Explaining the Health Bill (NHS Modernisation Bill 2026): what does it mean for health and care?

Key takeaways

• The King’s Speech to parliament on 13 May 2026 opened the government’s new legislative session and outlined its next areas of focus. One of the key pieces of legislation laid before Parliament was a new health bill – introduced in The King’s Speech as the ‘NHS Modernisation Bill’. 

•  The main aim of the NHS Modernisation Bill is to provide a legal basis for the largest reorganisation of the NHS in more than a decade. It is the government’s primary legislative vehicle for delivering its commitment to abolish NHS England (NHSE) and to implement its 10 Year Health Plan. The proposals mark a significant shift in how the NHS is run at national and local levels. 

• This government has already shown what can be achieved with legislation to improve the health of the nation through the historic Tobacco and Vapes Act. The Bill has the potential to shape how health care is experienced and who is accountable for delivering it.  

• However, much of the Bill focuses on structural change rather than directly addressing patient experience and outcomes. Evidence from previous reorganisations suggests structural reform alone can be a huge distraction and rarely improves care unless it is clearly linked to practical changes in how services are delivered. 

• The Bill therefore presents both opportunities and risks. Its most promising element is the potential to link data and improve co-ordination of care through a single patient record.  

• Its biggest risk is that organisational change absorbs leadership attention and capacity without delivering tangible improvements for patients. Whilst structures do matter to how a health service runs, ultimately, they aren’t what patients care about. They are far more interested in the quality and speed of the care they receive.  

• The government says that it would like to devolve power from Whitehall and give patients more control over their care. However, there is a risk that this Bill does the opposite with more power centralised and the disbanding of the independent organisations set up to listen and ensure patient voices are heard across health and care services.

Key tests for the Health Bill 

The provisions in the Bill are intended to align the system more closely with the government’s strategic priorities. However, their implications for accountability, local autonomy and delivery are significant and require careful scrutiny. Key tests for the Bill include whether it will: 

• make a difference to patient care 

• reduce bureaucracy 

• strengthen patient voice 

• improve patient safety 

• stabilise the NHS. 

What will abolishing NHS England mean for accountability and decision-making? 

 What the Bill proposes 

At the heart of this debate is the balance of powers and accountability at the ‘centre’ of the system, particularly what the Secretary of State has the power to do. The stated rationale for abolishing NHSE and other arm’s length bodies and pulling functions back into DHSC is that there are too many bodies with overlapping responsibilities. Local health systems are overrun with directives and are servicing ‘two centres’ in NHSE and DHSC. 

Why it matters 

The Bill may simplify accountability and reduce duplication between organisations. However, this change raises several risks:

• First, over-centralisation. Bringing operational functions closer to the Secretary of State may increase political control over day-to-day NHS decisions, potentially reducing system stability and stifling local innovation. 

• Second, creating bottlenecks in decision-making. Concentrating authority at the centre could slow down responsiveness, particularly in a complex system that requires local adaptation. 

• Third, there are lessons from previous reorganisations. Structural change can be disruptive, diverting leadership capacity away from service improvement and creating uncertainty for staff. 

• Additionally, there is a risk that too high a proportion of how these changes will work in practice are to be set out in further guidance and regulations, rather than the Bill itself. This limits the opportunity for legislative scrutiny over how the NHS – which accounts for a large share of the expenditure covered by the Parliamentary vote – will operate in future.
  

The King’s Fund’s view on what happens next 

The King’s Fund agrees that the Secretary of State should have the tools to assure patient safety, uphold national standards and ensure system alignment. However, we have concerns about unchecked statutory powers over commissioning, performance management and spending allocations. The risk is an interventionist health chief who could destabilise an already jaded workforce with a slew of new directives and politically charged appointments. 

How will the Bill change the role of integrated care boards? 

What the Bill proposes 

The Bill seeks to strengthen ICBs as the primary strategic commissioners within local systems, including taking on greater responsibility for primary care commissioning and long-term planning. At the same time, ICBs are to become directly accountable to DHSC rather than NHSE. This represents a significant shift in the system architecture. The Bill is also expected to require statutory mayors (or a nominated deputy) to be members of ICBs, alongside introducing changes to strategic planning requirements to align more closely with the priorities set out in the 10 Year Health Plan. 

Why it matters 

If ICBs are to deliver on the government’s ambitions, particularly the shift towards prevention and community-based care, the legislation needs to strike a careful balance. On one hand, ICBs need sufficient autonomy to respond to local population needs and to develop long-term strategies. On the other hand, they must operate within clear national priorities and accountability frameworks. 

Key risks include:

• undermining partnership work between the NHS, social care and public health at a local level with the removal of mandatory local authority representatives within ICBs 

• capacity constraints within ICBs, particularly following recent cost-reduction requirements to radically downsize headcount by 50 per cent 

• unintended consequences of granting greater financial control to high-performing organisations.

The King’s Fund’s view on what happens next 

The King’s Fund welcomes the separation of performance management and strategic commissioning roles. The dual role of ICBs supporting local system development, whilst also being taskmasters for national priorities, hasn’t been working. Immediate priorities of access and finance have crowded out the opportunities for ICBs to prioritise long-term development and improvement in services. 

Additionally, involving mayors more closely could strengthen local accountability and community engagement, working with ICBs to fulfil their respective duties around health and health inequalities. However, it also raises questions about the balance of influence within ICBs and how ICBs will reconcile any differences between nationally determined NHS priorities and local political priorities.