The King’s Fund responds to the publication of the NHS Modernisation Bill

Responding to the publication of the NHS Modernisation Bill, Sarah Woolnough, Chief Executive of The King's Fund, said: 

‘The NHS Modernisation Bill contains one genuinely transformative proposal- the creation of a Single Patient Record, which if done well could help end fragmented care and significantly improve how patients and staff experience the NHS.

‘But this opportunity comes with some risks, and against a backdrop of political instability. The Bill centralises more power in Whitehall and the hands of the Secretary of State, and may weaken independent patient voice by abolishing Healthwatch, at the very time Ministers say they want to devolve more to local organisations and empower patients.

‘Whether this Bill improves care will depend less on organisational reshuffling and more on whether patients ultimately see faster, better, more joined up care.’

Abolition of NHSE and reconfiguration of ICB duties

'The abolition of NHS England and the transfer of its functions to the Department of Health and Social Care (DHSC) and local Integrated Care Boards (ICBS) will fundamentally reshape how the NHS is run.

‘These changes will also significantly impact how ICBs operate, from who sits around the table to shifting who they are accountable to from NHS England directly to DHSC.

‘There are some welcome changes. Separating day-to-day performance management from ICBs’ strategic role as service commissioners is sensible, and involving mayors more closely could strengthen local accountability and community engagement. But there is a risk that power becomes increasingly concentrated in Whitehall. If every major change to services requires ministerial sign off, it could make clinically necessary reforms harder not easier.

‘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. For those on the outside looking in, these technocratic restructures might look like rearranging deck chairs on the Titanic whilst many core problems around the nation’s health remain unresolved. And for every minute spent navigating reorganisation is a minute not spent planning and delivering high-quality care.’

Single Patient Record

'The Single Patient Record represents the greatest opportunity to improve people's experience of the NHS and their health contained within this legislation. On the NHS App, people would be able to see their primary, secondary and social care record all in one place, ending decades of frustrations around fragmented information and care.

'There are concerns over who will ultimately be responsible for the data and ministers must ensure it is designed carefully to allay those fears. It is likely to be the most controversial element of the NHS Modernisation Bill but is worth making the argument for and one that we hope the government wins.'

Abolition of Healthwatch

'Scrapping Healthwatch England and its local branches removes a mechanism for independently gathering rich and often unsolicited feedback of people’s experience using the health and social care system in England.

'Earlier this year, The King's Fund published research on the learnings from Healthwatch and what the future of the patient voice should look like. It concluded it should have independence at its heart and operate on a scale which supports both local and national insights. Without it, this Bill could leave the door open to the NHS and ministers 'marking their own homework' on patient experience by locating these functions in Whitehall and the local organisations that themselves commission services.'

Missing from the Bill

'Away from all the political drama and the actual text of the Bill, perhaps the bigger story is what is not in the legislation. The lack of focus on prevention means opportunities are being missed on obesity, alcohol misuse, the promotion of clean air and generally shifting the balance of health spending away from hospitals.

'To borrow the government's phrase of going 'further and faster', without more announcements in this area, structural reform alone won’t be enough to make the NHS ‘fit for the future’ in a way that patients will feel.’

Notes to editors     

The King’s Fund’s response to the NHS meeting its interim 18-week elective waits target: Milestone achievement meeting interim 18-week target but government must go further on prevention | The King's Fund.

The King’s Fund’s response to Wes Streeting’s resignation as Secretary of State: Wes Streeting Has Gone | The King's Fund and The King’s Fund Responds to the Resignation of Wes Streeting MP as Secretary of State for Health and Social Care | The King's Fund.

The King’s Fund’s response to the King’s Speech: The King's Fund responds to the King's Speech and the introduction of the NHS Modernisation Bill | The King's Fund.

The King’s Fund’s previous commentary on NHS restructures: Why Do Politicians Restructure The NHS | The King's Fund.

The King’s Fund’s previous work on Healthwatch: The future of patient voice: learning from the Healthwatch model | The King's Fund.

The King’s Fund, Healthwatch England, National Voices and Ipsos Mori’s recent work on NHS admin: Still Lost In The System: The Urgent Need For Better NHS Admin | The King's Fund and 10 Actions The Government And NHS Leaders Should Take On NHS Admin | The King's Fund.