Can the government's NHS reform agenda, and the upcoming Health Bill, genuinely translate into local change? 

That was the central question explored by a panel of the NHS's most experienced operational leaders at NHS ConfedExpo. 

Anu Singh, Chair of Leicester, Leicestershire and Rutland ICB and Northamptonshire ICB cluster, led the session featuring Matthew Kershaw, Chief Executive of Croydon Health Services, Dr Amit Sharma, GP and CEO of Berkshire West Primary Care Alliance, and David Williams, Deputy Director of Policy at the NHS Alliance.

The consensus view was cautiously optimistic: this is one of the best opportunities to drive real change in many generations. But there was no shortage of honest reflection on what could go wrong and where gaps in legislation exist. 

The legislative moment

The Health Bill represents the most significant structural reform to the NHS Act 2006 since the Health and Social Care Act 2012. It abolishes NHS England, returns commissioning and performance functions directly to the Secretary of State, and simultaneously introduces measures intended to empower local leaders and strengthen the digital infrastructure underpinning NHS care.

David Williams, drawing on the NHS Alliance's engagement with civil servants over recent months, explained the government's diagnosis from Whitehall's perspective: large public institutions have too often been seen as insular, self-serving, and insufficiently accountable – and the government draws a direct line between that diagnosis and recent public scandals. Increasing ministerial accountability is, for the government, integral to restoring public trust in public bodies.

But this sits in tension with the language of localism and decentralisation that also runs through the reform programme. 

Matthew Kershaw captured the paradox well from a provider perspective. He said that while the reduction in the size of NHS England and ICBs becoming strategic commissioners creates genuine opportunities for decentralisation and better local decision-making, the simultaneous expansion of Secretary of State powers represents a significant centralisation. 

He believes the only way to dissipate that feeling of central control is for local organisations to seize the opportunity of decentralisation and demonstrate they can deliver.

What the Health Bill is missing

Dr Amit Sharma offered the sharpest critique from a primary care perspective. The desire to cut bureaucracy by abolishing arm's-length bodies is evident in the Bill, but what is conspicuously absent is a meaningful route for primary care to be at the table. 

Expansion of arrangements under section 75 of the NHS Act 2006 – which currently allow for the joint or integrated delivery of functions by NHS bodies and local authorities with associated pooled budgets – could be a key lever for bringing funding and risk-sharing together across health and social care, but such changes have not been proposed in the new legislation.

He also called out the under-utilisation of the voluntary sector. He cited faith groups as representing the largest volunteer capacity in the health system, but remain formally unrecognised as assets. There is an opportunity, he argued, to give these organisations a more formal role in providing patient voice, and in genuinely integrating with health and social care.

On frontline empowerment, David Williams echoed a concern that has been aired more widely in the sector, saying there is not much in the Bill that indicates a more empowered frontline. 

Ministers will need to tell a convincing story about how other interventions will create an environment where clinicians and local leaders feel they are able to take ownership of decisions, rather than waiting for direction from the centre.

Single patient record represents biggest risk and reward

The session's most animated exchange came on the single patient record (SPR), which is introduced in the Health Bill. The chair described it as "the biggest two-sided coin" in the entire reform package.

Clinicians will be given powers to create, maintain, share and provide access to a single patient record per patient, with provisions on information content, access, platform and security. 

This power is broad and could affect a wide range of providers, and compliance infrastructure and data security obligations will require careful planning.

Dr Sharma described the SPR as a great concept in theory – giving patients genuine ownership of their data, enabling freedom of information between providers – but one that creates significant risk if not handled correctly. GPs, he noted, are the owners of the greatest amounts of patient data, and GP systems feed information back into clinical systems in ways that affect performance measures and targets. If the government is serious about developing the SPR at scale, there needs to be a proper conversation about who owns that data, effective regulation to address it, and robust safeguards.

David Williams remarked on how trust in public institutions is currently low and the government has real work to do to ensure GPs, patients and the public can have faith in how the SPR will be set up and governed. 

The risk, he warned, is the public debate becomes dominated by data privacy concerns and the interests of individual providers, rather than staying focused on the genuine and significant benefits the SPR could deliver. Keeping eyes on the prize matters.

Our view: Getting the legal foundations right

When the government published its 10-year health plan last year, it was clear the shift from analogue to digital would require a fundamental regulatory rethink on the approach to accessing and sharing personal health data with healthcare providers and other relevant bodies.

Healthcare can learn much from the banking industry's digital transformation journey, which has been underpinned by consumer acceptance, and enthusiasm, for sharing sensitive data that provides real-time metrics and intelligent insights. 

The concept of 'digital health wallets' – secure, user-controlled platforms for storing, managing and sharing health information – is what the SPR aspires to be.

To effectively manage risks, the NHS must address concerns around data security, patient privacy and the digital divide that could marginalise those without access to technology. This requires robust cybersecurity measures, widespread digital literacy campaigns and policies ensuring equitable access to digital health tools. The NHS must be clear with the public on the benefits of sharing personal data.

What the panel discussion made clear is that clarity on data ownership is the foundation on which patient and clinical trust must be built. Establishing clear ethical guidelines and standards, underpinned by rigorous testing and evaluation, must be a priority in any regulatory framework. The regulation-making powers in the Bill are broad. What fills that regulatory space will determine whether the SPR becomes a transformative tool or a source of litigation, mistrust and missed opportunity.

Providers should not wait for the secondary legislation to begin assessing their readiness. The time to start thinking about data governance, compliance infrastructure and contractual arrangements is now, before the regulations are made, not after they come into force.