The Health Bill has been published – bringing sweeping organisational and structural changes to the NHS. 

After its inclusion in Wednesday’s King’s Speech under the name of the NHS Modernisation Bill, detailed of the Health Bill were published yesterday.

It represents the most significant structural changes to the NHS Act 2006 since the Health and Social Care Act 2012, principally abolishing NHS England and returning its functions directly to the Secretary of State, while simultaneously strengthening ministerial control over integrated care boards, NHS trusts and NHS foundation trusts. 

All functions previously under the responsibility of NHS England – including commissioning, financial oversight, and performance assessment – will transfer directly to the Secretary of State, marking a fundamental reversion to direct ministerial control and dismantling the arm's-length body architecture established over a decade ago. 

The Bill also introduces new patient rights, digital infrastructure powers including a single patient record regime and revised financial accountability frameworks.

Rebecca Hainsworth, Partner in the health and life sciences team at UK and Ireland law firm Browne Jacobson, said: "The Health Bill does not merely reform NHS foundation trusts – it dismantles almost everything that made them distinct. 

“When foundation trust status was created in 2003, it was designed to be arm's-length from Whitehall, with genuine constitutional independence. What the Bill leaves behind is a body accountable almost entirely upward to the Secretary of State – no more independent of ministerial control than an ordinary NHS trust.

“Foundation trust status will no longer be a permanent achievement. It becomes a contingent status, held at the pleasure of the Secretary of State's assessment of performance. The Secretary of State will control the appointment, suspension and removal of chairs and non-executive directors, and will have the power to convert a failing foundation trust back into an NHS trust by order.

“Even changes to a foundation trust's own constitution will require Secretary of State approval – in many ways giving foundation trusts less governance flexibility than an NHS trust. Boards and trust secretaries need to understand the implications of this now, not when the Bill becomes law."