October 2026
The Health Bill that is moving swiftly through Parliament reveals that the Labour government has little interest in reinstating the NHS as a publicly provided service. Instead it shows an intention to allow new opportunities for the private sector.
The legislation, proposing the most significant restructuring of the NHS for over a decade, will put many of the proposals of the NHS 10 Year Health Plan on a legal footing, and shift it from an arms-length model to one of direct government control. For example, if passed, the Bill will abolish NHS England (NHSE) and transfer many of its responsibilities to the Department of Health and Social Care (DHSC). Yet despite the scale of change, the Bill is skeletal: it provides little detail and instead gives the Health Minister extensive new powers to introduce change with little parliamentary scrutiny through the use of secondary legislation.
Regardless of government rhetoric about decentralisation, the Bill aims to give the Health Minister direct control over ICBs with, for example, powers to set capital and revenue resource limits, or to return Foundation Trusts (FTs) to NHS Trust status if unhappy with their performance. Proposals also include removing FTs’ statutory duty to have a council of governors and giving their existing powers (such as appointing and removing Chairs, holding the Board of Directors to account and representing the interests of the public) to the Minister. These proposals raise concerns about reduced accountability of FTs as well as potential political interference in the management of the NHS.
The Bill would allow the Health Minister to delegate health service-related functions not just to public bodies (as things stand now) but to other ‘persons’ prescribed in regulation, which could mean private companies. One consequence of this, besides further NHS privatisation, is that the liability for carrying out such delegated functions will rest with the provider, allowing the Minister to evade responsibility for service failings.
The Minister would also be able to change the balance of services provided by the public and private sectors if this was thought to be in the interests of the health service. Whether this is a positive measure or not, and how ‘interests’ might be defined, will depend on the nature of the government in office.
The Bill would give ICBs extra duties, such as managing over 90% of the NHS commissioning budget, with new responsibilities for primary care, dentistry, ophthalmology, and pharmacy services. However, the Bill cements the ability for direct central control of ICBs by empowering the Health Minister to impose duties through regulations, raising concerns that ICBs may not have sufficient autonomy to be effective.
In addition, the Bill proposes that in commissioning a service, ICBs (and the Minister) may allow the provider to exercise their discretion about how those services will be delivered – meaning, for example, that a private provider contracted to redesign service provision would have a free hand, as long as they achieved the outcomes set by the commissioner.
The Bill additionally enables the Health Minister to compel multiple providers of care (NHS and private) to share data for a single patient record (SPR) while narrowing the scope of the national Data Opt-out. Measures, including forcing compliance with future regulations, aim to ensure that patient information becomes available to patients and care providers, ostensibly to support more co-ordinated, neighbourhood-based care. However, these new opportunities for government involvement in the control and use of health data may well undermine public trust in how their data is handled.
The Bill also proposes absorbing the Health Services Safety Investigations Body (HSSIB) into the Care Quality Commission (CQC) (long known for its ineffectiveness in regulating and inspecting health and social care). This is likely to change the way that clinical incidents are investigated, from an approach based on creating safe spaces in which to identify risk and learning, to one based on compliance and a search for blame.
Finally, the Bill intends to abolish Healthwatch England and local Healthwatch organisations: their responsibilities will be transferred to the DHSC and ICBs respectively. Although Healthwatch organisations have been seen as largely ineffectual, any semblance of independence in reporting and championing patient experience may be lost.
In conclusion, The Government claims that the Bill will reduce duplication, bureaucracy and costs, allowing power and resources to be given to frontline organisations. In effect, the Bill appears to do the reverse, actually increasing central control with little indication of checks and balances on the powers of the Health Minister.
We are concerned that the Bill will introduce significant structural change, resulting in weakened accountability and transparency at a time when 50% of jobs across NHSE and DHSC are being cut. As well as destabilising the NHS the Bill will do little to improve care or patient experience (as has been the case with previous re-organisations). It will also mean a weaker voice for patients, and do nothing to abolish the market while raising concerns about data privacy and control.
On this basis KONP calls for the progress of the Bill to be stopped unless it is sufficiently amended to address these concerns.
For more detail on the Health Bill see full article here
See also
NHS Privatisation Agenda page
Labour and the NHS
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