The Health Bill makes the most significant structural changes to the NHS Act 2006 since the Health and Social Care Act 2012, principally by abolishing NHS England and returning its functions directly to the Secretary of State, whilst simultaneously strengthening ministerial control over integrated care boards (ICBs), NHS trusts and NHS foundation trusts.

The Bill also introduces new patient rights, digital infrastructure powers, and revised financial accountability frameworks.

Key changes by topic

1. Abolition of NHS England [cl.1; Sch.11]

• NHS England is abolished entirely. Chapter A1 of Part 2 of the NHS Act 2006, Schedule 1A, and all associated provisions are omitted.
• All functions previously exercisable by NHS England (including commissioning, financial oversight, performance assessment, and consolidated accounting) transfer directly to the Secretary of State.
• The mandate regime (section 1I) is abolished alongside NHS England.
• Impact: A fundamental reversion to direct ministerial control of the NHS in England, removing the arm's-length body architecture established in 2012.

2. Secretary of State: Expanded powers and duties [cls.4–10; 12; 15; 39–41]

• Commissioning: The Secretary of State assumes direct responsibility for commissioning services under sections 3 and 3A (previously NHS England). A new power under section 5A permits the Secretary of State to delegate commissioning functions to ICBs with discretion.
• Direction powers: New section 7B (substituted) gives the Secretary of State an express power to direct ICBs to exercise Secretary of State functions, with a publication requirement and no Crown status conferred on ICBs in that capacity.
• Prohibition on privatisation: New section 12E prohibits the Secretary of State from exercising functions in a manner intended or likely to alter the public/private balance of service provision unless satisfied it is in the interests of the health service.
• Assistance power: New section 12DA enables the Secretary of State to provide financial assistance, goods, services or staff to health service providers.
• Public involvement: New section 5B places a duty on the Secretary of State to involve patients and the public in commissioning decisions.
• Inequality duty: Section 1C is substituted to extend the inequality duty explicitly to both access to services and outcomes, and to inequalities between different parts of England.
• Innovation duty: New section 1CC requires the Secretary of State to promote innovation, with prize-making and advisory committee powers.
• Patient involvement and choice: New sections 1CA and 1CB introduce duties to promote patient involvement in decisions and to enable patient choice.

3. Integrated Care Boards: Strengthened oversight and new functions [cls.11; 16–22; Sch.10]

• Performance assessments: Section 14Z59 is substituted to require the Secretary of State to carry out an annual performance assessment of each ICB and publish a written summary.
• Direction powers: Section 14Z61 is substituted with a more detailed regime allowing the Secretary of State to direct ICBs on any function (with consultation and publication requirements, and an urgency exception).
• Significant failure: New section 14Z62A enables the Secretary of State to remove an ICB's chief executive from office in cases of significant failure and to direct the chair on replacement.
• Mayoral representation: Schedule 1B, paragraph 8 requires ICB boards to include at least one member nominated by each mayoral strategic authority (including the Greater London Authority and combined authorities) whose area overlaps with the ICB.
• Waiting times: New section 14Z45A enables regulations to set maximum waiting times for prescribed health services.
• Patient choice: New section 14Z45B requires the Secretary of State to make regulations conferring patient choice rights, with ICB facilitation duties and an enforcement framework under new section 14Z45C.
• Individual commissioning appeals: New section 14Z45D enables regulations providing for appeals against individual ICB commissioning decisions.
• Border areas: New section 14Z45E requires neighbouring ICBs to cooperate to ensure equivalent access for patients in border areas.
• Transfer schemes: Section 14Z28 is amended to strengthen transfer scheme provisions on ICB variation or abolition, with a duty to ensure all non-criminal liabilities transfer before abolition takes effect.
• Joint working: Section 65Z5 is extended to permit ICBs to establish joint committees and pooled funds with local authorities (not only other NHS bodies).
• Consultation: Section 14Z45 is substituted to impose a more detailed duty on ICBs to involve patients and the public in commissioning and operational decisions.
• Forward plans and capital resource plans: Sections 14Z52–14Z57 (joint forward plans and capital resource plans) are omitted.

4. NHS Trusts and NHS Foundation Trusts: Structural reforms [cls.25–35; Schs.3–6]

• Foundation trust constitutions: Section 30 is substituted to require Secretary of State approval of NHS foundation trust constitutions. Section 37 is substituted to require Secretary of State approval for constitutional amendments. Schedule 7 is substituted in full with a new constitution framework.
• Governors and members abolished: Sections 59–61 (governors and members of NHS foundation trusts) are omitted, removing the elected governance structure introduced in 2003.
• Conversion of failing foundation trusts: New sections 57B and 57C and new Schedule 9A allow the Secretary of State to convert a failing NHS foundation trust into an NHS trust by order, with transfer of property, rights and liabilities, and a consultation requirement (subject to urgency exception).
• Trust special administration: Sections 65B–65DA are substituted and the regime extended (Schedule 6), with all NHS England functions in the regime replaced by Secretary of State functions.
• Expenditure limits: Sections 42B and 42C are substituted, giving the Secretary of State an order-making power to set annual expenditure limits on NHS foundation trusts.
• Register abolished: Section 39 (register of NHS foundation trusts, previously maintained by NHS England) is omitted.
• Foundation trust authorisation: Section 35(5)–(6) (consultation requirements on authorisation) omitted.
• Accounts: New provisions in sections 36 and 56AA (and Schedule 4, paragraph 11A) impose obligations on NHS foundation trusts to prepare final accounts for predecessor NHS trusts on dissolution.

5. Financial accountability [cls.40; 42–44]

• NHS England financial duties removed: Sections 223B–223F and associated headings are omitted.
• ICB allotments: Sections 223G–223GB are substituted so the Secretary of State directly allots resources to ICBs, may attach conditions, and may give directions on the use of those resources.
• Joint financial objectives: Section 223L is substituted, allowing the Secretary of State to set financial objectives for ICBs (published), with which ICBs must have regard.
• Consolidated accounts: Section 65Z4 is substituted so the Secretary of State prepares consolidated accounts for all ICBs, NHS trusts and foundation trusts annually, with Comptroller and Auditor General certification and Parliamentary laying.
• Provisions omitted: Sections 223M–223O, 223K and section 275(5)(a) are omitted consequentially.

6. Digital and data: Single patient record [cl.47]

• New sections 250E and 250F introduce a regulation-making power requiring prescribed persons to create, maintain, share and provide access to a single patient record per patient, with provisions on information content, access, platform, and security.
• An enforcement mechanism allows the Secretary of State to direct non-compliant persons.

7. Disclosure of information about health service products [cl.48]

• Section 264B is amended to expand the list of persons to whom information about health service products may be disclosed.
• New subsections (6)–(7) prohibit onward disclosure of confidential or commercially sensitive information by recipients.

8. Public health and local authority consultation [Sch.10]

• Section 242 is consequentially amended, and new section 242ZA is inserted, requiring local authorities to consult persons affected before making a significant change to a public health service. Significance is to be assessed by reference to Secretary of State guidance.

Risk and implications

The abolition of NHS England concentrates control of the NHS in central government, with a wholesale return of commissioning, performance, and financial functions to the Secretary of State. For example, the proposed powers to remove ICB chief executives and impose directions without prior consultation in urgent cases, appoint and remove chairs and non-executives of NHS foundation trusts and changes to trust special administration indicate a far more interventionist approach. These powers may create significant operational uncertainty for organisations, at least in the interim as the new structures bed in.

For NHS foundation trusts the removal of elected governors and members and the introduction of direct Secretary of State approvals represents a fundamental change to the quasi-democratic model. You can read our further analysis of the implications of the Health Bill for NHS provider trusts here [link to first article].

Patient choice rights have long been an area of contention and the requirement to make regulations establishing an appeals regime for individual commissioning decisions may generate a material volume of formal challenges to commissioning decisions.

The regulation-making power for the single patient record is broad and could affect a wide range of providers. Compliance infrastructure and data security obligations will require careful planning and providers should consider what steps they may need to take to assess readiness for a single patient record regime.

The draft Health Bill was introduced on 14 May 2026 and will likely be subject to further amendment as it passes through both the Commons and the Lords. We will be providing regular updates on the Health Bill and any material changes to it over the coming months.

Recommended actions

1. Monitor commencement: Most provisions commence by regulations. Practitioners should track commencement orders closely, particularly for the abolition of NHS England, the new ICB direction regime, and the single patient record powers.
2. Foundation trust governance review: NHS foundation trusts should review their constitutions and governance arrangements in light of the removal of governors/members and the new Secretary of State approval requirement.
3. Integrated Care Boards advice: ICBs should seek legal advice on the new direction and intervention regime, particularly the circumstances in which the urgency exception may disapply consultation requirements.
4. Commercial contracts: Any contracts referencing NHS England as a party or counterparty will require novation or amendment upon abolition.
5. Data and digital compliance: Providers should begin assessing readiness for a single patient record regime in anticipation of regulations under new sections 250E–250F.
6. This note is based on the Health Bill as introduced and does not reflect any amendments made during Parliamentary passage. It should not be relied upon as legal advice.

How we can help

Browne Jacobson's expert NHS and healthcare law team has advised NHS bodies and local authorities through every major wave of NHS reform, and we are already preparing practical steps clients need to take in response to this Bill. If you would like to discuss your specific circumstances further, please contact our governance for health team.