In the 2026 King’s Speech, the government outlined plans to introduce legislation to reform how the NHS is led and managed in the form of an NHS Modernisation Bill. The Health Bill is supporting two main overarching aims: "improving patient safety and experience through a new single patient record (SPR)"; and "putting power and resources in the hands of NHS organisations providing direct patient care by abolishing NHS England and stripping back national bureaucracy."
The proposed reforms include:
- the abolition of NHS England (NHSE), pulling functions directly into the Department of Health and Social Care (DHSC), including transferring of some powers directly to the Secretary of State
- the reconfiguration of certain duties of integrated care boards
- changes to statutory data functions and the single patient record
- abolition of Healthwatch and the creation of a new DHSC patient voice function.
Other changes included reducing the number of patient safety organisations, including bringing the Health Services Safety Investigations Body (HSSIB) into the Care Quality Commission (CQC), and changes to flexibility and governance of local NHS organisations.
Responding to the King's Speech and the government's announced intention to pass the NHS Modernisation Bill in this parliamentary session, Sarah Woolnough, Chief Executive of The King's Fund, said: “The NHS Modernisation Bill will put on a legal footing the government's plan to embark on the largest reorganisation of the NHS in more than a decade. This includes the formal abolition of NHS England, with many powers returning to the Secretary of State for Health and Social Care.
“The government has said it wants to devolve power from Whitehall and give patients more control over their care. There is a danger that the Bill creates the opposite impression, of a government pulling power back to the centre and disbanding the independent organisations set up to listen to patients and ensure their voices are heard across health and care services. Many of the Bill’s provisions won’t make much difference to patients, day to day, because they focus on how the NHS is organised rather than on care itself.
“Potentially the greatest opportunity it offers to improve patient experience is the intention to create a Single Patient Record by joining up health and care records, something successive governments have promised but struggled to deliver. With the right safeguards in place, patients and staff are supportive of this and can’t understand why it doesn’t already exist. This would give patients, and different health and care professionals, access to a single, shared record linking primary and secondary care information and social care data.
“Time and again, patients and carers are left in the dark when it comes to being updated about their care, with the impact most shockingly being that some patients are put off seeking care in the future. A Single Patient Record could be a real gamechanger, facilitating joined-up communication that will impact how people feel in waiting rooms, at home and in hospitals. But more ambitious action to improve people’s day-to-day experience of NHS admin could significantly boost public satisfaction with the NHS and, in turn, how people judge the government in guiding it.
“Previous attempts at formalising a Single Patient Record have failed or been delayed, in part due to concerns about privacy, with some health professionals worried about data control responsibilities. The government will need to win the argument in parliament, that they can both protect individual’s health information and allay the fears of those health professionals. It's an argument worth having and one we hope the government wins.”
Chief Executive of the Patients Association, Rachel Power, commented: "The NHS Modernisation Bill contains real opportunities for patients, but also significant risks… Done well, a Single Patient Record could make a genuine difference to people's lives. But it must be designed with patients, it must work for people who find digital technology difficult, and patients must stay in control of their own information. We also note that the Bill’s initial commitment to a single patient record is limited to maternity and frailty care by 2028. Patients will want to see a clear timetable for how this is extended to all.
“We welcome the proposal for a new Patient Experience Directorate within the Department of Health and Social Care. Embedding patient voice in national decision-making is long overdue, and if done properly, this could mark a genuine shift in how the system listens and responds. But we need clarity on how this will operate, how it will connect with patients and whether it will have the mandate and the genuine authority to make patient experience a driver of policy - not simply a box to be ticked.”
Rachel Power added that the Patients Association is "deeply concerned" about the disbanding of Healthwatch England: “Whatever the case for reform, it is currently the only body in England with a statutory duty to listen to patients and ensure that their experiences shape how services are run. Transferring its functions into the Department of Health and Social Care raises serious questions about independence - a patient voice that sits inside government is not the same as one that can challenge it.”