. The bill is also expected to provide the legislative mechanism to abolish NHS England, aiming to simplify the national landscape with a slimmed down role from the centre, restore democratic accountability and free up resources for frontline services. 

Through the bill, the government also intends to reform the accountabilities and governance structures of integrated care boards and reforms foundation trusts, aiming to enable more locally driven, accountable and efficient care delivery, aligned with wider prevention and digital priorities. It also aims to pave the way for the universal adoption of the single patient record, bringing health and social care data together so information follows the patient, supports early intervention and empowers people to manage their care through the NHS App.

The NHS Alliance has undertaken analysis of pledges made in various health policy announcements, including the 10 Year Health Plan, to assess which government policy announcements to date may require legislation. We have taken these likely changes and consulted on them with our members, who are leaders across the primary, mental health, acute, community and ambulance sectors, as well as commissioners. The below is a summary of this analysis and feedback that you may wish to use when assessing your approach to the bill.

If you have any questions or would like to discuss this briefing further, please contact publicaffairs@thenhsalliance.org 

Over the last year, integrated care boards (ICBs) have been undergoing significant changes to their geographies, going from 42 boards last year, to 26 by the end of this year. Changes to their functions have also been imposed and their staff budgets have been cut by 50 per cent, to achieve a maximum running cost of £19.40 per head of population.

In addition to these changes, the proposed abolition of local Healthwatch organisations that collect and analyse patient experience to assess the delivery of health and care services, will likely result in their functions being transferred over to local ICBs.

Given reduced budgets, many of our members leading ICBs have expressed concerns over their ability to deliver within their budget envelope and are calling for extra provision to be made to deliver those Healthwatch oversight functions.

Suggested interventions

• Recent changes to integrated care board budgets, coupled with the likely new responsibility they have in taking over local Healthwatch functions, have left ICB leaders doubtful about whether they can deliver all of their services within their £19.40 per head commissioning budget. Will the Minister commit to resourcing these new duties outside of the envelope?

Primary care is the ‘front door’ of the NHS, with 90 per cent of patient interactions with the NHS taking place in GP practices, community pharmacy, dentists, and opticians. Primary care is key to delivering a truly neighbourhood approach to health, as outlined in the 10 Year Health Plan. However, primary care providers, and many community providers, are often unable to participate in decision-making around health spending and prioritisation as they are not statutory organisations. This lack of statutory status prevents them from pooling budgets with NHS bodies and local authorities under s.75 of the NHS Act 2006.

Our members have strongly recommended that the bill creates a route for mature primary care organisations, operating at a multi-neighbourhood provider footprint, such as GP federations and primary care collaboratives to become statutory NHS bodies, with equivalent duties and accountabilities. Specific criteria for this would need to be met to ensure providers are able to take on delegated functions from the ICB, such as not-for-profit status and adequate governance and risk arrangements to deliver contracted services. It would also be separate from the General Medical Services contract which should remain with GP practices.

Suggested intervention

• Primary care is where most of us most regularly interact with the health service, but providers are unable to access pots of money to proactively address local health issues and inequalities. Will the Minister consider giving the most mature primary care organisations, and community providers that are community interest companies, a route to become statutory NHS bodies, enabling them to take on more functions and deliver services closer to home?

Removal of councils of governors

The 10 Year Health Plan proposes removing the requirement for foundation trusts (FTs) to have a council of governors (CoGs). CoGs are made up of elected and appointed representatives who reflect a trust’s key stakeholders, and provide oversight and represent the interests of patients and the public. They also have a role in appointing the trust’s senior leadership.

With the abolition of CoGs, we can assume that appointments of FT chairs and non-executive directors (NEDs) will be made by the secretary of state (SoS) – as they are for NHS trusts at present. Our members are concerned that this may reduce public trust in FT governance, with the perception of the politicisation of appointments and a reduction in provider autonomy. The NHS Alliance therefore proposes that a new system for independent chair and NED appointments (for both trusts and FTs) be created, that safeguards their independence. This could take the form of an independent panel within DHSC, an arm’s length appointments body or oversight from the commissioner for public appointments.

Another implication of the removal of CoGs is that approval for changes to FT constitutions may revert to the SoS. If this is proposed in the bill, our members would like assurances that they would retain their existing degree of control over their governance arrangements. The bill could provide this by limiting or mitigating the ability of the SoS to veto changes to FT constitutions unless they were in contravention of NHS Act Schedule 7.

Suggested interventions

• In the wake of the decision to remove the requirement for foundation trusts to have councils of governors, what steps will the Minister take to ensure that appointments to trust boards are made independently from the centre and deliver the best possible leadership for their organisations?
• Does the Minister agree that the boards of NHS foundation trusts are best placed to manage their own governance arrangements and, if so, what measures will the bill take to ensure that this autonomy is protected?

Currently, NHS England holds certain powers of direction over NHS bodies. For instance, it can direct an ICB in the exercise of its functions where that ICB is failing to discharge them. With the abolition of NHS England, it seems likely that these powers will be transferred to the SoS through the Bill.

Our members believe that any transferred or newly conferred powers of direction should be subject to clear statutory limits. Such powers should only be exercisable in very specific circumstances, with a requirement to share the reasons for their use, transparency about their scope and duration, and provision for review or challenge. Clear statutory definition of where and when the powers may, and may not, be exercised is essential to ensure appropriate ministerial accountability to Parliament, while preserving the locally led model of service delivery and neighbourhood health set out in the 10 Year Health Plan.

While is it right that the SoS and ministers are able to set national strategy and policy, undue interference should be avoided in operational decision-making in areas such as service reconfigurations or capital investment. Where ministers or mayors are able to override local decisions, there is a risk that clinically appropriate or organisationally necessary changes are blocked or delayed. This could potentially compromise patient outcomes, delay changes that would lead to a more efficient use of taxpayers’ money, and divert resources from frontline care. Maintaining clear boundaries around the use of powers of direction is therefore vital to sustaining public confidence that decisions are taken in the best interests of patients and population health.

Suggested interventions

• NHS leaders are concerned that the transfer of unqualified powers of direction to the Secretary of State could jeopardise the government’s localised vision for healthcare delivery. What steps will be taken in the bill to ensure that NHS bodies, which have the knowledge to address local health needs, have the autonomy to do so?

Over the last few years, a number of steps have been taken to make the delivery of healthcare more democratically accountable. The English Devolution and Community Empowerment Act, which became law in April 2026, has conferred a ‘health duty’ on strategic authority mayors, and this year saw the first two pilots for deputy mayors for health in the South Yorkshire and Greater Manchester mayoral combined authorities.o

Decisions taken by strategic authorities will impact on local NHS services and their effective delivery, our members believe there should be a statutory duty on ICBs, strategic authorities and/or local authorities to collaborate in the interests of integration and/or better outcomes. Alongside other sector partners, The NHS Alliance called for a similar amendment to be made to the English Devolution and Community Empowerment Act, and plans to revisit this as the health bill progresses through Parliament. To support this, we believe there should be an expectation in guidance that ICBs should be invited to strategic authority and/or local authority meetings where decisions impacting them are made.

Suggested interventions

• It is crucial that strategic and local authorities work closely with health bodies to deliver a joint approach to the wider determinants of health and tackle health inequalities. Would the Minister support inclusion in the Bill of a statutory duty on integrated care boards and strategic authorities to collaborate on health matters?

In the 10 Year Health Plan the government proposed establishing the single patient record (SPR). This would allow patients to see their entire digital health record, and for practitioners to see information provided about their patient by others. Our members see the SPR as essential to delivering more joined up and patient-centred care. To deliver the SPR, the government is likely to need legislation which requires patient data to be processed and shared directly with both patients and those directly responsible for delivering their care.

Our primary care members have raised significant concerns around the implications of their role in feeding patient data into the SPR, namely that they would be personally liable for data that is used, transformed, or linked for purposes outside their control. The absence of explicit, statutory clarity on data controllership heightens risk for them. GPs tell us that the lack of indemnity cover and clear local roles and responsibilities for the SPR could inhibit the creation of rapid data-sharing agreements.

It is therefore important that the bill provides clarity on data controllership, liability protections, permitted uses of patient data, and associated transparency obligations, including ensuring that the NHS National Data Opt‑Out applies to secondary uses such as research and service improvement.

Suggested interventions

• The establishment of the single patient record will allow patients to see their entire digital health record, and for practitioners to see information provided about their patient by others, however primary care leaders are concerned about personal liability of patient data. How will the minister ensure that GPs do not end up as the sole data controllers?
• Patients will want to be clear that their data can only be used as part of their health care. What safeguards will the minister put in place to reassure the public about the use of their personal data, stored in the single patient record, for other purposes such as research and clinical trials?