The Government's Health Bill has moved from the Commons to the House of Lords. It comprises a substantial programme of reform that extends far beyond the proposed abolition of NHS England. The Bill would also establish the legal framework for a Single Patient Record, reform ICBs, reshape aspects of patient safety oversight and introduce changes affecting medicines, medical devices, pharmacy regulation and patient representation.
Alongside the legislation, DHSC has published a series of final-stage impact assessments that provide a clearer picture of how these proposals are expected to operate in practice and where their impact is likely to be felt.
NHS England abolition and system accountability
The most significant reform remains the abolition of NHSE and the transfer of most of its functions to DHSC, the Secretary of State and ICBs with the aim of reducing duplication, strengthening accountability and contributing to savings of up to £1 billion per year.
For providers, commissioners and independent healthcare organisations, the question is going to be how accountability operates in practice as these reforms sit alongside a multitude of wider developments such as neighbourhood health, place-based care, integration and the increasing importance of regional and mayoral structures which are likely to create new governance and partnership arrangements.
Single Patient Record
The proposed Single Patient Record has the potential to be one of the most significant operational elements of the Bill.
While the Government believes that improved information sharing across health and care settings could support better coordination of care, reduce duplication and improve patient experience, the SPR raises important questions around information governance, interoperability, cybersecurity and patient confidence.
Reform of ICBs
ICBs are intended to move further towards a strategic commissioner role, with greater flexibility over local service planning and fewer statutory structures. The reforms are intended to simplify governance, strengthen local decision-making and improve accountability for outcomes.
Emphasis remains on strategic commissioning, neighbourhood delivery models and closer integration across systems. Also, greater collaboration with combined authorities and regional mayoral structures. Again, this presents providers and commissioners with practical challenges around who has decision-making authority and accountability.
It has just been announced that the planned formal merger of ICBs in April 2027 isn’t going ahead “to allow time for the national picture to become clearer before decisions are made about how future NHS and local government structures fit together” (the HSJ reporting that most ICBs and ICB clusters do not match the boundaries of the strategic authorities and mayoral combined authorities which are already in place).
Medicines, medical devices and regulatory reform
The Bill contains a package of reforms affecting medicines and medical devices, including expanding the MHRA information-sharing powers and streamlining the framework for a future medical device licensing regime. The intended effect is a more agile regulator able to respond more quickly to innovation, safety concerns and emerging evidence.
These proposals reflect the broader challenge facing regulators: enabling innovation while maintaining patient safety. The Government argues that the current framework can be slow to adapt and that reforms are needed to support innovation, improve collaboration and create a more sustainable domestic route to market for medical technologies.
Patient voice and patient safety
The Bill currently provides for the abolition of Healthwatch and transferral of HSSIB into the CQC – intended to simply the system. Stakeholders think the changes could weaken patient voice and the independence of patient safety investigations. The Government has therefore indicated that it intends to revisit those provisions during Lords scrutiny.
Visiting rights and patient experience
A further Commons amendment to promote patient visiting rights reflects a wider emphasis on patient experience, family involvement and person-centred care, as well as demonstrating the continued influence of lessons learned during and after the pandemic.
Maternity safety
The Government has committed to amending the legislation in the House of Lords to establish a statutory maternity and neonatal commissioner. The proposal follows the Amos Review, which identified concerns around accountability, patient voice and learning within maternity services. Ministers have indicated that the commissioner would provide independent leadership, champion the interests of women, babies and families and help drive improvement across the system. For providers, it is a further indication that maternity safety and accountability will remain a major area of policy and regulatory focus for the foreseeable future.
What is next?
The Bill is entering House of Lords scrutiny, with second reading scheduled for 13 October 2026.
For health and care organisations, the question will be what these changes might mean in practice, particularly in terms of accountability and governance; the most important question being whether they help organisations deliver safer, more joined-up and more effective care for patients.
For more information, please contact our expert health and care solicitors.
Read More