Parliamentary briefing: Second reading of the health bill

The health bill, introduced to Parliament on 14 May, seeks to empower patients through access to their personal data; create and leaner and more effective centre; and to empower integrated care boards (ICBs) and foundation trusts (FTs) to deliver the best care for the patients and the populations they serve. NHS leaders are working hard to improve care and population health outcomes, as well as deliver against the ambitions of the government’s 10 Year Health Plan.

Ahead of the second reading of the health bill, the NHS Alliance has identified six areas on which we are most likely to proposed amendments:

1. Reducing bureaucracy and reinforcing democratic ministerial accountability
2. Empowering NHS providers
3. Empowering NHS commissioners
4. Prioritising patient safety
5. Supporting integration and system working
6. Enabling the Single Patient Record

These have been developed following feedback from our members, who are leaders across the primary care, mental health, acute and ambulance and community sectors, as well as commissioners. The below is a summary of this feedback, our view, and suggested interventions that you may wish to consider 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.

The bill seeks to abolish NHS England and transfer its functions to the Secretary of State (SoS) and DHSC or to the wider system. The functions to be transferred to the SoS/DHSC include powers of direction, board and executive appointments, and resource allocation and regulation of providers and ICBs. While the government maintains that this will streamline bureaucracy and reinforce democratic ministerial accountability in national decision making, there is a risk that increased direction by ministers could lead to a high level of central control, which could be very difficult to manage. The delivery of NHS services and regulatory functions have been significantly independent from government, to protect their ability to operate in the best interests of patients and the public by providing appropriate separation from political considerations.

We are also concerned that this may unintentionally give a signal to local leaders that they should wait to be directed, or that their decisions could be overridden at any time. This would be at odds with the stated intention to devolve power and risks delaying or inhibiting local leaders from redesigning services around patient outcomes and value for money. The NHS Alliance is keen to go further by seeking qualifications to the use of powers.

Suggested interventions:

• Can the Minister confirm what steps will be taken to ensure that any directions and appointments made by the Secretary of State are done in a fair and transparent way?
• Would the Minister consider supporting the creation of an operationally independent regulatory function for NHS providers and commissioners within DHSC to ensure operational segregation from the Secretary of State to avoid the Minister marking his own homework and maintain confidence that services are operating in the best interests of patients?

The government’s 10 Year Health Plan praises the foundation trust model for its ability to harness the benefits of reasonable autonomy to make decisions in the best interests of local populations. It is also the model of NHS provider organisation that the plan says all providers will move to by 2035. However, the transfer of certain powers to the SoS, such as FT board appointments, compromises that independence.

The bill proposes to abolish the requirement for FTs to have councils of governors (CoGs) and remove their statutory functions. This is intended to give providers more freedom to design services around local need. However, a consequence of this change is to transfer several powers to the Secretary of State (SoS), including the appointment and removal of FT chairs and non-executive directors (NEDs), and approval of changes to an FT’s constitution. The constitution of an FT sets out the rules that establish the internal governance of the organisation. Each constitution must in any case comply with the law, but their use was intended to leave FTs flexibility to make other such local arrangements as would best enable them to be effective. Giving power of approval or veto to the SoS risks undermining that local flexibility.

 The bill also grants the SoS the authority to set limits on FT’s annual revenue expenditure, extending beyond NHS England’s current capital only powers. Revenue limits are qualitatively different from capital controls as they can directly affect staffing, activity, beds, community capacity, diagnostics and the ability of FTs to hit financial targets and invest in service redesign. The bill’s proposal risks undermining the stated aim of empowering local leaders and moving care towards more integrated, preventative and neighbourhood models and for these reasons we would like to see the extension of the power removed.

Our members have concerns about some implications for FT governance once CoGs are removed and we question how the extension of ministerial powers over FTs to match those over NHS trusts aids the government’s stated aim of empower FTs. We are seeking realistic checks and balances to protect good governance and reasonable autonomy for trusts.

Suggested intervention:

• What assessment has the Minister made of the impact of the Bill's proposed removal of Foundation Trusts' autonomy over board appointments, revenue spending and local arrangements on their ability to serve the specific health needs of their local populations?

The NHS Alliance does not believe the stated intention to empower ICBs as commissioners is well reflected in the government’s proposals in the bill.

The development of strategic authorities with devolved powers and integrated funding settlements presents an opportunity to integrate NHS and non-NHS public services in new and promising ways, to strengthen democratic accountability, align with the wider determinants of health, and lead to more coherent place‑based prevention strategies.

The former SoS recently announced that two strategic authority mayors will be trialling an approach in the South Yorkshire and Greater Manchester mayoral combined authorities which sees ICB chairs ‘in effect, become like deputy mayors for health’, accountable to both the SoS and the mayor. This development builds on the new ability, established in the English Devolution and Community Empowerment Act 2026, for mayors to appoint ‘commissioners’ in their formal areas of competence, one of which is health, wellbeing and public service reform. The Act also conferred a ‘health duty’ on strategic authority mayors.

ICB leaders have some concerns about the apparent lack of acknowledgement of the potential conflict of interest in having a politically appointed representative who is also expected to be an independent chair. There are also risks in making ICBs accountable to both the SoS and the strategic authority that should be worked through, including the potential for politicisation of decision-making and a blurring of lines of accountability for ICBs.

Clarity is also needed for areas where there is no, or not yet, a strategic authority, with the presumption that ICBs have the flexibility to appoint to their boards as many politically appointed representatives – or non-political authority employees in their stead – as required given local circumstances. The role, membership and function of health and wellbeing boards in this context should also be defined.

In order to place the relationship between ICBs and local government on a footing that would support integration, the bill might introduce a statutory duty to collaborate on ICBs and local government bodies. There should also be an expectation that ICBs, as strategic commissioners, should be involved in local government decisions that impact them and local health provision.

The bill retains broad powers for the SoS to ‘call-in’ (and subsequently take over, modify or block) any proposed change to how an ICB arranges NHS services, powers that were only introduced in the Health and Care Act 2022. Service change is often politically difficult, but is necessary to improve safety, outcomes and value for money. Given the role in health envisaged for strategic authorities and their mayors, we believe it would make sense to revert to the system that was in place until 2022, where local government (via its health overview and scrutiny committee) could refer a proposal to the SoS if it believed consultation was inadequate or the proposal was not in the interests of the local health service. This would better service the principle of subsidiarity and support integrated local decision-making.

Suggested interventions:

• Will the Minister confirm whether the Bill will place a statutory duty on ICBs and strategic or local authorities to collaborate in the interests of better population health outcomes, and whether guidance will be issued to ensure ICBs are invited to relevant strategic or local authority meetings?
• Given the role in health for strategic authorities in the English Devolution and Community Empowerment Act 2026, can the Minister explain why the Secretary of State wishes to retain the power to call-in and intervene or otherwise direct local service reconfigurations, rather than returning to health overview and scrutiny committees the power to refer a reconfiguration to the Secretary of State?

The bill seeks to abolish Healthwatch England and local Healthwatch by transferring its functions to the SoS and ICBs (for healthcare) and local authorities (for social care) respectively. The government maintains that this will enhance local patient voice and ensure that community input more directly informs the design and delivery of services. However, our members have some serious concerns about the practicability of transferring local Healthwatch functions into ICBs and local authorities. ICBs would be required to gather and consider views from patients, carers, and their representatives when planning services or considering changes for service delivery. 

The NHS Alliance has raised two urgent issues with DHSC:

• Clarity is needed on how potential conflicts of interest will be managed to keep patients safe, given local Healthwatch’s current role in providing assurance to both local authorities and commissioners. Embedding this function within the very bodies it is meant to inform and hold to account may undermine its effectiveness.
• Outside the legislation, ICBs need clarity that they will receive the appropriate resourcing to effectively deliver the patient engagement functions previously held by local Healthwatch.

Suggested intervention:

• As part of the Bill, will the Government consider amending the NHS Act 2006 to preserve current local Healthwatch powers and protections, such as a clear duty to report publicly and structural independence, from both commissioners and providers?
• Given recent reductions to their budgets, ICB leaders are concerned that assuming oversight functions in the wake of the abolition of local Healthwatch may compromise their ability to invest in commissioning. Can the Minister confirm as to whether further resources will be available to them to deliver these important functions?

Aside from the long-planned delegation of commissioning responsibilities for pharmaceutical, general ophthalmic and dental (POD) services to ICBs, the bill does not propose any legislative changes related to primary care. However, given the changes envisaged in the 10YHP, the NHS Alliance believes that there is a need to enable primary care to be a more effective partner and to take on a fuller leadership role at place level (250,000-500,000 population).

Primary care providers are funded and contracted separately from statutory NHS bodies and are therefore not subject to the same statutory duties. This misalignment continues to hinder effective integration, which is essential for shifting to a more prevention-focused model of care. NHS England has signalled its intention to consider ways for non-NHS organisations to hold integrated health organisation (IHO) contracts in its Towards Population Health Delivery Models blueprint – either by partnering with NHS organisations or forming new NHS organisations. IHO contracts present a potential major shift in how care is organised, moving from activity-based contracting to population-based models. This would give providers responsibility for outcomes and resource use across whole populations.

The NHS Alliance is keen to see a route created for mature primary care organisations such as GP federations and primary care collaboratives to become statutory NHS bodies, with equivalent duties and accountabilities. These providers would need to fulfil specified criteria to ensure they are able to take on delegated functions from the ICB. This would enable them to participate fully in system governance and enter pooled budget arrangements with other NHS bodies and local authorities under section 75 of the NHS Act 2006. Currently, non-statutory organisations are excluded from this to protect public accountability, financial propriety, and democratic control. This would unlock closer collaboration to help to address local health challenges.

Suggested intervention:

• Does the Minister accept that providing the opportunity for the most mature primary care organisations to become statutory NHS bodies would remove a barrier to delivering a genuinely collaborative neighbourhood health service?

The single patient record (SPR) is a landmark development which holds the potential to support safer, joined‑up care by ensuring access to the right information at the right time. Our members see the SPR as essential to delivering more joined up and patient-centred care. To establish the SPR, legislation necessarily requires that patient data is processed and made available to patients and those involved in the delivery of their care.

The NHS Alliance believes that the right model is national standards with federated implementation: the centre should set interoperability, cyber, privacy and transparency standards to ensure consistency and patient safety. But local NHS systems should retain clear responsibility for stewardship, implementation and use in direct care where accountability is clearest. We also believe the bill should state clearly who is controller for each function, who carries liability for what, what indemnities apply, which uses are permitted for what, and what transparency obligations are owed to patients. Without that clarity, the SPR risks creating uncertainty for providers and undermine trust in patients.

The transfer of data controllership for the SPR to the SoS raises key governance and accountability questions. Without robust and clear safeguards, it risks creating some distance between the individuals to whom the data relates and organisations and actors who need to use it. With pertinent decisions about data use resting with the secretary of state as data controller, this decision‑making authority over personal data risks weakening local accountability, reducing NHS organisational responsiveness and undermining public trust in the SPR overall.

There is also a significant risk of placing GPs in an untenable position where they would be concerned about personal liability for data that is used (as they are sole data controllers of the largest NHS data set – GP care data), transformed or linked for purposes outside of their direct control. GPs already report concerns about liability when information coded into their records by other providers are coded incorrectly, sometimes leading to missed health checks or clinical errors. The absence of explicit, statutory clarity on data controllership also heightens risk for them. GPs tell us this could inhibit the creation of rapid data-sharing agreements without some form of indemnity cover and clear local roles and responsibilities for the SPR. GPs have also raised concerns about the risk of unintended workload transfer if the SPR is not implemented and managed with local input from primary care, commissioners and NHS trusts/FTs, alongside clear rules and principles regarding how data is used within shared care arrangements across the NHS and between the NHS and the independent sector.

Suggested interventions:

• Can the Minister confirm who will hold data controllership for the SPR, and who is liable should patient data be misused?
• Will the Minister advise whether central indemnity protection will be provided to general practice as the data controller for the GP patient record, and whether the national data opt-out will be written into the Bill?

The Bill as laid before Parliament on 14 May 2026.

Health Bill fact sheets:

• Health Bill: summary - fact sheet - GOV.UK
• Health Bill: single patient record - fact sheet - GOV.UK
• Health Bill: role and functions of the restructured DHSC - fact sheet - GOV.UK
• Health Bill: data and digital functions - fact sheet - GOV.UK
•  Health Bill: oversight of the health system - fact sheet - GOV.UK
• Health Bill: ICBs as strategic commissioners - fact sheet - GOV.UK
• Health Bill: providers - fact sheet - GOV.UK
•  Health Bill: patient safety - fact sheet - GOV.UK
• Health Bill: patient voice - fact sheet - GOV.UK